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

We looked for evidence that the service met people’s needs. 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 Responsive.

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

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

The service demonstrated a commitment to supporting parents and promoting safe care through accessible information and inclusive practices. Posters displayed QR codes linking to guidance on car seat safety, enabling families to access reliable advice to support safe discharge planning. Twin cots were available on the unit, supporting families with multiple births to remain together where appropriate.

The service worked closely with maternity colleagues, including an equality, diversity and inclusion (EDI) midwife, to ensure care was accessible and responsive to the needs of diverse populations. Interpreter services were readily available, supported by three dedicated translation phones to facilitate timely communication with families whose first language was not English. The Maternity and Neonatal Voices Partnership (MNVP), which included representation from diverse backgrounds, was actively involved in assessing the service, including completing a ‘15 Steps Challenge’ from a service user perspective.

Leaders were also reviewing the physical environment to ensure it met the needs of all families. This included a physical disability review of the ward, considering the needs of postnatal babies, including those recovering from caesarean sections, for example assessing door accessibility and ease of movement around the unit. The shared decision-making team also reviewed the environment from a parent perspective and used social media, including an Instagram page, to engage and communicate with families.

The unit promoted a family-centred approach. There were no restrictions on visiting, and there were no designated quiet or protected times for procedures. Lighting on the NICU was kept low to support a calm environment and could be adjusted at individual bed spaces depending on clinical need. Wi-Fi access was readily available, with passwords clearly displayed, enabling families to remain connected during what could be prolonged stays on the unit.

We scored the service as 3. The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities.

The service had facilities and processes to support families experiencing bereavement. A dedicated bereavement suite was available, which included a cold cot to allow families additional time with their baby in a private area. At the time of inspection, the local hospital charity was funding refurbishment works to further improve the bereavement facilities. The service was also in the process of recruiting a Band 7 bereavement lead to strengthen leadership, coordination and support for families and staff.

Staff used a discreet system to maintain privacy and dignity when a baby passed on the unit. Staff placed a candle outside the bereavement suite to sensitively indicate when a bereavement had occurred. There was also a separate exit available, allowing families to leave the unit privately when going to the mortuary.

Staff demonstrated a compassionate approach to memory-making. They offered hand and foot prints, photography and memory boxes in partnership with external organisations. This service had an average turnaround time of 24 hours for photographs. These practices supported families during extremely difficult circumstances and reflected thoughtful, person-centred care.

There was protected mealtimes, ensuring that babies’ care was not unnecessarily interrupted and supported a calm and structured environment for both babies and families.

We scored the service as 3. The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The service provided accessible and appropriate information to support parents and families. All three units offered a wide range of information leaflets covering key topics such as the benefits of skin-to-skin care, the use of donated breast milk, medical terminology, tube feeding and support for siblings. Information was available in different formats, including translated versions, large print and braille, to meet the diverse needs of families.

The trust had implemented Martha’s Rule, and staff demonstrated a good understanding of its purpose and how to support families to escalate concerns if required. This ensured parents and carers were empowered to raise concerns about their baby’s condition.

Each unit displayed a ‘Quality, Safety and Patient Feedback’ board. These boards provided clear and accessible information for parents and visitors, including learning from incidents, infection prevention and control audit results, and planned versus actual staffing levels. They also included a ‘You said, we did’ section and highlighted the unit’s top risks. This approach supported openness, transparency and engagement with families.

Staff understood their responsibilities in maintaining confidentiality and protecting personal information. All staff had completed data protection training. During the inspection, we observed that care records, medication charts and electronic systems were used in a way that maintained privacy. Computer screens were appropriately locked and password protected, and confidential information was stored securely.

We scored the service as 3. The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support.

Feedback and complaints were managed collaboratively, particularly where concerns related to both neonatal and maternity services. A monthly triangulation and learning committee reviewed themes and shared learning across services to drive improvements.

We viewed four complaints and noted they were responded to in line with policy. There was evidence of learning, and the trusts responses were sympathetic to the complainant. The trust acknowledged where errors had been made and responses gave clear information regarding next steps.

The service demonstrated that feedback led to meaningful change. For example, concerns and complaints about a lack of suitable seating for parents, impacting their ability to undertake skin-to-skin care and express milk, resulted in the purchase of 48 new cot-side chairs. Previously, chairs were not part of a rolling replacement programme and were moved between departments, making them difficult to track and maintain. In response, a repair and replacement programme was introduced, with chairs now colour-coded and individually identified to ensure effective asset management. Further improvements were planned, with additional chairs for high dependency and low dependency areas scheduled for delivery.

The service used a range of feedback mechanisms. “Say on the Day” provided a weekly reviewed, anonymous electronic platform for parents and staff to share real-time feedback, covering both practical and emotional experiences. This enabled timely responses—for example, adjustments to the environment such as installing blinds in staff areas where temperatures were reported as too high.

Friends and Family Test (FFT) data was reviewed monthly, and feedback was clearly displayed across the unit. Posters encouraged families to share their experiences via QR codes, email, or telephone, making the process accessible.

Visible “You said, we did” displays demonstrated how feedback informed improvements. Examples included enhanced seating provision, the introduction of “snack packs” offering accessible healthy food options, and clear communication that families could request hot meals if needed.

We also observed informal feedback opportunities, such as a dedicated whiteboard where families could share comments, suggestions, and experiences. Families spoke positively about this, describing it as a meaningful way to express their thoughts.

We scored the service as 3. The evidence showed a good standard. The service made sure that people could access the care, support and treatment they needed when they needed it.

There were established operational processes to support patient flow. Elective planning meetings considered capacity, admissions, discharges, and step-down arrangements, with input from bed managers and the designated “Bronze” lead. During periods of increased demand, such as winter, the service used additional forums, including weekday “winter flow” meetings and twice-weekly children’s operational calls. These meetings reviewed pressures such as seasonal illness, bed capacity, and outliers, and involved multidisciplinary teams including discharge coordinators and hospital-at-home services to support timely movement of babies where appropriate.

The service had a discharge outreach team that supported babies transitioning home, including those requiring ongoing care such as oxygen therapy or tube feeding. Parents received training prior to discharge, delivered by the outreach and complex discharge team, to ensure they felt confident in managing their baby’s care at home.

Innovative approaches, such as the integrated care NEST team, supported parents to be more involved in their baby’s care. This included improvements to admission information and the introduction of tools such as parent and baby “passports” to track progress and encourage engagement.

Staff working on the LDU raised concerns regarding discharge processes. They reported delays in completing final medical checks following a change from an Advanced Neonatal Practitioner-led model to a remote consultant-led oversight model. Staff told us there was no clearly defined or consistently implemented pathway setting out roles and responsibilities within the discharge process. This lack of clarity impacted staff confidence and efficiency. For example, nursery nurses reported undertaking elements of the discharge process, including parent education (such as oxygen management and safety checks), while also being required to sign discharge documentation, leading to uncertainty about accountability and scope of practice. Staff on the LDU also raised concerns to us regarding the accuracy and oversight of discharge documentation. Discharge summaries were sometimes completed and discussed with parents prior to final consultant sign-off, and consultants signing these were not always familiar with the individual baby’s care, increasing the risk of errors or inconsistencies. Although staff described perceived delays, we did not find evidence that this change had resulted in an increase in discharge delays or errors on the LDU at the time of inspection. However, staff were not consistently recording or escalating these concerns through formal reporting systems. This limited leaders’ oversight of potential delays and meant opportunities to identify and address process issues may have been missed. This was another example where leaders needed to strengthen communication and culture within the LDU.

We scored the service as 3. The evidence showed a good standard. Staff and leaders actively listened to families to ensure there was no inequality in experience or outcomes.

There was a dedicated parent room equipped with a sofa, kitchen facilities, lockers and a sleep pod. This area was supported by the hospital charity, which also facilitated weekly parent support sessions. The unit provided an emergency/procedure room and three ‘homeward bound’ rooms for babies nearing discharge. These rooms were also used as a second bereavement suite, enabling families to spend meaningful time with their baby where needed. Each room was secure with code-lock access.

The unit had three expressing rooms available to support mothers wishing to breastfeed or express milk, recognising that privacy could not always be maintained at the cot side. There were plans to refurbish these facilities to further improve the experience for mothers. Outcomes relating to supporting mothers to provide breast milk had significantly improved, with initiation within the expected timeframe increasing from 57% in 2022 to 92% at the time of inspection.

Accommodation for parents was well supported. There were four parent bedrooms on the unit, and families also had access to Ronald McDonald House on-site, shared with the children’s hospital. Additional resources, including portable phone chargers and a small selection of books and toys, were available to improve the experience for families during their stay. The service also supported families experiencing longer admissions through access to parking permits, helping to reduce financial burden.

Staff were considerate of parents’ involvement in their baby’s care. Parents were informed when their baby was being moved between bed spaces or bays. Where parents wished to be present during transfers, staff accommodated this wherever possible.

Clinical responsiveness was supported through effective transport arrangements. The service had access to its own neonatal transport provision, including ambulance support for transfers home or to other services. Performance data showed that 97% of journeys met the service’s target response time, with mobilisation within one hour.

Audit data demonstrated that the service was meeting expected standards for clinical care. The most recent intraventricular haemorrhage (IVH) audit confirmed compliance with relevant guidelines and timeframes.

We scored the service as 3. The evidence showed a good standard. The service had plans for developing and improving the service.

The service was focused on continuing to implement the findings from the external review.

We reviewed the unit’s annual oversight report, which clearly set out priorities for the coming year. These included improving infant feeding and strengthening parent–infant relationships, with a particular focus on achieving UNICEF Baby Friendly Initiative (BFI) re-accreditation. There was also plans to enhance the environment for families, including increasing the availability of comfortable seating on the unit.

The service had also identified workforce development as a key priority. This included supporting an increase in the number of nurses with Qualified in Specialty (QIS) status, as outlined in the staffing section of the report. In addition, leaders were reviewing medical staffing arrangements, with plans to recruit additional resident medical staff to strengthen overnight cover. These actions demonstrated a forward-looking approach to service improvement, aligned with both patient/carer experience and workforce sustainability.