Nottingham City Hospital

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• 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 looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities. Staff felt that immediate leaders were supportive and that teams supported one another. Despite processes in place the staff reported feeling unheard and unaware of changes that had occurred as a result of speaking up about issues. Staff actively contribute to safe, effective practice and research. They spoke to immediate line managers when issues arose.

We have not awarded this service a score for Well-led.

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

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

During this inspection we only assessed limited aspects of this quality statement please see the previous report for a full assessment of the quality statement. The rating is based on our previous assessments.

Leaders did not always demonstrate the ability to lead effectively. They were faced with pressures to deal with the challenges from extensive external scrutiny of the service, and this gave some of them insufficient time to run the department and be as visible and supportive as possible. However, they understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation.

Staff told us that they felt supported by their colleagues about concerns or personal issues. However, many staff described frustrations of a lack of visibility of the senior maternity leadership. Staff still reported they did not see the triumvirate. Staff would expect them to have been more visible due to the increased scrutiny the service was faced with. Staff felt “abandoned” and that their concerns were not being heard or appreciated. We spoke with the director of midwifery and the head of midwifery during our inspection. Both senior leaders told us they split their time between the trust’s sites so they could be available to staff. However, their days were often filled with meetings etc.

The obstetric clinical lead was based at a different NHS trust and outside of the region. Staff told us they had not met this individual and that they were not aware if they had not attended on-site meetings. The obstetric team reported they felt disconnected from the clinical lead and reported that when concerns were raised, they felt placated rather than heard, with no effective action taken to address the issues raised.

One ward manager told us that they had proactively sought to support their team. They had held team building days, established paths of communication and made themselves available to the staff on their ward. As a result, sickness and retention had improved. We spoke to staff on this ward and in general they were more positive about their working environment than others. We saw that where a manager was proactive and visibly led their teams staff reported feeling more supported.

Staff reported being affected by the pressures of the local and national media around maternity care. They felt that this led to the aggression experienced on the ward areas. Several staff were aware that a further podcast was about to occur and felt that this would again have a negative impact. Some members of staff were also aware that the trusts communications team had rebuffed inaccuracies reported in the media. They felt that the trust needed to do more of this to support them.

During this inspection we only assessed limited aspects of this quality statement please see the previous report for a full assessment of the quality statement. The rating is based on our previous assessments.

Despite, the freedom to speak up service attempting to foster a positive culture where people felt they could speak up and their voice would be heard, people did not always feel they could speak up and that their voice would be heard. Staff were aware of the freedom to speak up process but those we spoke to had not used it. Staff were unaware of any changes made because of staff speaking up. Staff reported that they would use the trusts intranet to find out how to contact someone from the Guardians office if they wanted to speak up.

Staff were happy to speak up to their line manager who they trusted to escalate matters. Staff also used the services of the professional midwifery advocates to raise issues. However, staff reported that they felt that in reality little had changed.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Governance, management and sustainability during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

During this inspection we only assessed limited aspects of this quality statement please see the previous report for a full assessment of the quality statement. The rating is based on our previous assessments.

Staff encouraged creative ways of delivering equality of experience, outcome and quality of life for people. Staff actively contribute to safe, effective practice and research.

Staff continued to receive information on changes by email. Some staff reported that there had been a lot of change but could not identify a change since our previous inspection. Staff were aware of the challenges in their areas and had adopted processes to seek to overcome these. We saw that there was on going quality improvement project work into third- and fourth-degree tears during labour.

We spoke to the team undertaking the elective caesarean section list that day. There had been a number of issues that had occurred including, a patient who did not speak or understand English and had no interpreter booked, a lady who was known to have a high blood pressure and a lady who had not consented and was concerned about the risks of surgery. Staff were concerned that the lessons that should have been learnt from these and an emergency case that occurred would not be learnt as the clinical lead was rarely on site.