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

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question requires improvement. The service was in breach of legal regulations in relation to good governance. The service has made improvements and is no longer in breach of regulations. The rating has improved to good. The governance framework had been strengthened, with clear structures and processes to support oversight of quality, risk and performance.

There was good evidence that managers reviewed and acted on risks identified through data and performance information. Governance systems were effective in identifying concerns, and leaders took timely action to drive improvements. The culture of the service had improved considerably. Staff described a more open, inclusive and supportive environment, and there was evidence that leaders had taken proactive steps to address cultural concerns, promote positive behaviours and strengthen engagement across teams. These changes demonstrated stronger leadership, governance and organisational culture, and as a result, the rating for Well-led has improved to good.

However, there remained work to be done to improve the culture among the medical staff. Although staff said they worked well as a multidisciplinary team, there was a lack of support at times for the medical workforce, and the culture was not always positive.

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.

We scored the service as 3. The evidence showed a good standard. There have been significant improvements in culture, although with more to do around issues with the medical staff culture. This was recognised by the senior leadership. The service had a shared vision and strategy. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Leaders ensured there was a shared vision and strategy. Staff across all areas understood and supported the vision, values and strategic goals, including how their roles contributed to achieving them. Leaders had strengthened this approach by updating one-to-one templates to align with the trust strategy, to provide a consistent and clear focus based on vision and values.

Maternity services had a clear three-year vision and strategy aligned to the trust strategy and its key principles. This had been developed in 2025 and since our previous visit when there was no formal strategy for the service. There were 4 high level themes which led the focus of the strategy:

• Listening to women, birthing people and families with compassion which supports safer care.
• Supporting our workforce to develop their skills and capacity to provide high-quality care.
• Developing and sustaining a culture of safety to benefit everyone.
• Meeting and improving standards and structures that underpin our national ambition.

As well as being based on the trust’s “5 Ps” namely:

• Patients
• People
• Potential
• Place
• Performance

the strategy was linked to the NHS England three-year delivery plan for maternity and neonatal services. The service had 6 objectives and set out how it was aiming to achieve these by 2028. The senior midwifery meeting was structured around the strategy.

The culture within midwifery service had significantly improved since the last inspection. Leaders demonstrated culture was a clear priority, embedding it as a core focus for staff through consistent engagement, visibility and support. Staff described a more open, inclusive and positive working environment. One staff member told us, “The shift in culture is palpable.”

The service held regular away days for different groups of midwifery staff. These away days centred on culture, and staff credited these for honest and open conversations, learning, and an improved understanding. Staff told us they allowed them to be heard and seen. Feedback from midwifery staff included the comment: “This is the first time in 10 years that my feedback has been asked or valued. Really excited to see the changes to come.” Staff commented upon the recent introduction of deputy ward managers having strengthened local leadership and staff wellbeing.

Leaders had implemented behavioural framework workshops for managers to support them in managing incivility and conducting difficult conversations. Managers told us the framework was embedded within regular one-to-one meetings with the Head of Midwifery. This provided opportunities to reflect on challenging interactions, discuss concerns, and receive guidance and support on how to respond effectively. This demonstrated a proactive approach to promoting positive behaviours and supporting managers to address workforce issues constructively.

The Director of Midwifery had established dedicated culture meetings for staff to identify and address barriers within the service. Leaders used these meetings to explore themes including communication between teams, relationships across the service and understanding the pressures experienced within different clinical areas. Action plans were developed in response to identified concerns. For example, the service introduced Band 6 midwife roles that worked across 2 clinical areas rather than 1. Staff told us this had improved working relationships, increased understanding of the challenges faced by colleagues and supported greater collaboration across the service.

Midwifery leaders ensured staff were collaborating on what was important to them and ensuring a staff voice in decision making. Staff were included in quality improvement work where it was relevant to their area. For example, Band 7 midwife co-ordinators had been rostered to attend rapid reviews and quality improvement meetings to help develop the service. Triage midwives were included in the triage working group to ensure pathways were developed in line with their vision for the service. The staff had been supported to attend and take part in 2 ‘community of interest’ meetings which enabled them to have a voice on everything affecting them. These were relatively new meetings set up in the last few months and supported by a senior leader focusing on culture for the trust.

There were established student forums for the trainee midwives. This enabled students to advocate for each other if anyone felt anxious about speaking up. Senior leaders said they tried hard to resolve issues for the students. Those we met at the focus groups at the end of March 2026, spoke about feeling supported and were hopeful of being able to work on the unit when they had completed their training.

Midwifery staff and leaders demonstrated a positive, compassionate and open culture that promoted listening, trust and understanding between them and women, with a focus on learning and continuous improvement. Staff across midwifery trusted their leaders and this was evident. All staff told us team working was great and there was no sense of hierarchy structures. Most staff told us the leaders were visible on the wards and very approachable. They continued to do ‘back to the floor Thursday’ where the senior teams attended clinical areas, talked to the staff and worked clinically alongside the staff.

Theatre staff spoke positively about the culture within the service, highlighting efforts to celebrate staff and recognise diverse ethnic backgrounds. They described good teamworking and involvement in team-building activities, which had also been opened to medical colleagues, although attendance had been variable, due to competing clinical commitments. The service had held a theatre culture workshop and participants’ reflections were overwhelmingly positive with some clear themes which emerged for the teams to work to improve.

There was an annual maternity staff survey. Recent results showed a marked improvement for leadership, culture and retention. The senior leaders met with staff to discuss these results and managers were finalising the action plan co-produced with staff at the time of the inspection.

Equality and diversity were actively promoted, and the causes of any workforce inequalities were identified, with action taken to address these. The equality, diversity and inclusion midwife had a clear focus on these issues. Initiatives included the implementation of an anti-racist framework, cultural humility training for all staff, participation in a race steering group and the introduction of an anonymous incivility reporting form. Staff told us leaders promoted inclusive values and were committed to identifying and addressing inequalities affecting both staff and women using the service.

While the culture within the midwifery team had improved significantly since our previous inspection, the issues with some poor experiences and the culture among medical staff had yet to be resolved. This impacted on the morale and wellbeing for some medical staff. Leaders recognised this and had introduced a monthly ‘bronze meeting’, where doctors’ wellbeing was discussed and action plans were developed to address concerns. Although staff reported they were not sure what had been done to address the concerns they had raised. There was a monthly resident forum meeting, and resident doctors told us there had been culture workshops which were well attended.

Surveys showed there were areas for improvement. The general medical council trainee survey for 2025 showed just 53.8% of respondents were satisfied overall with their training and only 58.8% found the environment supportive. There continued to be a focus on training and consultant support.

There was good feedback from the Maternity and Neonatal Voices Partnership (MNVP) team who worked closely with the maternity team. MNVP is an independent body who works with women and their families on both the wards and in the community to hear their feedback and share this with the maternity staff. We met with one of the MNVP staff at the unit at the end of March 2026 during a focused engagement day with the unit staff. The person we met had been working closely with Birmingham Heartlands Hospital’s maternity unit and staff for a number of years. They were therefore able to determine and share how feedback had been exceptionally positive and significantly improved. On their most recent visit, 99% of the feedback had been positive.

There was great partnership working and mutual respect with MNVP. The member of MNVP staff commented on their excellent relationship with the senior leaders and how they were receptive to feedback and advice, which was managed proactively and not defensively. They spoke of excellent partnership working and great communication which was carried out with respect and mutual support. They had a partnership engagement event in October 2025 where ideas were shared on the quality improvement work, and the MNVP team presented they work they were doing.

We did not look at Capable, compassionate and inclusive leaders during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

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.

We scored the service as 3. The evidence showed a good standard. The service had improved to have clear responsibilities, roles, systems of accountability and good governance. Staff used these to manage and deliver good quality, sustainable care, treatment, and support. They acted on the best information about risk, performance, and outcomes, and shared this securely with others when appropriate.

There were much improved and effective governance, management and accountability arrangements. Since our previous inspection in May 2025, the senior leaders had acted to improve the governance of the service to demonstrate their assurance as to how the service provided quality and safe care. Our previous inspection criticised the service for failing to provide a comprehensive and reliable system of governance. There was still more to do in some areas, which was raised openly and honestly with us, but this was recognised and there was work in progress. However, work undertaken to have a strong system of governance had been building in the past year, and was now in a far better place.

Senior staff had been appointed to lead and focus on governance roles. The maternity department had a matron as the lead midwife for quality governance, assurance and compliance leading on quality and safety of care supported by a consultant midwife and consultants leading on clinical areas. The governance framework was overseen by the senior leadership team and ultimately by the Director of Midwifery, who reported to the Chief Nurse and the trust board.

Leaders reported a clear ambition to strengthen assurance processes from ward to board and improve how risk was communicated across the service. The Head of Midwifery had introduced monthly cross-site ward manager assurance meetings, where ward managers and matrons met to present their data. This was corroborated with governance information to ensure accuracy and effective oversight. Joint action plans were developed, and risks were addressed collaboratively across the service. One matron told us, “It is great for shared learning and a shared approach.” Managers also incorporated targeted training into these meetings, based on identified needs. For example, when ward managers highlighted challenges in managing difficult conversations, focused training was arranged to support them.

Ward managers completed an ‘advise, alert, assure’ report monthly for their matrons with key items to discuss. This was a ‘red, amber, green’ concise action plan which alerted the matrons to key issues. For example, in April 2026, the delivery suite had a red alert which was ‘mandatory training manual handling was 74%’ with clear actions on what was being done to make improvements.

There were opportunities for feedback from governance topics every day. ‘Real time governance’ had been relaunched in the service to enable messages to be delivered to staff promptly. There was a governance session every day at 12.30pm with a different topic each day. These ranged from PMRT (perinatal mortality review tool); ‘you said: we did’; incidents and complaints; and safety matters. It provided immediate senior clinical and operational oversight and prompt resolution of issues. There were QR codes within the clinical areas for staff to submit issues, learning or positive practice to be discussed within the meetings. Staff told us these meetings were effective and beneficial.

The governance team created a quarterly newsletter. It included updates to policies, safety and learning highlights including PMRT learning, risk register updates, a ‘case of the month’, and recognition of positive practice.

The service had established governance arrangements to support the oversight of quality and safety, although there were opportunities to strengthen the consistency of follow-up actions.Governance arrangements were underpinned by a maternity governance framework, which set out clear processes for governance within the maternity service. There were established core governance meetings, with a structured agenda covering key areas of quality and safety, including incidents, the risk register, complaints, feedback and clinical effectiveness.

Meeting minutes demonstrated that concerns were appropriately identified and discussed and mostly actions were closed. However, in some instances, meetings did not consistently result in clearly documented action plans.

There were regular meetings to keep a watching brief on the service. There was a monthly maternity and neonatal safety champions meeting chaired by the chief nurse. Leaders discussed safety incidents, quality improvement projects, safety walkaround feedback, and theatres updates. Actions were created and followed up monthly. For example, the service had held 3 workshops for all staff including theatre staff, consultants, midwives, matrons and addressed key themes within the safety champion meeting. Themes were around the culture and behaviours, and next steps were being taken to give staff shared spaces for breaks to improve working relationships.

There were effective systems to manage risks and support the delivery of safe care, with evidence of improvements over time. There was a combined maternity services risk register, which captured risks across both hospital sites as maternity services covered both Heartlands and Good Hope sites. The governance facilitation lead met regularly with speciality leaders to review risks and associated actions. In addition, a monthly risk review meeting was held to approve high-level risks, monitor compliance and identify actions to address any gaps. At the time of inspection, there were 14 risks recorded on the register, including 4 which were awaiting approval. One of these was rated as red, indicating a high risk relating to the safe delivery of services due to insufficient maternity staffing.

The service had made progress in reducing risks since the previous inspection. For example, delays in induction of labour had improved following the introduction of gestational age ranges, the use of a digital system and revised guidelines.

Managers had arranged documentation workshops aligned to themes identified through audits and incidents. These were delivered by the governance team as drop-in sessions accessible to all staff.

Data and statutory notifications were consistently submitted to external organisations as required. The service participated in oversight groups, local maternity networks, and worked closely with stakeholders to ensure information was shared openly and with transparency.

There were effective arrangements to ensure the availability, integrity and confidentiality of data, records and data management systems. Women’s records, with the exception of medicine records on paper, were held on secure computer systems with access to staff restricted to those who were authorised.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We scored the service as 3. The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system.

Staff and leaders had a good understanding of how to deliver improvement. The approach was consistent and included measuring outcomes and impact. Numerous quality improvement groups met regularly to identify areas for development and implement actions to drive change. There had been improvements in the safety of the service since our inspection in April 2025. Leaders were fully aware of the issues within the service, and these were either on the risk register, quality improvement groups had been established, or there were actions underway to make improvements.

Leaders recognised that not all changes could be implemented immediately and took a measured approach to improvement. They worked to ensure changes were carefully introduced, embedded effectively and sustained over time. This meant there were still a number of changes needed to make improvements within the service, but they were well managed, risks were mitigated where possible and prioritised effectively.

There was a positive approach to quality improvement systems. Several new processes and quality improvement groups had been introduced in the last 12 months and embedded within the service. The senior leadership team was actively working across multiple areas to drive improvements in care for women. There were still improvements needed in some recognised areas, but teams were moving in a positive direction.

Leaders demonstrated a strong commitment to engaging women and families in the development and improvement of services. Staff and leaders ensured women and their families were involved in developing and evaluating improvement and innovation initiatives. Leaders had established a strong relationship with the Maternity and Neonatal Voices Partnership (MNVP), which worked collaboratively with service users, families and staff to gather feedback and shape maternity services based on lived experience. The MNVP produced quarterly reports, which outlined key areas of focus and findings from engagement activities, including feedback from service users and ward walks. These insights were used to co-produce action plans aimed at driving improvements. At the time of inspection, some actions had been completed, including the introduction of wellbeing walks, and others were underway.

There were processes to ensure learning occurred when things went wrong, as well as from examples of good practice. Leaders encouraged reflection and collective problem-solving.

Leaders encouraged staff to speak up with ideas for improvement and innovation and invested time in listening and engaging. There was a strong sense of trust between leaders and staff. Away days had strengthened the trust in the leadership team and ensured staff had a voice for change. Most staff were involved in making changes within their departments and were consulted when policies were changed. Most staff felt they were listened to.

The service held engagement days and training sessions to enhance staff knowledge and working relationships. Leaders had held an international day of the midwife virtual conference in May 2026 which included information about quality improvement projects, education opportunities and staff wellbeing. They celebrated achievements, shared learning, and highlighted opportunities for service improvement.

The service has developed a pregnancy passport to support women who attend other secondary hospital services and were pregnant, to support their pathway. The passport had a QR code for healthcare professionals to scan with a set of simple instructions. It contained reference to the standard operating procedure for ‘Maternity inpatient being cared for outside of Maternity areas’.

The Equality, Diversity and Inclusion Midwife worked collaboratively with stakeholders, including community link workers, to improve education and antenatal care. Stakeholders shared valuable insights into both hospital services and women’s experiences and worked together to develop actions to drive improvements.

The service used feedback from women effectively to monitor performance and drive improvements in the experience of them and their families. The service asked women to take part in the annual CQC maternity survey in 2025 and reported a significant improvement in women’s experience compared with the 2024 results. There were no areas where scores had decreased. The results provided assurance that actions implemented by maternity teams were having a positive impact on the experience of women and their families.

The service used data effectively to drive improvements and support innovation in clinical practice. For example, a time and motion study identified that midwives experienced delays in locating necessary equipment when caring for women with suspected sepsis. In response, the Advanced Clinical Practitioner and their team developed and piloted sepsis grab bags. The pilot demonstrated improvements in response times, consistency of care and compliance with the Sepsis Six pathway. Following the success of the pilot, sepsis grab bags were rolled out across the trust for use in all services.