Queens 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 women who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

At our last assessment we rated this key question inadequate. At this assessment the rating has improved to requires improvement.

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 shared vision and strategy but it was not based on a positive culture with transparency, equity, inclusion, and engagement. Since the last inspection the maternity service had developed a strategy with an embedded programme of work to improve the service. However, throughout the assessment it was clear the shared direction was not embedded and the culture with the staff was poor. For example, on our previous inspection in August 2023 we outlined that there were concerns of a high number of PPH and MOH. Our current assessment found that this number remained high but there had been a slight reduction, the risk remains high

Staff reported that they felt senior leaders did not listen to their concerns and that there was a ‘us and them culture’. This was also reported in our previous report in which there has been no change.

Not all leaders understood the context in how the service delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Whilst leaders had the skills, knowledge, experience they did not lead effectively, with integrity, openness and honesty.

Senior leaders were not visible in the clinical areas. The midwifery team articulated there was a disconnect between the service leaders and the operational clinical staff, and therefore did not understand their everyday roles and concerns.

Leaders informed us that they had an open door policy. Staff did feel that they could talk to the direct manager about any issues they had whilst at work. However, they did feel confident that if they raised issues with senior leaders within the maternity service they would be listened to or acted on. This is due to historical issues across the maternity service.

Although there was a freedom to speak up policy staff were unaware of who the freedom to speak up guardians were or who to contact beyond their line managers if they wish to speak up.

Leaders ensured that staffs wellbeing was paramount. They valued their workforce and the diversity within it. Staff were able to work flexibly to not only meet the needs of the service but their work life balance too.

The governance process had been developed since the last inspection, which as an improvement. However, there was still more work to be done to ensure that effectively support the service to assess and monitor all areas of risk and mitigate against it.

The service did not have clear responsibilities, roles, systems of accountability and did not demonstrate a good governance process. Staff did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. Staff were unable to articulate the governance process, and escalation processes.

The trust was required by the commission, to take immediate action to ensure that they implement an effective audit of the PPH and MOH management proforma. The trust had complied with this. However, this had not led to a sustained period of compliance with completing the risk assessment. Data showed that compliance form July 2024 to Dec 2024 was variable from 20% to 90% compliance. The trust expected this fall in compliance sure to the implementation of the EPR system which has been noted within other organisations too. By August the compliance rate was back up to 60%.

The trust was required by the commission, to take immediate action to ensure that they audit the occurrence as a proportion of deliveries and severity of PPH and MOH. The trust had complied with this requirement.

The service did have a quality dashboard; however, we were not assured leaders recognised themes and trends which required some investigation for example, the significantly low levels of vaginal birth after caesarean section and the support for women with a body mass index over 35 at booking and additional support for them throughout their pregnancy.

Whilst the service did understand their duty to collaborate and work in partnership, so services worked seamlessly for women not all staff did so. However, we did note that senior staff were working closing within a maternity improvement plan to bring about positive changed and embedding good practice and outcomes for woman.

Junior staff did not always share information and learning with partners or collaborate for improvement. There was missed opportunities to have them involved in the partnership working.

The service did not always follow standard pathways and work with partners and other agencies such as NHS England and the Integrated Care Board. Correct information is not always shared, for example the OPEL rating. Therefore, oversite from partners do not always have a good overview of the maternity service.

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