Birmingham Heartlands Hospital

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• 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

We looked for evidence that people were always at the centre of how care was planned and delivered. We also looked for evidence that people could access care in ways that met their personal circumstances. This means we looked for evidence that the service met people’s needs.

At our last assessment we rated this key question requires improvement. At this assessment, the rating has changed to good. This meant people’s needs were met through good organisation and delivery.

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.

We scored the service as 3. The evidence showed a good standard. The service mostly made sure people were at the centre of their care and treatment choices and staff decided, in partnership with people, how to respond to any relevant changes in people’s needs. However, there remained some issues with women where English was not their first language, and this had affected their experience.

Women’s care plans fully reflected their 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. One woman told us all aspects of her care planning was discussed throughout, and the staff were “so accommodating” at all stages of her inpatient stay.

Women had a choice about where to give birth. The service had opened a 3-bedded midwifery-led unit ‘Willow’ in April 2026 and had seen an increase in midwifery led births. When the unit was not busy, it was utilised to assist with flow such has women waiting discharge. There was a clear guideline and escalation pathway for the unit. There was also a home birth team which was staffed by community midwives, although there had only been 5 home births in the last 12 months.

The service was creating a soundproofed bereavement room at the end of the delivery suite ward, designed in line with national guidance. It was to give families a private space to grieve. The staff in the antenatal clinic told us they wanted to develop a counselling room for difficult news away from other antenatal women. The current environment needed improving to include a counselling room but also more toilet facilities as there was only 1 for the whole clinic.

There was good access for partners at any time. Birthing partners were able to visit the wards 24 hours a day, 7 days a week.

Staff made efforts to provide person-centred care and support women to communicate their needs. However, this was not always consistent and did not always mitigate risks to women and babies. Midwives and maternity support workers mostly took time to understand women’s birth preferences and supported them to communicate these, including through the use of pictorial charts displayed on the ward. The service also used a video interpreting service where required to help ensure women were aware of their options and felt involved in their care. However, learning from Perinatal Mortality Review Tool (PMRT) reviews indicated that interpreting services were not always used effectively. This had been identified as a key area of focus, with the Equality, Diversity and Inclusion midwife leading work to improve the use of interpreters and staff understanding of women’s levels of comprehension.

There were other issues with some PMRT reviews. We reviewed cases where ‘did not attend’ guidance had not been followed, and scans were not completed in line with guidance. The PMRT panel identified care issues in at least two cases, where women with limited English had missed appointments due to not understanding English, were unaware of scheduled appointments, and had not been provided with an interpreter.

The service made reasonable adjustments to ensure women received appropriate care and treatment. Women with mental health needs or learning disabilities, for example, 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 drawn up. Staff told us all women who needed adjustments had comprehensive plans on admission to the ward areas. We reviewed the notes of a woman who was section under the Mental Health Act, and they provided a clear plan of care for her and her baby.

Antenatal clinic appointments were arranged to suit families’ needs. Leaders had recognised that some women found it difficult to attend around school pick-up and drop-off times and asked staff to arrange appointments at other times. They also tried to ensure where women had multiple appointments, they were all booked on the same day to reduce travel and costs for women and their families.

Leaders recognised delays in the review of scans and test results and were acting to improve timeliness and reduce risks to women. There were delays in the review of women’s scans and test results by medical staff. Midwives had escalated concerns regarding these delays, with some scans taking up to 8 days to be reviewed. Leaders were aware of the issue and had implemented measures to address the backlog. This included allocating time within antenatal clinic sessions to support staff to review scans. Operational managers monitored the position daily to maintain oversight and identify any ongoing concerns. Delays were discussed through operational processes, and we noted when on site, an additional doctor was allocated dedicated time to review scans and results to support the reduction of the backlog.

There was an efficient process for ultrasound scans. The Day Assessment Unit operated a ‘scan and go’ policy whereby midwives performed ultrasound scans on antenatal women. Women with normal findings were discharged without medical review, whereas those with abnormal findings were reviewed by a doctor. The medical review could be done remotely to improve time to review.

Leaders wanted to strengthen support for women within the community, antenatal clinics and induction of labour. Ward managers did daily walk arounds of their areas to gain real-time patient feedback and ensure person-centred care. Leaders wanted to improve this by ensuring women within the community had a touch point to feedback on their care.

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.

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

We did not look at Listening to and involving people during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We scored the service as 2. The evidence showed some shortfalls. Due to rising demand and limited capacity in the maternity service, it did not always make sure that people could access the care, support and treatment they needed when they needed it, but there were actions being taken to resolve the issues around medical triage times.

Women were not always able to access care and treatment in a timely way, although leaders had identified this as a priority and were taking action to improve. Due to rising demand and limited space in the maternity service, staff were not able to consistently ensure women could access the care, support and treatment they required in a timely manner. For example, despite medical staffing levels following guidance, women were not always seen promptly in triage at night and over weekends. This had improved since our last visit, but it remained still poorly organised given the levels of staffing.

Triage was a key focus for improvement for service leaders. A quality improvement group had been established, with good multidisciplinary engagement, and there were clear actions with realistic timescales to address the identified concerns and improve access to timely care.

The service had made improvements to the induction of labour (IOL) pathway, although delays remained and continued to require active management. While women still experienced delays, these were appropriately managed and risks were assessed. Typically, 6 women a day were scheduled for IOL. However, staffing pressures and bed capacity meant women were not always able to attend as planned.

The service had implemented gestational age ranges for induction, providing greater flexibility for scheduling. Each woman was recorded on a tracking system, which was reviewed daily. IOL was discussed twice daily during safety huddles, where plans were made for all women awaiting induction.

Where delays persisted, the maternity escalation procedure was initiated, including adjustments to the Operational Pressure Escalation Level (OPEL) and associated actions. On 3 June 2026, we saw the service was operating at OPEL red, and actions were taken to maintain IOL activity. This included co-ordinating with the Local Maternity and Neonatal System to redirect women to alternative hospitals to help manage capacity pressures.

The leaders prioritised and allocated resources appropriately to address inequalities and support equitable access. There was an equality, diversity and inclusion (EDI) lead midwife who co-ordinated projects including those that addressed health inequalities. The main areas of focus in 2026 had been to improve the interpreting services and the service had begun to develop a language assessment tool. Staff had found within incidents that often people had not had access to an interpreter and there was some uncertainty as to whether an interpreter was needed.

Reviews using the Perinatal Mortality Review Tool (PMRT) showed interpreters were not always used well in the antenatal period and some women’s language needs were not well explored. The language assessment tool was based on European standards and would allow staff to determine the level of interpreting required. It was due to be piloted at the end of June 2026, and a dashboard was being created alongside this.

The skills of interpreters were recognised by staff and valued. During a safety walkaround by one of the safety champions on the ward, it was recognised how one of the women had very limited English. An interpreter was requested and it was discovered that the needs of the woman were different to what had been picked up so far. However, staff were aware there were still challenges, not least with needing the interpreters to recognise quite complex medical and technical language.

The service had created communication boxes to help improve this. Staff found the maternity section within the existing communication book, which was picture orientated, had minimal maternity content. The EDI lead had developed an application which showed pictures for every stage of the maternity journey and could be used to aid communication.

EDI was being promoted to be everyone’s business. The EDI lead midwife had created EDI champions within the maternity service who were due have their first meeting in June 2026.

Leaders demonstrated a commitment to learning from the experiences of bereaved families and using feedback to drive improvements in the quality and equity of care provided. The service had undertaken a thematic review of parents’ experiences following stillbirth between October 2025 and January 2026. Thirteen families contributed their perspectives to the review. The review explored key themes, the impact of care experiences, and identified opportunities for learning and improvement. A summary of findings, recommendations and associated actions was produced.

The service acted on the findings. One of the recommendations was to reduce unwarranted variation in parents’ experiences related to ethnicity, language, culture, or previous pregnancy loss. In response, the service had developed actions to ensure the availability of culturally appropriate information, and strengthen inclusive communication practices. Leaders also planned to use equality data alongside parental feedback to identify, monitor and address disparities in experience, supporting more equitable care for all families.

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.