William Harvey 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

Leaders recognised the maternity service had been under considerable public scrutiny in recent years and they had supported staff effectively and with compassion throughout a significant journey of improvement. All staff were fully committed to the improvement work and were proud of what they had achieved together. Leaders and staff had a shared vision and culture based on listening, learning and trust.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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 vision and strategy for the maternity unit was aligned with the national vision to deliver a safer, kinder, more personalised service.

‘Empowering our staff to work with women and their families to make a difference in outcomes for maternity and neonatal care’

These were also aligned with the trust values of Caring, Safe, Respect and Making a Difference.

Leaders had developed the vision and strategy in consultation with staff of all grades and the Maternity and Neonatal Improvement Programme. Staff we spoke with could describe the vision and strategy for the service. Staff told us that improving the culture of the department was the golden thread which ran through the vision and strategy of the department. The strategy had 6 workstreams as part of the 3-year improvement plan – Positive Culture, Safety Culture, Clinical Pathways, Listening, Workforce and Infrastructure.

The maternity unit had been through a very difficult period where the culture was poor, and the pressure and scrutiny of the staff and unit had been very intense. Staff told us the new leadership team worked tirelessly to improve outcomes for women and babies, improve the culture and make the service somewhere desirable to work.

The service had exceptionally 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 maternity service had been under the intensive element of the Maternity Support Programme since February 2024 and moved from intensive element to sustainability element. A plan of exit was in progress and we were told (during the factual accuracy process) that this had been approved by Board.

Leaders recognised staff were hard-working and committed, but they were under a lot of pressure. Leaders were compassionate and it was clear staff well-being was a priority.

The service was part of the maternity and women’s directorate and was led by a director of midwifery, consultant obstetrician and operational lead who led maternity services for the whole trust. The triumvirate were supported by a deputy director of midwifery and a head of midwifery on each hospital site. The senior leadership team felt the executive team understood and supported their vision for the maternity service.

Staff told us the change in leadership had improved their voice across the service and they felt valued and included. The senior leadership team felt the executive team understood and supported their vision for the maternity service.

The director and deputy director of midwifery were consistently described as visible, inclusive and responsive. They spent a lot of time in clinical areas, speaking with families and staff and were seen as clinically credible. They made it a priority to meet with bereaved parents and offered them home visits.

Leaders were visible in the service for women and staff. Leaders were welcomed and valued by staff who told us they were well supported by their line managers, ward managers and matrons. All leaders worked clinically with the maternity unit team on a regular basis. This had improved communication and trust in the leadership team.

There had been an increase in pastoral support through the corporate wellbeing team, pastoral care team and mental health first-aiders. There was a large team of professional midwifery advocates (PMA) who supported staff across the hospitals and community. They provided restorative supervision, ran staff support groups, supported with revalidation, writing statements and more.

Leaders ran listening events so staff felt heard and could raise concerns and ideas for improvement. They had invested heavily in staff wellbeing and had rewarded staff and acknowledged their achievements. There was an established staff recognition reward programmed at local and national level and increased opportunities for external courses to support staff development.

Leaders were completing restorative work with families who were involved in the Kirkup investigation. They were working in partnership with an external team to learn and better support families who had historically experienced horrific times at the service. Leaders also wanted to better understand the impact of this on staff.

The NHS Staff Survey results for 2023 showed a positive upward trend across all people promises and both domains of engagement and morale. Actions from the survey were included in improvement workstreams for positive culture and workforce

Leaders worked alongside the trust’s staff engagement team to increase the response rate for the 2024 survey, and this had increased from 138 responses in 2023 to 246 in 2024. The results had not been published at the time of writing the report but following publication leaders planned to extract the data and include it in relevant workstreams of their improvement work. This ensured feedback was acted on through a structured platform and approach.Leaders used the team engagement dashboard to identify areas of success and areas for improvement with clinical teams.

The maternity safety champion and non-executive director supported services to monitor safety and outcomes. Both were highly visible to the service and demonstrated a strong understanding of the challenges and opportunities the service faced. They completed walk-arounds of the department on a regular basis and often at weekends and evenings to ensure they had a rounded experience of the service. The chief executive officer had recently spent a morning observing elective caesarean sections.

The trust valued leaders and worked to develop the next generation of leaders in the organisation. For example, there was a senior mentorship programme. This involved a Band 6 member of staff shadowing a senior leader to gain experience and share learning.

There was a strong sense of pride in the service, hospital and community from our discussions with staff, Maternity and Neonatal Voices Partnership (MNVP), women and families.

The service celebrated staff and team success and supported good practice through meetings, maternity newsletters, a Broadcast Communication Channel and team away days.The service made a point of including student midwives from the local university, this investment in the relationship with students led to most students taking up offers of work within the department once qualified.

One member of staff received a star of the month award and a small gift by leaders. This was a monthly celebration to help ensure staff felt valued. There were many more examples of how leaders showed they cared. For example, the professional midwifery advocates (PMAs) had developed an electronic database of information and resources for some staff that were hard of hearing and provided additional support.

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

Staff felt supported, respected and valued. Staff we spoke with during the inspection told us they felt able to speak with leaders about difficult issues and when things went wrong. Staff told us when practice needed to be improved there was a no blame culture and they were supported to learn and develop within their roles.

The trust had a freedom to speak up strategy but the posts within the maternity department had yet to filled. Leaders told us this was an urgent priority for the organisation, and we saw this reflected on the risk register for monitoring and oversight.

The service valued diversity in their workforce. Staff worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. Staff we spoke with on the inspection described a supportive and improved approach to leadership within the maternity department.

The service recruited a large cohort of internationally educated midwives (IEM) and through restorative supervision leaders learnt that the IEM were concerned about a closed culture on the unit, especially when working with agency midwives.

Leaders responded to this information swiftly and held a meeting with the IEM and gave them the opportunity to raise any concerns individually.

Leaders arranged a cultural exchange event and invited all the hospital, community and agency midwives to bring their own food wear traditional clothes and spend quality time together. Midwives from different countries shared music, stories and funny anecdotes. We heard very positive feedback about this event, which helped to build bridges and understand and respect cultural values and celebrate difference.

Leaders continued to have regular meetings with IEM to help ensure positive relationships were maintained and support was tailored to meet the needs of IEM. For example, they were offered English and maths lessons and we spoke with 3 IEM who told us they felt well supported and described the culture as inclusive.

The service had clear responsibilities, roles, systems of accountability and good governance. Staff used these to manage and deliver good quality, sustainable care, treatment and support. Staff acted on information about risk, performance and outcomes, and shared this securely with others when appropriate.

There was a clearly defined governance structure which detailed the governance oversight and accountability from the service level to the trust board. Leaders operated an effective governance process and monitored key safety and performance metrics through a comprehensive structure of governance meetings.

Staff at all levels could describe their role in the governance process and had regular opportunities to meet discuss and learn from the performance of the service. They knew how to escalate issues to the clinical governance team and divisional management team.

Governance meeting agendas included discussion around all aspects of governance and oversight of the data. Meetings included discussions related to performance, audits and training, feedback, guidelines and research. During the inspection we reviewed several audits including; MEWS (maternity early warning score), NEWS (national early warning score) and LocSSIP (Local Safety Standards for Invasive Procedures) and found they were completed and discussed during governance meeting.

The service provided assurance to the trust board through their Maternity and Neonatal Assurance Group (MNAG) and reported directly to the trust board through the quality and safety committee. Maternity and Neonatal Assurance Group was chaired by the chief nurse which provided executive oversight and the non-executive director who acted as the safety champion for maternity also attended these meetings.

Trust board minutes showed maternity items were regularly part of the agenda. Items included serious incidents, performance reports, performance data and Clinical Negligence Scheme for Trusts (CNST).

Several platforms were used for sharing information with the maternity team, which included a closed Facebook group, encrypted WhatsApp chats, and a weekly wrap-up message by voice note (which was also shared via email). A ‘Message of the Week’ was used for sharing key learning from the patient safety team; these were also shared during ward-based handovers and huddles. In addition, the learning bulletins were another format for shared learning.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. Staff share information and learning with partners and collaborate for improvement.

Leaders worked with the local Maternity and Neonatal Voices Partnership (MNVP) to contribute to decisions about care in maternity services. Service leaders had built genuinely meaningful relationships with the local MNVP and encouraged them to attend meetings on site. The MNVP were passionate about their role and had regular contact with leaders to make a difference to services provided to women. The MNVP also conducted regular walk-arounds of the maternity unit speak to staff, women about their experiences and how things could be improved.

The MNVP engaged with charities and organisations to address inequalities and improve the experience and outcomes of women and families. The maternity service had developed a link with the local asylum-seeking women who were pregnant. As a result of this we were told services had been redesigned so the blood test result followed the woman wherever she was relocated in the country, so the antenatal team caring for the woman or birthing person had up-to date clinical results.

They contributed to the design of user information leaflets, information packs, the maternity website, guidelines, outreach work and much more.

The service focused on continuous learning, innovation and improvement across the organisation and local system. Staff encouraged creative ways of delivering equality of experience, outcome and quality of life for people and actively contributed to safe, effective practice and research.

All staff we met were committed to learning and improving services. They had a good understanding of quality improvement tools and had the skills to use them. Leaders encouraged innovation and research.

There was a maternity improvement and transformation manager in post. They described their pride in the improvement journey and how they had worked collaboratively with all staff to support the development of the 6 work streams.

The service prioritised hearing the voices of women who gave birth in the unit. Every woman received a call 6 weeks after the birth of their baby and were asked for detailed feedback on their experience. Over 12,000 women had provided feedback and just over 90% of women had confirmed they would be happy to have another baby at the hospital.

We saw and heard of many improvements that had been made in response to this feedback. For example, a family bathroom had been created on the postnatal ward for partners to use. A welcome booklet had been created for the labour ward, soft close bins had been purchased to reduce the sounds overnight and the buzzer system had been improved.

The patient experience midwives had supported a career progression day for Band 5 and 6 midwives and ran a career café day which offered drop-in. There was a plan to repeat this in February 2025, in response to positive feedback.

The matron for education and quality had received the trust award for safety and quality and specifically in relation to the PROMPT programme multi-disciplinary working.

The bereavement midwife and team had been nominated for and won several awards including ‘Special Recognition – Bereavement Midwife of the Year’ and ‘Specialist Midwife of the Year ‘.