The Tunbridge Wells Hospital at Pembury

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

We assessed all 7 quality statements for this key question. Leaders had strengthened the governance team and improved their oversight, monitoring and management of risk. However, they were still in breach of the legal regulation for governance. This was because improvements needed to continue, become business-as-usual and the voice and experience of women, birthing people and families needed to be weaved throughout the improvement work.

The leadership style and culture had improved. Leaders were compassionate, inclusive and responsive and all staff were committed and passionate about their improvement journey.

Leaders told us they valued diversity in their workforce and that they worked towards an inclusive and fair culture. Staff felt encouraged to speak up and told us they were supported and treated with compassion when they had raised concerns. Staff told us senior leads and matrons were visible, approachable and responsive and described the leadership style as inclusive.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Maternity services were part of the women’s and children’s division and included a monthly people’s committee to support staff. The service had been through a difficult period since the publication of our last maternity report. Leaders told us the scrutiny of the staff and unit had felt intense. Staff told us all teams had worked tirelessly to improve outcomes for women and babies, and they felt leaders did their best to make the service somewhere desirable to work.

Maternity services were part of the women’s and children’s division and included a monthly people’s committee to support staff. The service had been through a difficult period since the publication of our last maternity report. Leaders told us the scrutiny of the staff and unit had felt intense. Staff told us all teams had worked tirelessly to improve outcomes for women and babies, and they felt leaders did their best to make the service somewhere desirable to work.

Staff felt respected, supported, and valued. They were focused on the needs of women and birthing people and were happy working for the trust. The head of midwifery (HOM) had been in post for the last 12 months and was highly respected by the staff we spoke to. Staff told us leaders and matrons were visible, approachable and responsive. They felt well supported and described the leadership style as inclusive.

There had been an increase in pastoral support through the establishment of a pastoral care lead nurse, listening events with the chief nurse, established councils for student nurses and international midwives. There was an established staff recognition reward program at local and national level and increased opportunities for external courses to support staff development.

Staff received a ‘hot debrief’ following incidents and additional support through a professional midwifery advocate. There were a variety of options for additional support, for example they could self-refer to the psychology team, occupational therapy or the trust-wide counselling service.

Leaders facilitated regular engagements sessions with staff and used staff survey results to explore issues and discuss solutions and improvements. Engagements sessions were held with all staff groups including students and consultants. Leaders felt this was effective in fostering relationships.

Consultants told us they had all recently completed the Consultant Leadership Programme with an external facilitator. The programme was specifically designed to strengthen leadership skills and actively engage them in the planning, delivery and transformation of the service. They told us it was effective and enabled them to focus on the improvement work and matrons were also completing the head of nursing leadership programme.

The maternity service had a clear leadership structure, with the director of midwifery (DOM) reporting professionally to the chief nurse. The DOM worked alongside the clinical director of women and newborn services and managed the head of midwifery (HOM) who oversaw senior midwives.

Leaders had established a Maternity Improvement Group who met weekly, and this was chaired by the chief nurse. This group maintained oversight of quality improvement groups and leaders developed a comprehensive communication plan to share the vision and progress for the improvement work, and how staff could get involved as individuals or teams.

Midwifery staffing was challenging due to the vacancy factor, but this was proactively managed by leaders. A detailed assessment for workforce planning had been completed in June 2023 and an establishment review was completed every October. This reflected the trust’s Nursing and Midwifery Establishment Review Policy and Procedure.  

Recruitment and retention were a key focus for leaders. The service had an ongoing rolling recruitment programme to address potential vacancies as early as possible, an international recruitment programme for both midwifery and medical staff and they offered a 2-year conversion course for registered nurses to convert to midwifery.

 Leaders collected data from staff exit interviews and collated it into themes. We saw that lack of work/life balance was 1 of the main reasons staff cited for people leaving the service and leaders told us they offered flexible working options and focused on staff wellbeing.

Leaders told us they were completing a review of demand and capacity in recognition of the flow and capacity issues impacted by the increasing birth rate and more complicated pregnancies and births. The maternity service had a clear leadership structure, with the director of midwifery (DOM) and neonatal services reporting to the chief nurse. The DOM worked alongside the clinical director of women and newborn services and managed the head of midwifery (HOM) who oversaw senior midwives.

Midwifery staffing was challenging due to the vacancy factor, but this was proactively managed by leaders. A detailed assessment for workforce planning had been completed in June 2023 and an establishment review was completed every October. This reflected the trusts Nursing and Midwifery Establishment Review Policy and Procedure.  

Recruitment and retention were a key focus for leaders. The service had an ongoing rolling recruitment programme to address potential vacancies as early as possible, an international recruitment programme for both midwifery and medical staff and they offered a 2-year conversion course for registered nurses to convert to midwifery.

 Leaders collected data from staff exit interviews and collated it into themes. We saw that lack of work/life balance was 1 of the main reasons staff cited for people leaving the service and leaders told us they offered flexible working options and focused on staff wellbeing.

Leaders told us they were completing a review of demand and capacity in recognition of the flow and capacity issues impacted by the increasing birth rate and more complicated pregnancies and births.

Staff consistently told us their experience of speaking up was positive. They felt encouraged to speak up and told us they were supported and treated with compassion when they had raised concerns. Staff knew how to raise concerns and gave examples of how they had raised clinical concerns such as unsafe staffing and delayed transfers with labour ward coordinators and care flow coordinators. Staff told us they were responsive but felt confident to escalate if there was an occasion where they did not feel heard.

Staff were familiar with how to raise concerns and the range of options available. This included but was not limited to safety huddles, staff engagement sessions, listening events and access to a maternity safety champion or freedom to speak up guardian (FTSuG). Freedom to Speak Up Guardians, supported staff to speak up when they felt that unable to do so by other routes. Contact details for FTSuG were clearly displayed in all clinical areas and staff were familiar with their remit. We saw FTSuG attended key meeting such as the People Committee and monthly meetings had been established with the triumvirate to discuss any themes and trends.

Maternity safety champions completed regular walk-abouts in all areas of the maternity service. This was to engage with staff, gather their views and create a more open culture. Maternity safety champions gave us examples of concerns staff had raised with them and actions that had followed. For example, procuring additional equipment.

Maternity safety champions felt the culture had changed during the improvement work as staff were keener to be engaged and volunteer for opportunities. For example,16 staff members had expressed an interest in becoming a maternity safety champion.

In addition, the head of midwifery arranged a 1:1 session with all labour ward coordinators during November and December 2024. This was in response to feedback from students and to expand on their ongoing culture development work. We also spoke with 3 student midwives who were very positive about the learning culture and individual support they had received.

Leaders told us they valued diversity in their workforce and that they worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

There was a trust-wide equality, diversity and inclusion (EDI) strategy (2022 – 2026) which outlined the trust’s commitment to create a culture where staff could bring their authentic selves to work, be valued for their contribution and thrive in an environment free from discrimination. 

The maternity education team incorporated equality and inclusion throughout maternity training. Staff also attended mandatory training in equality, diversity and inclusion and compliance was 97.6% at the time of our assessment.

There was a live advert for a lead midwife in EDI. Leaders told us this appointment would be responsible for improving patient experience and health inequalities within their local maternity service.

The EDI champions attended the equality and oversight meetings for the trust and Local Maternity and Neonatal System. These meetings were focused on women and birthing people. They also attended trust wide staff network groups such as the Cultural and Ethnic Minorities Network, Disability Network and Neurodiversity support group which focused on staff inclusion.

We saw evidence that leaders considered the complexities for international midwives adapting to living and working in the UK. They had conversation with human resources and considered flexible options to support their transition. In addition, EDI data related to staff was shared with the maternity leadership team and the trust had an EDI Strategy and WRES and WDES action plans in response to data and survey responses.

eaders told us the governance team had been restructured, and key appointments had been recently appointed. During the factual accuracy response, leaders confirmed that the governance positions were now embedded, and the team were working effectively to support the right level of oversight. Staff understood their role and responsibilities and the maternity team had regular opportunities to meet, discuss and learn from the performance of the service.

Staff told us they were encouraged to report incidents, and they received feedback. However, we noted some incidents were not always reported. This implied it had not become 'business-as-usual’ although the maternity patient safety team also had a failsafe process to identify, through the maternity information system, several clinical outcomes which should trigger a report and ensure that the incident had been logged.

We saw a lack of audit to determine if improvements were effective although the process for reporting compliance, challenges and actions to drive improvements was recently reported to the Maternity Operational Forum and escalated through the maternity meeting structure (since August 2024). This had shown improvement in compliance and oversight.

Despite there not being any incidents relating to a retained swab in the last 3 years the maternity service was still not compliant with their swab count policy. Audit highlighted that documentation was a key issue. For example, the most recent audit (September 2024) to compliance for correct swab count proforma highlighted that only 68% of proformas were completed correctly and in full. Leaders told us they were engaging with staff to improve this documentation and ensure safe practice.

Documentation was also a factor regarding the oversight of delayed emergency caesarean sections and although the most recent documentation audit was completed in June 2024, it only included a sample of 15 and no actions were outlined. In addition, the data collection tool for the maternity record keeping clinical audit had not been developed until May 2025.

Documentation was also a factor regarding the oversight of delayed emergency caesarean sections and although the most recent documentation audit was completed in June 2024, it only included a sample of 15 and no actions were outlined. In addition, the data collection tool for the maternity record keeping clinical audit had not been developed until May 2025.

Risks were identified through quality and safety within the monthly risk and governance meetings. There were 12 open risks on the risk register and 4 were rated red.

The challenges opening the second obstetric theatre was recorded as a red rated risk since May 2016 as this could cause delayed emergency caesarean sections. However, detailed analysis of the c/s delays identified that access to a second theatre was not a leading contributor to delays or associated harm, and these emergencies were managed through internal escalation pathways and broader risk management processes. Consequently, the risk had been downgraded.

Delayed induction of labour had been recorded as a red rated risk since July 2022. A working group continued to monitor the rate of delays. Leaders told us the group also implemented a review of demand and capacity in maternity, which had led to a proposal for bed reconfiguration and several quality improvement measures to improve the flow through the department.

The service worked closely with the maternity and neonatal voice partnership (MNVP) to gain feedback from women and birthing people and leaders told us this fed into the development of a maternity strategy which commenced in September 2024. We were told a key focus of the strategy was to engage with service users to identify drivers for the future direction of services. In addition, the voice of pregnant and birthing people was included in other improvement work. For example, vaginal examinations, experience of triage, communication and consent and more.

We saw that there was more effective governance process and monitoring since our last inspection, but this needed to be strengthened, and improvements needed to become embedded.

The service worked closely with the maternity and neonatal voice partnership (MNVP) to gain feedback from women and birthing people and leaders told us this fed into the development of a maternity strategy which commenced in September 2024. We were told a key focus of the strategy was to engage with service users to identify drivers for the future direction of services. In addition, the voice of pregnant and birthing people was included in other improvement work. For example, vaginal examinations, experience of triage, communication and consent and more.

Staff and leaders told us how they worked in collaboration with partnership organisations to improve services for families.

There was a whole Trust approach to the improvement work that included board directorate representation, senior trust leaders, the non-executive directors, the local maternity and neonatal board and the maternity and neonatal voice partnership. Leaders had recently visited another trust who were experiencing similar issues but had made positive changes. Leaders had stayed in contact and told us they planned to replicate some of their improvement work.

The service was supported by maternity safety champions and a non-executive director. The non-executive director (NED) was there to provide an objective view and external challenge. Their remit was to understand the current outcomes of the service, review services, current maternity risks, and report to board.

The maternity safety board champions visited the maternity unit and liaised with outside representatives such as the maternity neonatal voices partnership (MNVP) to review services, monitor risk and provide the board with a report of maternity services. They used their feedback to triangulate what they heard and saw on walk-abouts.

uring our assessment leaders showed us the new digital maternity governance dashboard which was about to go live. This covered the live maternity National Institute of Clinical Excellence, clinical audit, clinical governance metrics and digital checklists. The dashboard would be able to highlight live themed data and performance to support monitoring, oversight and improvements.

Maternity services had a research team that included 4 research midwives. The service collaborated with regional universities and charities to support research studies. Maternity services participated in some large-scale studies that included several maternity units across the UK, and smaller local studies that were exclusive to their maternity service. For example, they were participating in the Obstetric Bleeding Study UK (OBS UK) which included 36 UK-based maternity units over a 30-month period.

When we visited the research team were analysing the results of their local study to explore if acupuncture could be used to treat an established labour that had slowed down, instead of using a hormone drip.

Some midwives had completed a highly specialised training programme endorsed by the British Medical Acupuncture Society. This meant they were able to offer acupuncture as an option for pain relief in labour, alongside more conventional methods.

A volunteer team of midwives, an obstetric nurse and a nursery nurse spent 18 days volunteering their time and skills at 2 different health centres in Uganda in June 2024. The team used their annual leave to visit the country and share their knowledge and expertise with local clinicians.

During the visit they were involved in antenatal education, labour, and intrapartum care, as well as immunisation and some postnatal care. They were also invited to attend a health initiative talking to a group of teenagers about sex education, menstruation, self-care, and pregnancy education.

The trip was organised by the labour ward manager who was also the founder of a non-profit organisation that facilitates the placements.