John Radcliffe Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. 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 Effective.

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

We scored the service as 2. The evidence showed some shortfalls as the service did not have full oversight of the risks associated with having numerous record systems.

The service was using a mix of digital and paper-based records system and was the last area in the trust to fully transition to digital records. Leaders were aware of the risks associated with this and had implemented mitigation measures, including regular audits of paper records to ensure documentation remained complete, accurate and accessible. A medical digital lead provided oversight of digital risk, and was supported by a seconded nursing lead to strengthen clinical engagement and governance. The community team was fully digital, enabling better integration with wider NHS systems.

There was three record systems. Information relating to surgical interventions was stored on a separate system, which not all relevant staff, including surgeons, could access. Similarly, neonatal staff did not have access to antenatal records. As a result, staff relied on verbal communication and coordination between teams. Babies requiring surgical input could have up to three separate sets of records which were not interoperable, increasing the risk of fragmented information and potential delays in accessing key clinical details.

Ward clerks played a key role in managing and locating records across the service. We observed they spent significant time physically retrieving, tracking and maintaining paper notes across multiple wards. Ward clerks told us they submitted incident reports when records were missing; however, due to the frequency of these occurrences, not all instances were formally reported. This meant that escalation was often informal, and the full extent of risks associated with managing multiple record systems may not have been consistently visible to, or fully understood by, senior leaders. Despite this, ward clerks demonstrated a proactive and diligent approach, which helped to reduce the potential for error and maintain continuity of care within the limitations of the system. The service was in breach of a regulation related to governance due to the lack of oversight of the risks related to the three record systems by the senior leadership team.

Despite these challenges, we found baby records were generally well maintained. We reviewed 10 care plans for babies recently admitted to the unit. Records reflected care in line with best practice, including appropriate monitoring of weight, temperature, and fluid input and output. Staff demonstrated a clear understanding of escalation processes where concerns were identified. All paper records were clearly labelled with baby identification stickers on each page, reducing the risk of mis-identification should pages become separated.

Pain was consistently assessed using recognised national tools, and staff responded promptly when babies were identified as being in pain. There was evidence that pain relief was evaluated to ensure it was effective, demonstrating a responsive and child-centred approach to care.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

There were clear policies and procedures available on the trust intranet, which staff confirmed they could easily access and use to guide their practice. Care and treatment were delivered in line with national guidance and best practice, including recommendations from the National Institute for Health and Care Excellence (NICE).

National standards, including those set by the National Neonatal Audit Programme (NNAP), were embedded into daily practice and routinely monitored to ensure compliance and continuous improvement. The service was in the process of strengthening adherence to the preterm infant brain injury care bundle; a recognised set of evidence-based interventions aimed at reducing brain injury and improving long-term outcomes for premature babies.

The service followed a catalogue of local audits to monitor performance; this was overseen by the matrons and was set by the trust. We viewed 10 local audits and noted they all passed standards and expectations.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

We observed multidisciplinary team (MDT) meetings on both the NICU and HDU. These were well structured, comprehensive and covered all aspects of babies’ care and treatment. Meetings were attended by a range of professionals, including medical staff and therapists, and all attendees were encouraged to contribute. Roles, responsibilities and next steps were clearly defined, supporting coordinated and effective care delivery.

The service demonstrated strong collaborative working across the wider division. Neonatal, children and young people’s services sit in one division and maternity services sit in a separate division, with clear shared governance meetings. This supported a good understanding of pressures, flow and risks across departments and enabled joined-up working.

Information sharing was effective and timely, supported through email communication and structured handovers. The service maintained strong links with maternity and fetal medicine teams, who proactively highlighted any concerns to ensure continuity of care.

The service also worked closely with the local children’s hospice. Senior leaders met regularly with the hospice perinatal team to discuss potential cases and referrals. Hospice staff were invited onto the unit to introduce themselves to families, which helped parents understand the support available and promoted continuity of care across services.

However, staff on the LDU told us that while a weekly MDT meeting took place, nursery nurses often found it difficult to attend due to competing clinical priorities. In addition, while coordinators on NICU and HDU were responsible for updating handovers, this responsibility sat with nursery nurses on the LDU. Staff told us they found it challenging to complete this alongside their clinical duties, which had the potential to impact consistency in communication and oversight. However, we found no evidence of poor care or incidents related to these concerns.

We scored the service as 3. The evidence showed a good standard. The service supported families to manage their and their baby's health and wellbeing to maximise choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

The service promoted health information and parental awareness through a range of visible resources across the unit. Posters highlighted the Baby Check app, which parents could download to help assess whether their baby required medical attention based on responses to a structured set of questions. This supported parents to feel more confident in recognising signs of illness.

We also observed posters displaying the signs and symptoms of infection in newborn and premature babies, helping to reinforce key safety messages for families.

The Blossom Ward information board included a dedicated section on the importance of skin-to-skin (kangaroo) care for newborn and premature babies. This promoted understanding of the benefits of bonding, temperature regulation and overall infant wellbeing.

The service was further supported by the Oxford Milk Bank, located within the NICU and affiliated with the UK Association for Milk Banking (UKAMB). The milk bank provided donor human milk to babies within the Special Care Baby Unit, supporting optimal nutrition and care for vulnerable infants.

We scored the service as 3. The evidence showed a good standard. The service ensured that outcomes were positive and consistent, and met both clinical expectations and the expectations of patients and families.

The service monitored performance through a range of audits and outcome measures.

We noted the service demonstrated sustained improvement in several key areas. For example, the proportion of babies developing late-onset infection reduced from 8.2% in 2022 to 7.8% in 2024, the most recent validated data available at the time of the inspection. Compliance with retinopathy of prematurity screening also improved, increasing from 66% in 2022 to 92%, indicating better adherence to national standards.

Benchmarking data showed the service performed well within its network and was ranked within the top six providers for key clinical outcomes, including necrotising enterocolitis, mortality, intraventricular haemorrhage (IVH), bronchopulmonary dysplasia and cystic periventricular leukomalacia. This reflected a strong focus on delivering evidence-based and effective care.

Performance in avoiding term admissions to the neonatal unit (the placement of a full-term baby born at or after 37 weeks of pregnancy, into neonatal care) was better than the national target, with a rate of 4.1% compared to the 5% benchmark, demonstrating effective management of babies within maternity services where appropriate.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff demonstrated a clear understanding of their roles and responsibilities in seeking, recording, and documenting consent. They were also knowledgeable about decision-making in a child’s best interests and how to support families where a parent may lack capacity.

Families were actively involved in care planning and decision-making. They were routinely included in ward rounds, which helped to improve their understanding of their baby’s condition, proposed treatments, and any procedures.

Consent processes were well embedded in practice. Staff obtained and documented consent appropriately, including written, verbal, and implied consent depending on the procedure. More invasive procedures, such as surgery, required formal written consent, while less invasive procedures (for example, lumbar puncture) were usually supported by verbal consent, which was clearly documented in the medical records. Staff ensured that risks, benefits, and alternatives were explained to parents before consent was obtained.

Consent practices were regularly audited, and results were recorded on the trust’s electronic reporting system. This enabled oversight at directorate, divisional, and executive levels, supporting ongoing monitoring and improvement.

Procedure-specific guidelines had recently been updated to clearly outline consent requirements for each clinical pathway, ensuring consistency in practice. Staff also ensured that both the cot-side nurse and the family were fully aware of any planned procedures.

Additional support was available to families where needed. The psychology team provided support to help parents understand complex information and make informed decisions about their baby’s care.