John Radcliffe Hospital

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect. This is the first inspection of the neonatal service. This key question has been rated good.

We have not awarded this service a score for Caring.

Find out about when we will not publish a key question score and what we look at when we assess Caring.

We scored the service as 3. The evidence showed a good standard. The service always treated people with kindness, empathy, and compassion. However, some physical barriers impacted privacy and dignity.

During ward rounds, staff spoke in quiet, low tones to minimise the risk of sensitive information being overheard by other families. However, this was more difficult to maintain in the high dependency unit due to space constraints. Staff told us they mitigated this by asking families to leave the clinical area during ward rounds to help preserve confidentiality.

Feedback from families was overwhelmingly positive. Comments included, “You’re an amazing team, your hard work is really noted,” and “Thank you so much everyone for the outstanding care you are providing. Your hard work and excellence is so much appreciated.”

We also observed numerous thank you cards displayed across all three units. Messages included, “A card cannot express the gratefulness we feel towards you.You are the best in what you do,” and “The eight weeks we spent here were very tough, but knowing he was in your care allowed us to get through it.” These reflected the compassionate and supportive care provided by staff.

However, we observed some physical constraints in the HDU that impacted women’s dignity. Whilst we were on-site, a mother had no option but to breastfeed in the open ward as there was insufficient room to put a screen around her baby’s cot.

We scored the service as 3. The evidence showed a good standard. 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.

We observed staff supporting women and families with positioning to promote effective breast-feeding, demonstrating a baby-centred approach and a good understanding of infant feeding practices.

Women and families were supported to stay overnight in a side room prior to discharge, without direct nursing input. This enabled them to gain confidence in caring for their baby independently, while still having access to staff if required. Families told us this approach was reassuring and could be repeated where additional support was needed, ensuring they felt fully prepared for discharge.

We also observed staff actively promoting and supporting kangaroo care (skin-to-skin contact). This involved supporting parents to hold their baby against their bare chest, usually under a blanket. Staff demonstrated a clear understanding of the importance of this practice and encouraged families to participate. This supported bonding, promoted infant stability and reflected care delivered in line with recognised national best practice.

We scored the service as 3. The evidence showed a good standard. The service promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment and well being.

The service had recently introduced a Friends and Family Test (FFT) specific to neonatal services; however, uptake remained low. Leaders recognised this as an area for improvement and were taking steps to increase engagement. The discharge and outreach team, as well as the service’s dedicated children’s transport team, had their own feedback processes, which were well utilised and provided valuable insight into baby and family experiences.

Staff were aware of the need to improve awareness and promotion of the FFT among parents. Ward clerks, who were present on-site 24 hours a day and already supported the transport service, were being identified to take a lead role in increasing parent awareness and encouraging participation. Feedback from the patient experience team highlighted that parents, particularly on the neonatal unit, preferred to be informed about the FFT through direct conversation rather than relying on posters or QR codes. There were plans to embed this approach into routine practice.

The service had established a shared decision-making council, which included staff from a range of professional backgrounds to contribute ideas for service improvement. While parents were not directly represented on the council, staff used feedback from families to inform discussions and decision-making. An example of this was a current review focused on refurbishing parent accommodation, demonstrating the service’s commitment to improving the experience of families using the unit.

We scored the service as 3. The evidence showed a good standard. The service listened to and understood people’s needs, views, and wishes. Staff responded to people’s needs and acted to minimise any discomfort, concern, or distress.

Families told us they were meaningfully involved in discussions about their baby’s care, including treatment options and next steps. We observed this on the unit, where staff communicated clearly and compassionately with parents, ensuring they understood their baby’s condition and care plan.

Where a baby was identified as having life-limiting conditions, staff involved parents and families in sensitive and timely discussions about treatment decisions, including the potential withdrawal or withholding of treatment. Families were supported to make informed choices about the place of care and death. Options included remaining on the unit, transfer to a local children’s hospice, or being supported to care for their baby at home. Staff demonstrated compassion and respect in these situations, ensuring care was individualised and aligned with family wishes.

The unit’s psychology team were available to support all families during their time on-site. Staff had good understanding of the signs and symptoms and events that would trigger a referral to the psychology team.

We scored the service as 2. The evidence showed some shortfalls. The service did not always provide facilities that promoted the well being of their staff.

Staff facilities were not always sufficient to provide restful breaks. The service had two staff rooms; however, neither provided a dedicated or sufficient space. They were cramped and had multiple uses. Therefore, there was no place for staff to have restful, recuperative breaks during their shift. There were plans to convert an unused parent room into a larger staff room. In addition, one of the smaller staff rooms was being repurposed into a private family support room, as it was located away from main thoroughfares to ensure confidentiality and privacy.

Staff described increased emotional pressure linked to external scrutiny of the trust, including negative attention on social media and findings from external agency reviews. Due to the close working relationship between neonatal and maternity services, neonatal staff had also been affected by wider public and media commentary. Leaders ensured a neonatal psychology team was available to support staff. Senior leaders, including matrons and medical leads, also met fortnightly to review and address staff wellbeing concerns, particularly following media coverage or high-profile events. Whilst these initiatives were in place, staff told us that the heightened level of scrutiny during this period made it a difficult time to work at the trust.

The service had established a range of support mechanisms to promote staff well being. For example, there was a Trauma Risk Management (TRiM) and a nurse advocate peer-to-peer support system, who provided emotional support following distressing or traumatic incidents. Staff were identified through the incident reporting system, and where cases met TRiM criteria, they were offered targeted support. Psychology colleagues were also involved in providing additional support following traumatic events. The unit benefitted from its own dedicated psychology team, primarily focused on supporting families, but also available to support staff where needed.

The service also worked collaboratively with the wider trust well being team to ensure staff had access to appropriate resources. Senior leaders demonstrated awareness of the need to acknowledge the wider challenges facing the trust, while supporting staff to remain focused and resilient in delivering care. Overall, there was a proactive and compassionate approach to supporting staff well being within a challenging working environment.