Birmingham Heartlands Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

At our inspection published in 2019, we rated this key question as requires improvement. At this assessment the rating remained requires improvement. This meant people's needs still not always being met. Women were not always seen promptly by the doctors when they had concerns. The service did not consistently ensure individuals could access the care, support, and treatment they required in a timely manner. They were unable to meet the demand for induction of labour and women whose inductions were delayed were not always reviewed by a doctor and not all cardiotocography scans were correctly interpreted. The service did not always ensure timely access to care, support, and treatment.

We have not awarded this service a score for Responsive.

Find out about when we will not publish a key question score and what we look at when we assess Responsive.

The service did not always make sure women were at the centre of their care and treatment choices and they did not always work in partnership with them, to decide how to respond to any relevant changes in their needs.

Women were not always seen promptly by the doctors when they had concerns. Although they could contact triage and be seen in the clinic to check on their baby’s health, medical reviews were not always timely, particularly overnight due to limited doctor availability.

Staff did not always follow national guidance which meant women were coming to avoidable harm. The service used the perinatal mortality review tool (PMRT) to review baby deaths. We reviewed cases where triage guidance had not been followed, and women were discharged without a medical review, contrary to national standards. The PMRT panel identified that, based on 1 woman’s history, her care should have been discussed with a consultant, and she should have been admitted. These were acknowledged as care issues by the panel. The PMRT thematic review report identified a case in which a woman presented to the service with active bleeding, but the major obstetric haemorrhage policy was not implemented as required. Additionally, 3 cases involving antenatal bleeding and 1 case of pre-eclampsia were not managed in line with national guidelines.

Staff did not always risk assess small babies in line with guidance which meant they were not always treated on the appropriate care pathway. The NHS England perinatal loss service wide thematic review in November 2024 found 80% of cases under ultrasound growth surveillance experienced delays in scanning across the service. In 55% of baby loss cases, the babies were not identified as small for gestational age during pregnancy and did not receive the appropriate care pathway. Only 37% of cases reviewed included a completed preterm birth risk assessment, highlighting the service lacked a standardised risk assessment tool and instead relied on a single data field. In 88% of cases, women received and discussed information about fetal movements, and 82% were advised to attend the service for assessment.

Care plans generally reflected individuals’ physical, mental, emotional, and social needs, including those related to protected characteristics under the Equality Act. There were personalised care plans for women requiring additional support. Women were mostly involved in planning and making shared decisions about their birth and care.

Women did not always have a choice about where to give birth. The hospital’s birthing unit was closed, with plans to reopen in May 2025. The Maternity and Neonatal Voices Partnership reported women were frustrated by the lack of access to a midwifery-led unit.

Women could not always get hold of the staff when they needed to. We spoke to 1 woman who said it took about a week to get a date for her caesarean section and contacted the maternity reception multiple times with no answer which they found frustrating.

There was good access for partners at any time. The postnatal ward had recently changed their visiting times to 24 hours a day, 7 days a week, to ensure birthing partners felt welcome and had open visiting to the ward.

Midwives and maternity support workers took time to understand birth preferences and supported women in communicating them, including through pictorial charts displayed on the ward.

The service made reasonable adjustments to ensure women received appropriate care and treatment. Women with mental health needs or learning disabilities were provided with individualised care plans. All women with mental health needs were seen by a mental health midwife at 36 weeks and had a postnatal care plan. Staff were supported by the hospital’s vulnerabilities team to meet specialist needs.

Antenatal clinic appointments were arranged to suit families’ needs, with regular clinics available for diabetes, endocrine issues, substance misuse, and mental health.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

Women could get information and advice which was accurate, up-to-date and provided in a way they could understand, and which met their communication needs.

People could have information tailored to individual needs. This included making reasonable adjustments for disabled people, interpreting and translation for women who did not speak English as a first language, and for D/deaf people who used British Sign Language. The service used portable digital devices with video interpreters to ensure women were able to communicate well. We observed a conversation using the video interpreters which ensured the woman was given a choice of pain relief in labour. However, the Maternity and Neonatal Voices Partnership (MNVP) team told us there was no interpreting service for people who were deaf or hard of hearing. They also told us women had fed back to them there was a lack of interpretation services.

The head midwife for equality and inclusion was working to improve their provision of interpreting services. They had carried out an audit which looked at how often an interpreter was being used. They found it was not always used when it should and were encouraging use.

Parents who had suffered a bereavement were invited to share care concerns, and feedback as part of the national perinatal mortality review tool (PMRT) process. The service PMRT information included an action where parents shared their experience of using interpretation services. One parent shared an experience where they had repeatedly used an interpreter. However, the telephone interpreter used during the consultant appointment did not speak the woman's native language resulting in miscommunication. Translation services had not been used on the postnatal ward and the woman was not able to alert staff to the concerns she had about her baby.

The service had recently ordered communication boxes for all areas which included tools for people who used British Sign Language, a hearing loop and information for finger spelling.

The service had created links with maternity support workers, of which there were 8, who followed women antenatally through to postpartum. Women were referred to the maternity link support workers in the antenatal period by their midwife. The maternity link support workers all spoke different languages and 1 was a specialist in neurodiversity; they supported women who did not speak English. They had a caseload of around 35 women each. The service was planning for the maternity support workers to attend the postnatal wards to assist with communications around discharge. At present they had 1 who spoke Urdu and attended once a week but wanted to increase this.

Efforts were being made to improve accessibility for those facing barriers to care. The service addressed digital poverty by providing devices with SIM cards offering free data and calls, enabling access to the maternity digital application containing antenatal information.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

People knew how to give feedback about their experiences of care and support including how to raise any concerns or issues and can do so in a range of accessible ways.

Managers conducted daily walkarounds to engage with women and their families. On Cedar Ward, the ward manager spoke with 5 women each day, asking 4 specific questions and prioritising those who did not speak English to ensure their voices were heard. Feedback from these interactions was typically simple and easily resolved. The information was analysed, and monthly feedback was shared with the ward, highlighting recurring themes such as noise at night and bland food.

Communication emerged as the most common theme in complaints. Some people felt information was not always clearly explained, particularly regarding the induction of labour, leading to unmet expectations. In response, the induction of labour quality improvement group began reviewing the information provided to ensure it included realistic timeframes and clear explanations.

Women and their families were informed about how to raise concerns, with visible signage and posters displaying QR codes for digital feedback. However, the feedback survey was only available in English, and managers said they wanted to make it accessible in other languages.

Staff were familiar with the complaints policy and knew how to manage complaints appropriately. All formal complaints were processed through the hospital's patient advice and liaison service and then assigned by the head of midwifery to the relevant manager. Managers investigated complaints, identified themes, and reported strong support from the complaints team. Walkarounds were introduced as a proactive measure to reduce complaints and were seen as effective. A quality improvement project was initiated to address complaints related to induction of labour, with a structured improvement plan.

Learning from complaints and concerns was viewed as an opportunity for service enhancement. Staff could provide examples of how they applied this learning in practice. For instance, in response to feedback about unchanged bedding, maternity support worker care rounds were introduced 2 to 3 times per shift. Band 5 and 6 staff also attended away days where complaints were discussed, and a behavioural framework was introduced.

Despite these efforts, some people felt their complaints were not thoroughly explored or responded to in a timely manner. The MNVP reported outstanding complaints from 2024. Managers stated the backlog had since been cleared and current complaints were being handled within the policy's timescales.

Where improvements were needed, people were involved in shaping solutions and evaluating their impact. The MNVP contributed to the development of a birth centre leaflet by gathering input from service users about the information they wanted included.

The engagement and communication workstream aimed to foster a culture of co-production and co-creation among staff and patients, achieve United Nations Children's Fund (UNICEF) baby friendly initiative accreditation for infant feeding, monitor outcomes and experiences across population groups, review barriers to care access with Maternity and Neonatal Voices Partnership, and collaborate with the third sector to support the Maternity and Neonatal Safety Improvement Programme (MNIP).

The service did not consistently ensure individuals could access the care, support, and treatment they required in a timely manner. Women were not always able to access care in a way that met their needs, particularly in triage, where they were not consistently seen promptly. At our previous assessment we issued a Warning Notice to the service as there were insufficient medical staff to provide safe care and treatment, to support the triage effectively. This meant there were delays in the time taken to review women.

At this assessment, we found there were still delays in triage due to lack of doctor availability. Although 2 doctors were assigned to triage from 8am to 8pm, they were frequently required elsewhere, particularly on the postnatal ward. After-hours and weekend coverage was poor, with doctors covering all areas, leading to most triage breaches occurring overnight. While these breaches were discussed in daily governance meetings, no actions had yet been taken to address them. There was a triage working group that looked at any emerging trends and incidents of harm due to delays.

The service and the system was often unable to meet demand for induction of labour. Delays in care posed potential risks to women. Some women experienced delays in induction of labour and in procedures such as artificial rupture of membranes. At the time of assessment, 33% of women were induced for their labour on time but with many others experiencing delays. One observed case and several patient safety reviews from October 2024 to April 2025 revealed delays of 4 to 6 hours due to operating theatre constraints. One woman experienced a major obstetric haemorrhage following such a delay, which constituted an emergency.

Daily, between 6 and 8 women were scheduled for induction, but staffing and bed shortages often prevented them from attending. Consultants and delivery suite coordinators reviewed the induction list twice daily, prioritising women using a red, amber, green system. When delays persisted, the maternity escalation procedure was activated, including updates to the operational pressure escalation levels score and corresponding actions. If all inductions could not proceed, a multidisciplinary team, including a consultant, met to discuss the next steps. Delays were also discussed in twice-daily safety huddles. Although the service attempted to coordinate with Local Maternity and Neonatal Services for support, they were often at full capacity.

Two perinatal mortality review tool reports highlighted delays in care for women experiencing baby loss, including prolonged induction and delayed pain relief due to doctors being occupied elsewhere. One high-risk woman experienced a 10-hour delay in receiving blood-thinning medication.

Managers acknowledged some induction decisions may not have been appropriate and were reviewing this process as part of a quality improvement initiative.

Women whose inductions were delayed were not always reviewed by a doctor and there was a risk that not all cardiotocography scans were correctly interpreted. In cases where no bed was available, women were brought to triage or the day assessment unit for cardiotocography (CTG). If the CTG was normal and there were no concerns, a doctor reviewed the notes and made a clinical decision. However, patients were only seen in person if the CTG was abnormal. We found not all midwives categorised CTGs correctly according to national guidance, raising the risk that women could be sent home without appropriate medical review.

Women could access some services when they needed to, but they were not always seen in a timely way. Delays were noted in the day assessment unit, where women waited up to 4 hours for a medical review. These delays were not monitored, and doctors from the delivery suite attended only when available.

Delays were also recorded for women scheduled for elective caesarean sections, with causes ranging from prioritisation of more urgent cases to operating theatre cancellations due to maintenance. Extra lists were scheduled where cases were cancelled.

Women did not always have care or treatment in line with evidence-based practice and some practices were exceeding national guidance which potentially reduced access for other women. For example, for women who experienced reduced fetal movements, they were seen daily until the staff were happy with the fetal movements. We saw an example where one woman was seen daily for 6 weeks; this was not in line with national guidance.

Leaders and staff demonstrated awareness of discrimination and inequality that could hinder access to care. In February 2025, a head midwife for equality and inclusion was appointed to address health inequalities. Initiatives included improving interpreting services, engaging with the Maternity and Neonatal Voices Partnership, and strengthening community relations. Specific efforts were made to support Black women, including attending antenatal clinics to raise awareness and providing multilingual maternity support workers to assist with postnatal discharges.

We did not look at Equity in experiences and outcomes during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Planning for the future during this assessment. The score for this quality statement is based on the previous rating for Responsive.