Birmingham Heartlands Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that people had the best possible outcomes because their needs were assessed. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work. This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment, the rating has changed to good. This meant people’s outcomes were mostly good, and people’s feedback confirmed this.

We have not awarded this service a score for Effective.

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

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The provider had effective systems to ensure staff remained up to date with national legislation, evidence-based practice and required standards. Policies were aligned with national guidance, and staff worked in accordance with these. New policies were shared with staff, and they told us they could access these easily. The policies we reviewed were current and up to date. The newly introduced sepsis policy had been introduced to staff during handovers and within the ‘team of the shift’ meetings.

Staff told us they were given opportunities to review and comment on draft policies and felt involved in their development. New policies and guidelines were also shared with staff through the quarterly governance newsletter.

Systems were effective in ensuring the implementation and monitoring of national guidance. The clinical governance and patient safety department managed the process for the implementation and monitoring of National Institute for Health and Care Excellence (NICE) guidelines. New guidance was shared with the relevant specialty lead, and a gap analysis was performed, and updates were made as required. Current compliance with NICE was 93% which was above trust target.

Audit processes were used to monitor compliance and drive improvements in clinical practice. There was a clinical audit programme for maternity, with audit activity used to support service improvement. For example, audits of ‘fresh eyes’ in 2025 identified poor compliance. In response, the service introduced the ‘Ask Me’ campaign in November 2025 to encourage staff to approach a Band 6 midwife to complete ‘fresh eyes’ checks when the Band 7 coordinator was unavailable.

The service also delivered documentation workshops and relaunched the ‘Ask Me’ campaign in March 2026. Since these interventions, the service reported improved compliance with ‘fresh eyes’ checks. Fetal surveillance midwives undertook regular walkarounds within the department to carry out spot checks, with findings presented in a quarterly report.

The service had effective systems to ensure compliance with national maternity safety standards and had met all safety actions. The trust participated in the Clinical Negligence Scheme for Trusts (CNST) Maternity Incentive Scheme. This is a financial incentive program designed to enhance maternity safety within NHS trusts. The trust self-declared its progress against 10 safety actions at the end of each year of the scheme. It is designed to support the delivery of best practice in maternity and neonatal services. In year 7 (results published April 2026), the trust had met all 10 safety actions.

Managers shared updated guidelines with staff. For example, during the ‘team of the shift’, the new antenatal guideline was being discussed. Leaders highlighted the escalation pathway for concerns with fetal heartbeat, including a flow chart and what staff requirements were. Staff were expected to pass this information onto their teams following the meeting. There were effective systems to keep staff informed about legislation, evidence-based practice, and standards, including regular updates through handovers and newsletters. The service’s intranet hosted a comprehensive set of up-to-date policies covering all aspects of maternity care.

Risk assessments were completed in line with guidance using tools which were recognised and based on national standards. Supporting documentation and policies were aligned with national guidance. Staff provided clear information to women about their care and treatment, and several clinics and specialist midwives were available to support both physical and mental health needs. Nutrition and hydration needs were met in line with current guidance. Women had access to drinks throughout their stay, and hot meals were available at lunch and dinner times.

Staff and leaders were encouraged to learn about new and innovative approaches that evidence showed could improve the way the service delivered care. The department had approached areas of concern with innovations around safety. For example, the senior team responded following staff reporting how they found it hard to screen women for sepsis, as the kit they needed was all in different places. They reviewed the process and found it was taking 11 minutes to gather all the items needed. A sepsis grab-bag was then created and placed in all the wards and clinic rooms. It had then been launched across the trust along with new guidelines meeting those of the National Institute for Health and Care Excellence (NICE) and those of the Sepsis Trust. The team had been put forward for an upcoming national award.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. Staff monitored outcomes so they could be positive and consistent, and met both clinical expectations and the expectations of people themselves. The senior leaders had acted on the high rates of stillbirths in the service and understood the reasons for this and what actions they could take to improve this data.

Women’s and babies outcomes were generally positive and aligned with expected standards, with systems to support learning and improvement where needed. Women who used the service mostly experienced positive outcomes that met agreed expectations set out in legislation, standards and evidence-based clinical guidance. Where outcomes were not positive, the service explored the reasons and developed care pathways or used quality improvement programmes to embed learning and support ongoing improvement.

The service took action when themes and trends were showing the need for recognition and improvement. Following an increase in stillbirths between October 2025 and January 2026, the maternity service undertook a comprehensive deep dive of stillbirth rates. During this period, there were 19 stillbirths across the trust, 15 of which occurred at Birmingham Heartlands Hospital, reflecting its role as the tertiary unit. The findings of this review were being presented to the trust mortality group for oversight and shared learning and the regional oversight group hosted by the integrated care board and NHS England.

Findings highlighted that many of the women were affected by health inequalities, including living in areas of deprivation, being from ethnically diverse backgrounds, and experiencing social vulnerability. The report identified key clinical themes and missed opportunities in care, as well as wider factors such as non-attendance at scheduled appointments. Recommendations were clearly outlined, and managers had developed an action plan to improve engagement, address health inequalities through improving interpreting services, and compliance with care.

The service demonstrated a structured approach to improving outcomes for premature babies through effective implementation and monitoring of the Perinatal Excellence to Reduce Injury in Premature Birth (PERIPrem) care bundle. The service implemented the PERIPrem pathway to improve outcomes for premature babies. Compliance with the PERIPrem care bundle was monitored monthly, with findings and recommendations shared across the speciality to support continuous improvement. The quality and safety report for January to March 2026 demonstrated progressive improvement. PERIPrem data was routinely shared and discussed at Local Maternity and Neonatal Service meetings to promote transparency, shared learning and regional alignment.

Key areas of focus included giving babies early breast milk and probiotics. The percentage of babies receiving expressed breast milk within six hours of birth improved from 50% in January to 71% in March 2026, although further improvement was required to achieve compliance. Similarly, the proportion of babies receiving probiotics (to restore natural gut balance) within 24 hours of birth increased from 38% to 70% over the same period. The PERIPrem team supported improvement through targeted teaching on early colostrum (the first form of breast milk which is high in nutrients and antibodies) administration and by delivering a probiotics workshop as part of the PERIPrem study day.

Rates of postpartum haemorrhage (PPH) had significantly improved. At our previous inspection, the service did not report PPH rates comprehensively or in line with guidance. Women were at risk of harm due to poor risk assessment, and failure to activate appropriate protocols. At this assessment, we found the service had worked hard to improve PPH rates through education, audit and implementation of an electronic risk assessment. In April 2026, the PPH rate was 4.6% and major obstetric haemorrhage (MOH) was 5.3% in April 2026. Data from this month showed women who had a PPH of 1,500 millilitres or more was less than (better) than the national average. There was an obstetric haemorrhage quality improvement working group which provided assurance of improved compliance to the risk assessment. There had been a new guideline launch on the 11 May 2026, and this had been communicated with staff through a number of different channels including the ‘listen, learn and share’ briefing.

There were systems to review significant clinical events and support learning, with further work underway to strengthen oversight and assurance. The service completed a standardised proforma for each case of major obstetric haemorrhage, obstetric anal sphincter injury, shoulder dystocia and postnatal readmission. The form captured key safety questions and contributory factors. This was collated and reviewed at the maternity weekly risk meeting. The service was developing this further and was in the process of implementing quarterly thematic reviews which will be reported on in the maternity quality and safety paper to provide assurance to the trust board.

The service demonstrated good engagement with national audit programmes and mostly maintained good compliance overall. The service participated in relevant national clinical audits, including the NHS England Saving Babies’ Lives Care Bundle Version 3. Overall compliance between January and March 2026 was 90%, with most elements of the bundle achieved. Compliance was reported quarterly and monitored using a dashboard. There was evidence of improving performance, particularly in smoking cessation, fetal growth risk assessment, and management of reduced fetal movements, with compliance consistently meeting or exceeding national targets. Ward managers were kept up to date with saving babies lives updates. We saw a presentation from February 2026 which provided key updates to the team.

Reviews using the Perinatal Mortality Review Tool (PMRT) revealed minimal cases were identified with suboptimal care. Key causes of death included prematurity, placental insufficiency, and cord-related issues. Some identified learning was around triage, recognition of abruption, and bereavement communication. The review generated clear learning and improvement actions, including 10 immediate actions. These focused on triage, interpreter access, PERIPrem compliance, and addressing deprivation-related outcomes. Managers met to triangulate learning. There was a shared action plan and learning which was overseen by the governance team.

Managers used performance data to identify areas for improvement and implement changes to enhance patient care, although some gaps remained. Managers monitored key metrics and made changes to improve outcomes for women. For example, they identified delays in triage, particularly during the afternoon period, and secured funding for an additional midwife to work in triage on the late shift to improve timeliness.

The service also recorded all triage calls and produced data reports, which identified further delays in answering calls overnight. At the time of inspection, there was no dedicated telephone triage midwife during the night, with this role being covered by midwives allocated to triage. Managers recognised the need for a formal escalation protocol for telephone triage, and this was being addressed as part of a wider triage quality improvement programme.

The service was mostly meeting national expectations for emergency caesarean section response times, with ongoing improvement work. A category 1 caesarean section, defined as an immediate threat to the life of the woman or baby requiring urgent delivery, should be performed within 30 minutes of the decision to operate. Women requiring a category 1 caesarean section were mostly treated within this national target timeframe. Performance data showed improvement over the review period, with compliance increasing from 80% in February 2026 to 89% in April 2026. There was an ongoing quality improvement project for this area of clinical intervention, led by the consultant midwife.

The service monitored decision-to-delivery intervals through regular audit and reviewed performance monthly. Leaders used this information to identify areas where improvements were needed and maintained oversight of compliance with expected standards. Audit data showed that in March 2026, 33 of 48 (69%) category 1 caesarean sections were completed within the 30-minute standard. In April 2026, 42 of 47 category 1 caesarean sections met the standard (89%). The longest delay was 47 minutes. Although performance had improved, it remained slightly below the Local Maternity and Neonatal System target of 90% or above. This demonstrated that while leaders had effective systems to monitor and review performance, work was required to sustain the improved timeliness of emergency caesarean section delivery. The main themes were delayed transfer from maternity unit assessment unit and consent delays due to language barriers. The service was working to improve its use of interpreters. Leaders had identified this as a risk and had added it to their risk register for monitoring.

Admissions to the neonatal unit were below (better than) the national average. The service monitored admissions into the neonatal unit which consistently better than the national Avoiding Term Admissions into Neonatal Unit (ATAIN) rates. The national target was 5% and in May 2026, for example, the term admission rate was 4.1%.

The service had effective systems to identify and respond to adverse neonatal outcomes, with ongoing review and improvement work in progress. There had been a cluster of babies in February 2026 who had Hypoxic-Ischaemic Encephalopathy (HIE) which is a type of brain injury caused by the lack of oxygen around the time of birth. The service was just above the national expected rates of 0.6% at 0.67% in April 2026. The service was completing a full review, and a report was expected in June 2026. Fetal monitoring was identified as a contributory factor in 2 out of the 7 cases. Leaders had linked this into their ongoing improvement plan.

The service performed better than the national average when monitoring and detecting small for gestational age babies. Small for gestational age (SGA) babies were monitored as part of ‘Element 2’ of the Saving Babies’ Lives Care Bundle (Version 3.2). Performance data showed that the service’s detection rate for SGA improved to 52.6% in April 2026, exceeding both the previous month and the national average. The service continued a review of service pathways and found that overall, there was an improvement of the trajectory in fetal growth surveillance.

The service performed better than the national average for Obstetric Anal Sphincter Injury (OASI). Leaders monitored and reviewed outcomes. They used learning from audit findings to identify areas for improvement and support safer maternity care. The service completed quarterly thematic reviews of women who experienced OASI. Data from January to March 2026 showed an OASI rate of 1.2%, which was better than the national average of 2.9%. Reviews considered risk factors and mode of birth, with forceps deliveries accounting for the highest number of cases. The service identified actions to improve antenatal and intrapartum documentation, progress the reliability of post-OASI pathways, and promote the OASI care bundle and documentation workshops to support evidence-based best practice.

The service used several dashboards to analyse data and monitor outcomes in line with national standards. These dashboards were sophisticated and allowed for patient-level analysis, including outcomes by ethnicity and deprivation.

Staff regularly assessed and monitored women for pain. Pain relief options were discussed during the antenatal period and upon arrival at the delivery suite. ‘Pain relief in labour’ leaflets were available in each delivery room from a QR code.Anaesthetists conducted daily postpartum ward rounds to review pain management.

Most women had a documented pain management plan, although this needed to improve. The April 2026 documentation audit for antenatal and postnatal wards showed that pain was recorded on transfer for 86% of women. Pain was reassessed and documented at least every 24 hours in 91% of cases, with all women reviewed in line with their management plan. Additionally, documentation of analgesia administration and effectiveness was recorded in 89.5% of cases.

Although there were no specific themes from which to improve this, there remained a high number of babies born before they reached the hospital. The service looked at the number of babies born before arrival to the hospital with 37 born before they arrived at the hospital in the year from June 2025. The service had audited this but found there were no themes but continued to monitor due to high rates.

The service was part of the Maternity and Neonatal Safety Programme (MNIP). It was graded as being in ‘sustainability’ mode and there was a plan of work around support to ensure progression as the service exited the programme. There were NHSE/ICB regional perinatal oversight meetings each month and 7 workstreams within the improvement plan.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.