Birmingham Heartlands Hospital

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

At our last assessment published in February 2024, we rated this key question inadequate. At this assessment, the rating has improved to requires improvement. The service was in breach of the legal regulation relating to good governance. Staff did not consistently act on the most accurate or current information regarding risk, performance, and outcomes. More needed to be done to have a comprehensive reliable system of governance. The strategy was not linked to the maternity service. However, the service management and leadership had improved but there was still work to be done to embed new processes, see sustained changes and ensure high-quality person-centred care.

We have not awarded this service a score for Well-led.

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

The trust had a strategy for 2024 to 2029 of `Building Healthier Lives' with 5 key priorities which aligned with the Local Maternity and Neonatal Services perinatal strategy. There was no standalone vision or strategy for the maternity service, although managers reported staff shared a common vision for the service. The team aligned their work with the Local Maternity and Neonatal Services strategy, which focused on achieving the best outcomes and experiences for babies born within the service. This included addressing health inequalities, building meaningful connections with the community and maternity service users, and ensuring care was responsive to cultural needs. Managers expressed a desire to develop a dedicated maternity strategy aligned with the broader trust strategy. Following the assessment, we were told the maternity strategy had been finalised and waiting hospital board approval; managers we spoke to were not aware of this.

Several new processes and quality improvement groups were being introduced and embedded within the service. The senior leadership team was actively working across multiple areas to drive improvements in care, though significant progress was still needed.

While staff and leaders generally demonstrated a positive and compassionate culture that supported women, this culture was not always centered on learning and improvement. Although some learning was evident, changes were not consistently implemented in a timely manner, which posed risks to patient safety. For instance, despite identifying poor documentation standards months before the April 2025 assessment, numerous examples of inadequate documentation were still seen by us. Although workshops were scheduled for June 2025, there was a lack of urgency in addressing these issues for women receiving care at the time.

The culture within the service was gradually improving, though further development was necessary. Feedback from the Maternity and Neonatal Voices Partnership indicated cultural change was beginning at the leadership level but had not yet pulled through at all levels. Most staff reported a more positive culture and felt supported and valued. The matron had organised away days focused on culture, encouraging staff to share their experiences, and feel empowered to challenge poor practices and contribute to team-driven improvements. However, the 2024 NHS Staff Survey results showed just over 40% of staff experienced harassment and bullying by staff on the obstetric wards.

Equality and diversity was becoming a priority within the service. An equality, diversity and inclusion midwife had been employed by the service. Staff consistently reported these values were actively promoted, with efforts made to identify and address workforce inequalities. The director of midwifery was described as particularly passionate about equality.

Consultant midwives led a training day on personalised care, cultural humility, and safety. This session explored how to deliver trauma-informed, culturally sensitive care and emphasized the impact of language, cultural safety, and trauma awareness. Staff responded positively to this training.

The leadership team had identified key priorities across several workstreams for 2025—2026. Within the culture, leadership and inclusion workstream, the focus was on supporting organisational development across specialties, improving workplace culture and communication, learning from patient feedback, enhancing training for doctors and student midwives, and developing compassionate, culturally competent leaders. There was a plan to appoint a `culture consultant' to the team to support the medical staff.

Leaders within the service demonstrated the necessary skills, knowledge, experience, and credibility to lead effectively. They were visible and approachable to both patients and staff. While many leaders were still relatively new to their roles, they demonstrated the capabilities required to manage the service. Improvements had been made since the last assessment, although further work remained. The newly established senior leadership team shared a strong commitment to driving service improvements and reported a cohesive and collaborative working approach.

The senior team was composed of the Director of Women’s and Children’s services and Medical Director of Women’s services. They were supported by a Head of Midwifery. All were experienced leaders who demonstrated decision-making abilities and had completed leadership training. They were supported by the wider hospital management team.

Managers were seen to have the experience, capacity, capability, and integrity to lead the service. They reported receiving strong support, and access to development opportunities helped them maintain their credibility and skills. One manager described the training as “fantastic” and “wonderful,” highlighting a culture that encouraged continuous improvement.

Good-quality leadership was sustained through effective, and inclusive recruitment and succession planning. For example, the matron had recently attended strength-based recruitment training to ensure they had the right staff in the right jobs. They arranged the training for their staff and had since done 2 sessions with managers.

There was more to do to ensure the leadership had a full grasp of the concerns in the service. While leaders were aware of some key issues and priorities related to service quality, there were significant safety concerns that had not been identified.

Managers held monthly ward meetings where possible, using them to share audit results, incident trends, and key learning points.

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Leaders and staff demonstrated openness, honesty, and transparency, with many staff reporting managers were approachable, listened attentively, and provided regular feedback. While most staff felt encouraged to raise concerns, a few expressed they did not always feel heard or their concerns were acted upon. To support those who felt less comfortable speaking up directly, anonymous reporting options were available.

There was a Freedom to Speak Up Guardian. Information about this role was displayed throughout the workplace. All Band 5 and 6 staff had attended an away day where the Guardian presented on their role. Additionally, an encrypted social media group was available for staff discussions.

Staff and leaders actively promoted staff empowerment to drive improvement. Staff were encouraged to raise concerns and understood the importance of doing so. Many felt confident their voices would be acknowledged. One staff member shared a positive experience participating in a round table discussion following a serious incident, describing it as a supportive, blame-free learning environment.

There was a culture of speaking up where staff actively raised concerns and those who did were supported, without fear of detriment. When concerns were raised, leaders investigated sensitively and confidentially, and lessons were shared and acted on.

Some staff noted the culture had begun to improve, though a few were unsure how to contact the Freedom to Speak Up Guardian. There were also mentions of lingering fears about potential repercussions from speaking up.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff did not consistently act on the most accurate or current information regarding risk, performance, and outcomes. Although the service had established clear responsibilities, roles, and systems of accountability to support good governance, these were not always implemented in a timely manner. The governance systems had failed to identify and rectify the widespread and significant concerns found at this assessment.

There were early signs of improvement but more to be done to have a comprehensive reliable system of governance. A comprehensive framework for risk and governance management was available, and since the previous assessment, the governance team had expanded. This included the addition of a new matron and Band 7 risk midwives. Staff were provided with time and resources to engage in governance activities and risk management. New systems and databases had been introduced to support data analysis, though these were still in early stages of use.

Risks were not always highlighted which meant senior managers were not aware of patient's outcomes and improvements needed. For example, postpartum haemorrhages were not recorded on the governance dashboard meaning there was a lack of oversight and therefore action to reduce numbers of women who had a haemorrhage. There were errors and missing documentation in patient notes that did not align with national guidelines. These issues had not been identified by the governance team due to the absence of a consistent audit process for patient records.

Governance meetings addressed the quality and safety of the service, with a fixed agenda covering incidents, the risk register, complaints, feedback, and clinical effectiveness. While meeting minutes showed concerns were identified, action plans were not always completed. Managers had the ability to escalate issues through divisional meetings, but with the information being not entirely effective, the system remained unreliable from ward to board.

Governance dashboards had recently been introduced, providing accurate and timely data. The governance team analysed this data to monitor performance and quality, recommending improvements as needed. Quality and safety were regularly discussed in governance meetings, and a monthly report was presented at the board level.

A monthly governance newsletter was produced and valued by staff as a useful source of information. Good practice was acknowledged and celebrated. Additionally, a daily `real-time governance' meeting, chaired by senior leadership, provided a platform for staff to raise and resolve concerns.

The department followed a collaborative approach to action planning. Matrons met monthly with ward managers to review action plans and key performance indicators, developing actions collectively. However, some of our evidence showed this to not always be effective in concluding actions. Daily real-time governance meetings allowed staff to raise concerns directly with managers, and staff reported issues raised in these meetings were addressed promptly.

Maternity services were identified as having the highest number of red risks on the trust's risk register, with 22 red risks awaiting approval. Some of these had not been reviewed since December 2024. The risk register was discussed at the obstetrics and gynaecology governance meetings. There were 7 high-risk items on the local risk register which included these identified in our assessment, among others:

• Risk to safe delivery of services due to insufficient maternity staffing.
• Insufficient capacity for induction of labour, leading to delays.
• Inadequate number of diabetic specialist midwives, impacting blood glucose monitoring.
• Risk of patient harm due to delays in inpatient admissions.

Governance papers from March 2025 showed the service knew it lacked capacity for induction of labour (IOL), resulting in a high number of women experiencing delays. The assessment team noted the local population and demographics contributed to a higher proportion of women requiring high-risk care, increasing the need for IOL. The same governance papers highlighted ongoing risks related to staffing and bed management. Although these remained challenges the service had a quality improvement work plan which continued to be monitored.

The service was on a maternity safety support programme and had a national maternity improvement advisor and a transformation programme manager. It was confirmed the service had made good progress with the maternity and neonatal safety improvement programme, and there was agreement on the key focus areas for 2025—2026. The decision for the trust to remain in the improvement phase was supported, with a follow-up review and reset meeting scheduled for October 2025.

The service understood the duty to collaborate and work in partnership, but had work to do in some areas Staff shared information and learning with partners and collaborated for improvement but partners sometimes felt excluded from participating in actions taken to make improvements.

The service collaborated with other hospitals within the Local Maternity and Neonatal Service and the Maternity and Neonatal Voices Partnership (MNVP) to ensure women received consistent and appropriate care for themselves, their babies, and their families. Additionally, the matron described working with a charity to design murals for the Cedar and Maple corridors. Once approved, the MNVP would be involved to gather feedback from service users.

Consultant midwives engaged with charities and established a working group with staff and the MNVP to explore personalised care plans and assess hospital systems. They aimed to use charities as a bridge to reach health groups and existing outreach programmes, with plans to deliver joint teaching sessions for women. Their goal was to identify barriers faced by women, gather their perspectives, and determine next steps for improvement.

The service also collaborated with other hospitals within the Local Maternity and Neonatal Service to ensure women received consistent and appropriate care for themselves, their babies, and their families. Additionally, the matron described working with a charity to design murals for the Cedar and Maple corridors. Once approved, the MNVP would be involved to gather feedback from service users.

The MNVP reported having positive relationships and engagement with the maternity service. However, they felt excluded from the follow-up on actions taken, which limited their ability to provide meaningful feedback to service users. Leaders acknowledged the value of the MNVP in strengthening connections with women. They were included in meetings, such as safety champion sessions and the intrapartum forum, to ensure user voices were represented. An engagement day was also held with professionals from outside maternity services, including the MNVP, and their input was incorporated into the ongoing improvement programme.

Although it was an objective, the service did not consistently achieve effective and continuous learning, innovation, or improvement across the organisation and local system. Staff did not consistently contribute to learning around safety and the quality of care.

While leaders demonstrated a commitment to improvement through various initiatives, particularly those under the maternity improvement programme, not all staff were engaged in these efforts. This lack of engagement impacted the safety of care provided to women. Leaders were also not fully aware of all the issues within the service. During the assessment, managers were found to be unaware of several safety concerns, including improper storage of medicines, inadequate management of postpartum haemorrhage, poor documentation, and poor adherence to the World Health Organisation (WHO) surgical safety checklist.

Several working groups had been established to drive improvements in areas such as induction of labour, but these were still in early stages. Further changes were necessary to enhance safety for women and their families. While processes existed to review outcomes and support learning, many improvement initiatives were still underway and not yet embedded or consistently effective. For example, although maternity governance reporting and data dashboards had been introduced, the service was not reporting postpartum haemorrhages under 1,500 millilitres to the trust board. This omission meant the board lacked accurate data on the prevalence and risks associated with postpartum haemorrhage.

There were away days which helped bring the staff together. The service had introduced ‘away days’ for staff at various band levels, beginning with Bands 5 and 6, with plans to include nursery nurses, midwife support workers, and Band 7 staff. These sessions were aligned with the service’s strategy and culture, featuring presentations from leadership and discussions on topics such as estates, the CQC survey, organisational culture, and the Maternity and Neonatal Voices Partnership. Staff were encouraged to make pledges for improvement, which would be revisited annually.