John Radcliffe Hospital

On this page

• 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

This means we looked for evidence that the service met people’s needs. At our last assessment in September 2021, we did not rate this key question.

At this assessment, we have rated this key question as good. This meant people’s needs were met through good organisation and delivery most of the time.

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.

The service was not always able to make sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Some women who were awaiting induction of labour experienced long delays, high risk women cared for on the observation area were not in clear line of sight to staff and women who experienced a pregnancy loss were not always cared for in the appropriate areas. Because of these issues women’s care was not always person centred which had a negative effect on the psychological aspect of their childbirth experiences. This was evident in the volume of concerns raised directly to the CQC.

We reviewed the complaints data to identify recurring concerns. Data showed themes from complaints that included but were not limited to delays and concerns in the management of labour and diagnosis, alongside inadequate pain relief during labour and postnatal care. Communication was often poor, with conflicting information and limited explanations about treatment.

Although maternity leaders had strengthened its bereavement care pathway, capacity pressures and staffing constraints meant women experiencing loss could not always access the bereavement suite, resulting in care being delivered in areas that did not meet privacy and dignity standards or align with national guidance.

Leaders outlined improvement actions in line with the National Bereavement Care Pathway, including appointing a Band 7 bereavement midwife, improving staff training, upgrading facilities such as the Butterfly Suite, and strengthening governance and referral processes. A leadership review identified six required actions: one action had been completed, and three actions were in progress, including updating guidelines, developing a referral pathway and reviewing cross‑cover arrangements at the time this report was written

Leaders confirmed the Butterfly Suite was available to all women following fetal loss. However, there was no data that showed how many times women experiencing bereavement were placed in other areas. The impact of this meant managers may not have full oversight of the challenges.

However, the service tailored care to meet the individual needs of women using various resources. Safeguarding teams worked with leaders to implement strategies that ensured safe person-centred care for an increase in vulnerable women and families who had recently migrated to the area. Safety net systems were well thought out and embedded.

Women had access to their maternity care records through a smartphone application. The app showed their episodes of care and diagnostic results. It also provided health information, such as baby movements, smoking cessation, and links to various resources. The service provided information in a range of sources and the women’s unit displayed information throughout.

Leaders complied with Accessible Information Standards by identifying, recording, flagging, sharing and meeting the information and communication needs of people with a disability or sensory loss.

Staff provided interpreting services and used various sources like telephone and virtual interpreting services. The service had identified that there was a large cohort of Tetum speaking families in Oxford. People with hearing loss accessed the trust’s interpreter live system so that messages could be relayed via a visible sign language interpreter.

The service offered a free online antenatal class for all women and parents and baby yoga for mental wellbeing and displayed posters in antenatal areas to promote these.

The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity. Staff reported issues about interpreting services as incidents.

The service made sure women had the right information to make their own decisions about their care. Staff at booking made women aware of their choices of place of birth and type of delivery via the women’s electronic maternity application.

The service formed part of a multiagency network and provided continuity of care for people with complex social needs. Women with a history of substance misuse, experiences of domestic violence, or complex mental health needs were supported by dedicated community teams. Staff used the ‘Tips and Tricks’ model to raise awareness and help women disclose domestic violence.

Leaders made care available across Oxfordshire for women and their newborn babies. They provided 3 standalone midwifery-led units (MLUs) across Oxfordshire, as well as an additional MLU at Horton General Hospital which will be reported separately under Horton General Hospital. Women could request care at the standalone MLUs. The service monitored how many babies were born in the MLUs. For example. data for September 2025 showed 77 babies were born in midwifery led settings, this included 50 women at the Spires co-located midwifery led unit, and 8 births at the standalone midwifery led units or the community setting. Care provision mainly focused on antenatal and postnatal support, including infant feeding.

Women requesting a low-intervention birth were risk assessed against the ‘Home Birth Standard Operating Procedure’ (2023), which identified those unsuitable for home birth due to existing medical conditions, complex mental health needs, or previous caesarean section. Data showed that intrapartum activity for community midwifery standalone services was better than the national average for the period 2024 to 2025 leaders reported a home birth rate of 2% and an additional combined total of 2.8% for births in their midwifery led units.

A dedicated team of midwives worked with community services and housing to support women at risk of homelessness or poverty. They collaborated with the local housing office and provided free smartphones and SIM cards so vulnerable women could access digital maternity records. Community staff visited migrant families in hotels to assess risks and give advice on safe sleeping and postnatal care.

The maternal mental health team within the trust was a multidisciplinary group and comprised of two band 7 mental health specialist midwives and one band 6 mental health specialist midwife, who worked alongside three consultant obstetricians with a specialist interest in perinatal mental health. Also, a specialist trauma midwife worked within OUH who worked alongside, part funded by the Maternal Mental Health Service (MMHS). Staff worked collaboratively with the MMHS and the Perinatal Mental Health team, led by Oxford Health NHS Foundation Trust, who provided care for the most complex cases. In addition, specialist midwives and obstetricians maintained close links with the acute trust’s dedicated and unique Psychological Medicine Team, ensuring timely review and comprehensive care planning for women requiring urgent inpatient mental health care.

There were times when the service was unable to facilitate women’s request to give birth on the Spires midwifery led unit. This had caused some women frustration, and we had seen complaints raised about this via campaign groups. This was partly due to staffing levels and partly due to a recent fire incident near the Spires midwifery led unit, which meant some rooms had to close for safety until repairs were completed.

The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Staff made notifications to external bodies as needed.

The service complied with the Accessible Information Standards and information was in a form accessible to the patient group.

Staff ensured that women and families could obtain information on treatments, local services, patients’ rights, how to complain. People accessed information about treatments, local services, their rights, and how to complain via their maternity app or trust leaflets. This was available in accessible formats, such as easy-read, and in languages spoken by the patient group. Interpreters and signers were available when needed.

Throughout the unit we saw a full range of information clearly displayed. Posters about services included QR codes so that people could access information when they needed it.

As a result of national concern about the late identification of neonatal jaundice in newborn babies born to parents of colour, information posters were displayed in key areas to raise awareness for staff and parents.

The Oxford Maternity and Neonatal Voices group displayed Your Voice Matters posters throughout the unit to ensure people knew how to share their experiences about pregnancy care pathways.

The service treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. They took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Managers investigated complaints and concerns, monitored themes and acted to resolve concerns and shared learning from complaints with staff.

An Oxfordshire campaign group had promoted full independent inquiry into over 600 maternity incidents dating back to the mid 1980’s by the trust. Leaders had reached out to the action group to foster open, honest conversations and showed a deep respect for the concerns families had raised. Leaders invited the group leads to attend joint meetings to discuss historic and current concerns. However, at the time of inspection we were told the action group had chosen to cease engagement with the trust preferring to seek support from other external stakeholders.

Themes and trends and learning from complaints were reported to the board on a regular basis. This was to support organisational oversight and improvement. The complaints were specifically reported through the quality report and reviewed by the Triangulation and Learning Committee. The process ensured learning from complaints informed quality and safety in maternity services.

Patients knew how to complain or raise concerns, and they received feedback about their complaint. Staff knew how to handle complaints appropriately and received feedback on the outcome of investigation of complaints and acted on the findings. Records showed that the service monitored the date complaints were received and responded to and the outcome of the complaint’s investigation.

Maternity complaints data showed the total number of complaints in last 6 months was 93. The complaints data showed that 44 complaints were partially or fully upheld. The data showed that 49 complaints had been resolved, and the remainder of the most recent complaints were in progress. People reported difficulties accessing care, including cancelled appointments, delays in induction of labour, and problems with call bells. Some felt emotionally unsupported, particularly around breastfeeding, and raised concerns about staff attitude and professionalism.

The hospital had taken steps to improve the elective caesarean section (ELCS) pathway in response to a high volume of maternal requests. Between January and October 2025, there were 1,312 ELCS procedures booked. Of these, 269 women had their planned date changed due to factors including early delivery, clinical safety risks, capacity constraints, and 199 cases because of maternal request. To manage increased demand, 155 additional weekend slots were created.

From June 2025, the service introduced the ‘DrDoctor’ system to strengthen communication and planning of high-risk births. Women received a text message with a provisional date range based on obstetric referral and risk assessment, with the final date confirmed two weeks prior to the procedure.

The service made sure that people could access support, care and treatment when they needed it most of the time. However, due to the high volume of women accessing care we found long delays in some areas like induction of labour.

Equity in access was not always equal to the needs of women. For example, antenatal obstetric staff worked across various areas, which created lengthy wait times due to a backlog of medical reviews during periods of high capacity.

The service worked hard to understand the needs of the local population, but due to the volume of women accessing the service from across Oxfordshire and neighbouring boroughs staff were not always able to deliver care within safe times frames.

Pathology services within the hospital were unpredictable due to high volumes of attendances. Waiting times for blood results were available from 45 minutes to 4 hours. The inspection team found that some patients waited all day for reviews and investigation results. During the inspection we observed 2 women left the maternity day assessment unit before their care plans had been updated.

Obstetric cover was not always adequate day and night. Women attended the maternity assessment unit for triage, but they were not always seen in timeframes aligned to national recommendations which set a target for triage by a midwife within 15 minutes. Due to the high volume of women attending the unit we saw that only 36% of women were triaged within 15 minutes.

Staff planned for patients’ discharge, including liaison with external stakeholders. However, Learning from Patient Safety Events (LfPSE) data showed reported gaps in the process. For example, missing documentation and missed referrals to the community midwifery teams.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support, and treatment in response to this.

Staff within the service and the wider organisation promoted a culture in which the people using the service felt empowered to give their views. The service provided padlets in all areas so that people could provide feedback. The trust’s website included a ‘listen and translate’ application which was available in common languages to help non-English people understand and access services.

Women were asked to state their language requirements at the first point of contact so that the booking team could arrange interpreters for face-to-face assessments if required.

The provider had undertaken equality impact assessments of their policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage. Managers used the perinatal mortality review tool (PMRT) to look at ethnicity when reviewing incidents to identify comorbidities associated with ethnicity like blood type.

Leaders developed strategies based on the local population to help people engage with services. For example, strengthening services at community level for people from vulnerable groups, providing telephone SIM cards for people in poverty, improving interpreting services to meet the needs of the local population.

Leaders introduced healthcare passports so that women could contribute their history to care planning and strengthened learning disability care pathways for pregnant women.

Staff and volunteers collected baby clothing and made this available for families in poverty.

Leaders developed trust wide mandatory equality, diversity, inclusion and human rights (EDI) training. Records confirmed staff completed this.

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.