Horton General 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 service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At the last assessment we rated this key question requires improvement.

At this assessment the rating has changed to good.

This meant the service was consistently managed and well-led. Leaders and the culture they created promoted 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 service had a shared vision, strategy, and culture. 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.

The trust’s Surgery, Women’s and Oncology division (SuWON), which included the Horton midwifery-led unit (MLU), had its own divisional strategy that aligned with, and fed into the overarching trust strategy.

The maternity service’s vision was that women experience excellent, compassionate care, with services delivered in the right place to meet their needs. The strategy focuses on four key priorities: providing the right services in the right places; tackling inequalities across the service; improving care pathways; and strengthening the research base for women’s health and empowering women with the knowledge to make informed choices.

Staff demonstrated a clear understanding of the strategic direction and were able to provide examples of how this was being implemented within the MLU. For example, the development of the birthing outside of guidance pathway which supported personalised care planning and increasing obstetrician-led outpatient clinics ensuring that women received the appropriate level of care in the most suitable setting. These initiatives demonstrated how the service was working to provide the right care, in the right place, for women in the local community.

The team demonstrated a positive and collaborative culture, with staff working effectively together to support safe, high-quality care. There was a shared focus on meeting the needs of women, and staff described open communication and mutual respect within the team. Team members worked collectively across roles to ensure care was coordinated and centred on the best interests of patients.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

The trust-wide maternity service had a clearly defined management and leadership structure. The service was led by a quadrumvirate comprising the clinical director, director of midwifery directorate manager and the clinical lead of neonates who sat in a different trust division.

The director of midwifery was supported by a safety, risk and compliance lead, the head of midwifery and two consultant midwives. The service also had two deputy heads of midwifery, one of whom had responsibility for community and outpatient services.

The midwifery-led unit (MLU) was managed by the community and MLU matron, supported by a dedicated band 7 ward manager. Outpatient clinics, delivered at the Horton General Hospital, were managed by the outpatient matron with support from two band 7 ward managers. Both matrons reported to the deputy head of midwifery.

The community and MLU matron and the consultant midwife were visibly present within the unit. They had office space on the unit and were on site each week, which supported leadership visibility and accessibility for staff.

Leaders at the midwifery-led unit had the appropriate skills, knowledge and experience to manage the service. They understood the key priorities and challenges within their areas of responsibility and demonstrated oversight of performance, safety and quality. Leaders monitored service data and used audit processes to review safety and quality performance. Audit findings were used to inform service development, strengthen clinical governance arrangements and support regulatory compliance. Leaders described how this oversight contributed to improving outcomes for women.

Leaders supported staff development and succession planning. Staff were encouraged to participate in leadership and professional development programmes. This enabled staff to develop their skills and progress into more senior roles.

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

The service recognised the importance of fostering a positive speaking-up culture in which staff felt able to raise concerns without fear of blame or detriment. Staff were encouraged to speak to their line managers if they had worries or concerns. In addition, they had access to a range of formal speaking-up routes, including human resources, union representatives, incident reporting systems, the whistleblowing policy, and the freedom to speak up guardian (FTSUG).

The trust had established Freedom to Speak Up (FTSU) arrangements, including a trust-wide FTSUG in post. The guardian was registered with the National Guardian’s Office and had completed relevant training. Information on how to contact the guardian was available via the staff intranet. The trust also maintained a network of FTSU champions across the organisation. These champions promoted awareness of speaking up, acted as points of contact for staff, and provided initial support to colleagues wishing to raise concerns. The role was voluntary and undertaken alongside substantive duties. We were not informed whether there was an FTSU champion specifically allocated to the MLU, which may limit visibility and accessibility of the role at local level.

Most staff members were aware of the FTSUG service and understood how to raise a concern. However, staff told us they would be more likely to raise issues with their line managers, as they felt confident, they would be listened to.

The 2024/2025 FTSU trust report showed that 197 cases had been raised to the FTSU Guardian, with 71% relating to concerns about staff safety and wellbeing. The data was not broken down to individual MLU, however, the division in which the service sat accounted for 18% of cases raised with the FTSUG. No FTSU concerns were raised specially in relation to the Horton MLU.

The 2024 staff survey indicated that 63% of maternity respondents agreed with the statement, “I feel safe to speak up about anything that concerns me in the organisation.” However, only 50% reported confidence that the organisation would address their concern if they raised it. This suggests that while a majority of staff feel able to speak up, confidence in organisational responsiveness may require further strengthening.

The trust and service demonstrated a commitment to valuing diversity within their workforce and promoting an inclusive and fair culture. Leaders described actions aimed at improving equality and equity for staff. However, detailed plans outlining how these objectives would be delivered and monitored at a local level were not clearly articulated.

In the 2024 staff survey (48% response rate), trust-wide results showed that 59% of staff reported experiencing discrimination on the grounds of ethnic background, 7% on the grounds of disability, and 2% on the grounds of sexual orientation.

Trust-wide data from the 2024 Workforce Race Equality Standard (WRES) report and Workforce Disability Equality Standard (WDES) report demonstrated that staff from non-white ethnic groups and those with long-term conditions or illness, were more likely to experience harassment, bullying or abuse from patients, relatives, the public and colleagues, including managers, compared with white staff and those without long-term conditions or illness. Staff from these groups were also less likely to report equal opportunities for career progression or promotion. Service-level data specific to the maternity service or MLU was not available. As a result, we were unable to determine whether these trust-wide findings were representative of the experiences of staff working within these areas.

The trust had articulated a commitment to embedding equality, diversity and inclusion (EDI) across the workforce. An EDI strategy aligned with the Equality, Diversity and Inclusion Objectives (2022–2026) set out six priority areas, including integrating EDI into daily practice and decision-making, fostering a culture of belonging, improving outcomes for deprived and seldom-heard communities, strengthening organisational capability to address inequalities, and positioning the trust as a leader in EDI.

The trust had established staff forums and networks to provide safe and inclusive spaces for staff to share experiences and influence policy. Networks included disability and accessibility, Black, Asian and minority ethnic, LGBT+, and women’s networks. Each network had an executive sponsor, providing direct access to board-level leadership.

The maternity service workforce was not representative of the local community. Leaders acknowledged this and described actions to support fair and inclusive recruitment and talent management processes aimed at addressing under-representation. However, we were not provided with detailed information at maternity service or MLU level to demonstrate how workforce EDI issues identified through WRES, WDES and the staff survey findings, were being specifically addressed within the service. As a result, assurance regarding the impact of EDI initiatives at local level was limited.

The maternity service had established governance and risk management arrangements that supported oversight of quality, safety and improvement. While information was escalated effectively through formal governance structures, local-level discussion of performance metrics and risk identification required strengthening to provide clearer assurance.

The maternity service had a well-established clinical governance framework in place, through which the department was accountable for continuously improving service quality, assuring patient safety, and managing key risks. A dedicated clinical governance lead supported this structure.

The principal governance forum for the service was the maternity clinical governance committee (MCGC). Standing agenda items included the maternity quality report, maternity performance dashboard, safeguarding, quality assurance, and quality improvement. Routine papers reviewed at this meeting included the quality report, maternity performance dashboard, and maternity services update. In addition, other governance groups fed into the MCGC, including the intrapartum group meeting and the risk management meeting and the triangulation and action committee (TALC). The TALC was a multidisciplinary forum focused on improving safety and quality by analysing multiple data sources to identify emerging risks and take timely action.

Governance information flowed from the MCGC to the divisional governance meeting, then to the trust governance meeting, and ultimately to the trust board. The maternity performance dashboard was also reported to the trust’s integrated assurance committee, a sub-committee of the board.

The community and midwifery-led unit (MLU) matron was responsible for collating information to present at the MCGC and for representing the MLU at that forum. We reviewed performance and quality spreadsheets to understand the data being collected. Meeting minutes from the MCGC were shared with all community and MLU senior leaders.

We also reviewed the minutes of the weekly community and MLU leaders’ meetings. These meetings followed a standard agenda of guest speaker, updates, and any other business. However, the updates section was not structured to include key metrics such as birth rates, transfer rates, quality indicators, safety issues, or risks. As a result, it was unclear how information from the MLU was discussed locally.

The MLU utilised the maternity safety board, located on the wall in the MLU, to communicate key information to staff. This was updated monthly by the patient safety coordinator and included learning from incidents, guideline updates, education and training information, and the top three risks on the risk register.

We reviewed the minutes from the maternity service monthly risk review meeting and saw that existing risks were routinely reviewed and new risks were discussed. It was unclear how, or in which forum, risks were identified and discussed at a local level before being escalated to the maternity service risk review meeting.

Staff told us about a current risk within the MLU relating to ligature points in 2 bathrooms due to exposed pipework. We saw that this risk had been recorded on the risk register, as had other risks relating to the unit. This demonstrated that, although the local forum for identifying and discussing risks was unclear, risks were being identified and captured on the maternity risk register.

Governance arrangements within the MLU supported oversight of safety and quality through the use of clinical audit and review processes. Audit activity was used to monitor key areas of practice, including labour assessment decision‑making, use of the modified early obstetric warning score (MEOWS), and staffing arrangements at birth. Audit findings and exception reviews were used to identify learning, reinforce standards and support continuous improvement. Evidence showed that occasions where expected standards were not met, such as instances where a second midwife was not present at birth, were documented, reviewed and considered through established maternity quality processes, supporting risk identification and management. Oversight of telephone advice calls that did not progress to labour assessment was less developed, as these contacts were not routinely included within audit activity.

The service understood their duty to collaborate and work in partnership, so their services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

The service had positive and collaborative relationships with external partners, which supported effective care provision, service development and joined-up working.

In collaboration with other health and social care provider midwives ran a weekly antenatal clinic in a local community centre. This brought together early help practitioners, citizens’ advice, sexual health doctors, dentists and food and larder representatives.

The Rose clinic operated at the Horton MLU once a month. It was an outreach clinic for pregnant women with female genital mutilation (FGM) and for vulnerable migrant women. The clinic worked closely with community-based groups in the local area including charities dedicated to supporting ethnic minority communities, refugees and asylum seekers.

The service had distributed multiple phones and SIM cards to women in the local area to support access to digital services as part of their digital inclusion initiative.

The maternity service showed a commitment to learning and improving practice in alignment with the maternity clinical strategy and across the local system. However, it was not clear what specific measures were being implemented at a local level to drive quality improvement and development within the service.

Staff demonstrated a commitment to continual learning and improvement. The service sought to improve care by learning from both positive practice and when things had not gone well, and it promoted training and innovation.

The trust promoted its improvement framework as the approach to quality improvement, with guidance available to staff on the intranet. However, we were not made aware of any quality improvement projects currently underway within the MLU.

As part of the maternity clinical strategy, the service had identified several areas for development, including improvements to care pathways. Examples included the development of outreach services within the local community and obstetrician-led clinics at the Horton General Hospital.

As part of the wider maternity service, the service was part of the perinatal improvement programme, focusing on critical safety elements such as maternity triage, reducing delays in the induction of labour and improving service user experience and staff wellbeing. The maternity service also participated in research, audits, and service improvement projects, often in collaboration with the local university.

However, it was not clear what specific initiatives were being progressed within the MLU itself to advance quality improvement and development at a local level, or how learning was being translated into measurable improvements in practice.