Queen's Medical Centre

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• 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 and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support, and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last inspection we rated this key question good. At this inspection, the rating remained good. This meant women’s outcomes were consistently good, and feedback confirmed this.

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 did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. Staff did this in line with legislation and current evidence-based good practice and standards.

Staff accessed policies and best practice guidance on the trust electronic system. We reviewed a sample of 30 guidelines; all we reviewed contained evidence they were reviewed regularly and aligned with national guidance and standards. Policies were also available on the trust website and could be accessed by the public.

Staff followed current evidence-based good practice and standards. For example, in theatre, all stages of the World Health Organisation (WHO) safer surgery checklist were completed with no gaps. This was recorded contemporaneously in the woman’s electronic record. We checked 10 women’s electronic records and all had a WHO checklist recorded.

The service was compliant with all elements of the saving babies lives care bundle (version 3). This was based on national guidance such as NICE and the Royal College of Obstetrics and Gynaecology (RCOG) to target a reduction in perinatal mortality. The service was fully compliant with all six elements. We requested site specific data however the service provided trust wide data as this is how it was collected and reported internally, therefore the data is mirrored with the Nottingham City Hospital report. For example, data relating to a reduction of smoking in pregnancy showed that between October 2024 and April 2025 the percentage of women smoking at booking was between 16.8% and 22.5% during the same period this was reduced to between 8.1% and 9.5% at delivery. This meant a reduction in the prevalence of women smoking in pregnancy between 8.7% and 13%.

The service had already implemented the Birmingham Symptom-specific Obstetric Triage System (BSOTS) in accordance with the Royal College of Obstetrics and Gynaecology (RCOG).

The mandatory training was reviewed regularly to ensure it was current and evidence based, it was also informed by learning from incidents.

The service used evidence based proformas to guide risk assessment and emergency situations, for example the post-partum haemorrhage (PPH) management checklist. This followed best practice guidance and provided space and guidance during a PPH to guide the maternity team and provide evidence for documentation.

The service worked well across teams and services to support people. Staff made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

External partner services that worked collaboratively with the trust told us obstetricians and midwives mostly worked well together with the neonatal teams and spoke positively about the personalised care for women with complex needs.

Each site offered mutual aid at times of high activity and between other maternity services and NHS trusts within the region. There was an escalation policy which staff followed when urgent transfers to another service were required.

The service provided care to women with complex medical needs with teams working together across specialities to support women. There were joint maternal fetal medicine clinics supported by specialist midwives, for example, multiple pregnancy and congenital abnormality.

The homebirth team was a team of midwives supported by a lead consultant obstetrician and a neonatologist. Comprehensive discussions took place between women and the maternity team which detailed the possible risks involved with continuing to birth at home. Plans of care were developed and shared with the wider maternity team; for example, the anaesthetic team were pre-alerted about women who were beyond 36 weeks gestation, and due to birth shortly.

We observed effective and supportive working relationships between midwives and obstetricians.

Overall, we found the multidisciplinary team demonstrated strong mutual support while navigating the demands and expectations placed on the service.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

The service routinely monitored people’s care and treatment to continuously improve it. Staff ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The service had a local dashboard and used statistical process control charts when presenting to the trust board on progress over time. Staff also submitted data to the national maternity services data set which consistently passed the data quality checks.

We requested site specific data however the service provided trust wide data as this is how it was collected and reported internally, therefore the data is mirrored with the Nottingham City Hospital report. Data showed between October 2024 and March 2025, between, 4.3% and 5.8% of women had a post-partum haemorrhage (PPH) of over 1,500mls following birth. This was above the target of 3.7%. The service had carried out a deep dive to understand contributory factors. It had optimised the management of PPH to reduce the total volume of blood lost, reduce the rate of PPH and identify the needs of women following a PPH. A quality improvement project was launched in July 2024 and found the usage of blood products reduced. However, there was inconsistent usage and completion of the PPH proforma. The caesarean section rate was identified as one of the contributory factors which was between 41% and 44.4% of deliveries however this was not corroborated with any data analysis.

Between October 2024 and April 2025, the number of women who had a 3rd or 4th degree tear was between 4.3% and 5% of births which was consistently higher than (worse than) the national average of between 2.8% and 3%. In March 2025, 4.4% of 3rd and 4th degree tears occurred following an unassisted birth which was above the target on 2.9%; and 12.3% resulted from an assisted birth (Forceps or Ventouse). This was above the target of 5.1%. The service was undertaking a deep dive and developing a trigger tool to support learning with a quality improvement focus to reduce the rate of tears.

The stillbirth rate was lower than the national average and there had been no direct maternal deaths in the year prior to our inspection. MBRRACE-UK data published in March 2025 showed the stillbirth rate for 2023 for the service was 3.5 per 1,000. This was lower (better) than the national average of 3.9 per 1,000.

We reviewed 20 completed Perinatal Mortality Review Tool (PMRT) reports and found these were all completed appropriately which included an independent representative which is in line with evidence-based practice guidance. Each review included learning and an action plan with an accountable lead. Additionally, parents were fully involved with the review process and offered opportunities to feedback.

The service reported to the learning from patient safety events tool and reviewed themes such as any unplanned admissions of babies to the neonatal unit. Staff reviewed thematic findings and shared learning where possible.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff understood how and when to assess whether a woman had the capacity to make decisions about their care. They gained consent from women for their care and treatment in line with legislation and guidance. Staff could access relevant policies including the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Although the consent policy was overdue for review, it referenced current relevant best practice guidance, such as making best interests’ decisions.

Staff made sure women consented to treatment based on all the information available and clearly recorded consent in the woman's records. We observed staff gain consent before any procedure and consent was recorded in all the maternity records we reviewed where applicable.

The service provided a trust wide audit of consent which showed 95% (n20) of the consent forms audited had the intended benefits recorded, and 100% (n21) had the significant, unavoidable and frequent risks recorded. However, this was audit data for the family health care group, therefore it was unclear if this audit data was specifically related to maternity services.

Staff told us how they worked to support women with protected characteristics to ensure they understood what was happening to them and give informed consent, and they could withdraw consent at any time.