Blackpool Victoria 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

We assessed 7 quality statements. Staff did not always feel respected, supported and valued. The service did not have an agreed shared vision, strategy and culture. Staff did not always feel they could speak up and that their voice would be heard. The service did not always provide an inclusive and fair culture by improving equality and equity for women who work for them. Leaders had the skills, knowledge, experience and credibility to lead effectively. There was now a strengthened leadership structure, with clearer roles and responsibilities. However, this was not embedded, and leaders did not always operate effective governance processes throughout the service.

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

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 women.

At our last assessment we rated this key question requires improvement. At this assessment the rating remained the same.

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 reviewed the families and integrated community care (FICC) annual plan for 2025/26 which included maternity and women’s services. However, this plan was incomplete and in draft form. For example, workforce strategies, activity plan, key performance indicators (KPI’s) and visions had not yet been agreed. This meant that leaders were not able to share planned KPI’s, and plans to achieve them, with staff. Leaders told us the FICC annual plan was due to be finalised and ratified through the board in April 2025. They told us that the vision and plan was not available for 2024/25.

We reviewed the staff survey results from 2024 for the FICC division. This included responses from the maternity service and showed that they performed worse than the trust overall for most of the questions. For example, 86 out of 100 questions had responses that were worse than the trust overall. Results showed that responses had declined when compared to the staff survey the previous year. For example, in 2023, 35 questions were better than or similar to the organisation overall. This had reduced to 14 in 2024.

The best scoring responses in 2024 were related to not experiencing harassment, bullying or physical violence from mangers, colleagues or patients and being encouraged to report incidents. The worst scoring responses were related to suboptimal staffing, feeling ‘worn out’, unrealistic time pressures and feeling frustrated by work.

At the time of this assessment the FICC division was developing an action plan in response to the results which was due in May 2025. Leaders told us they recognised the areas specific to maternity services such as learning opportunities, meeting more as teams, and reducing working over contracted hours. The service planned to gather further feedback on the metrics that had deteriorated throughout the year.

Staff feedback about the culture within the maternity service was mixed. Some staff were positive about the department and its leadership team. They told us they could speak to leaders about difficult issues and when things went wrong. Other staff told us that the culture within the service had not improved since the last assessment and not all staff felt valued. Staff told us that morale was low and they did not feel supported by senior leaders. Some staff felt there was a culture of ‘blame’ when things went wrong.

Leaders we spoke with were clear about how they planned to build a culture of support to increase staff morale. However, they were aware new systems to improve oversight and scrutiny, staff and patient engagement, the perinatal improvement plan and divisional operating model still needed to be embedded.

The trust held improvement workshops as leaders recognised challenges were being felt in morale and workloads. To support development, a Divisional Leadership Forum was recently commenced. This aimed to educate senior colleagues about different leadership styles, challenges, and opportunities.

In addition, staff wellbeing initiatives such as Wellbeing Wednesday and Friday Focus were implemented to provide forums where staff could meet and focus on their wellbeing.

The maternity and women’s service were part of the FICC division at the trust. The service had restructured, appointed new senior leaders and moved away from separate maternity and neonatal services to a multidisciplinary perinatal team. Since our last assessment in 2022, a director of midwifery (DoM) and consultant midwife had been appointed. Other roles included a specialist bereavement midwife, pelvic health midwife, risk midwife and a quality and safety lead. The service had two matrons; previously it had one. They managed inpatient services and community/specialist services separately.

The leadership team for the maternity and women’s service included a new interim head of midwifery (HoM). They reported directly to the DoM. The interim HoM role had been filled by the consultant midwife which left this role vacant. The service had a head of department who was also new in post.

The senior leadership team was led by a triumvirate which consisted of the DoM, the divisional director of operations and the divisional director.

Managers we spoke with explained how the new leadership model promoted improved teamwork, communication and set out a more clearly a defined structure of leadership, responsibilities and ownership.

Leaders we met were committed to improvement of the service. However, leaders had not fully identified, prioritised and managed all of the risks associated with the lack of effective governance processes throughout the service.

Managers we spoke with told us about the recent appointment of two practice development midwives to support multidisciplinary training and competencies.

We spoke with external partners and stakeholders who recognised that gaps in obstetric and midwifery leadership roles had impacted the ability to progress with key improvements. Other partners told us that leaders were very responsive to external reviews, professional, supportive and engaged.

Feedback from staff we spoke to about management, was mixed. Most staff told us that managers and senior managers were supportive and took prompt action to help them resolve issues. However, some staff told us that concerns on ward D regarding staffing, acuity and the impact on care and treatment had not been acted on in a timely manner.

Not all staff felt supported by senior managers or felt they promoted an open and transparent culture. For example, they told us that when discussing concerns, they would often be dismissed or interrupted.

Some staff we spoke with told us they did not know who managers were because leadership had changed so often. Most staff we spoke with did not know who the executive and non-executive director (NED) maternity safety champions were.

We spoke with external partners and stakeholders about the freedom to speak up culture at the service. Feedback was mixed. There were positive examples of when the trust has responded effectively to concerns raised. However, some feedback described a defensive response from leaders when providing information of concern.

Encouraging staff to speak up when necessary, without fear of judgment was incorporated into maternity service improvement workshops. However, staff we spoke with told us they were not always confident about speaking up. For example, some staff told us they did not feel they could speak up because they feared the consequences and had been discouraged from openly sharing concerns in meetings.

We reviewed the staff survey results for 2023 and 2024 for the families and integrated community care (FICC) division. This included responses from the maternity service. Data showed that in 2023, 60% of staff felt safe to speak up about concerns. This had declined to 53% in 2024 for the same metric. The trust average for the same metric in 2023 and 2024 was 64% and 61% respectively. Data showed that only 31% of staff felt the trust would address their concerns.

The trust had a freedom to speak up guardian and a deputy. There were also numerous champions across the trust. Staff were clear about their role and freedom to speak up was promoted widely via newsletters, emails, social media and policy. Staff could contact the guardians via anonymous forms or in person. Main themes identified were alleged bullying and harassment, poor behaviours, poor communication between staff and patient safety concerns. However, these themes were trust wide and not maternity specific.

We reviewed the staff survey results 2024 for the FICC division. This included the maternity service and findings showed there was improvement required with workforce equality. Data showed that 56% of staff felt that the organisation acted fairly for career progression. This had reduced from 2023 (61%) and was slightly worse than the whole trust comparator (60%).

Data showed that 44% of staff believed that the organisation had made reasonable adjustments for their disability. This showed improvement from 2023 (40%) but was worse than the rest of the trust (72%)

However, findings showed that 93% of respondents had not experienced discrimination from managers, team leaders or other colleagues. This was similar to the rest of the trust and also comparable to results from the 2023 survey.

The survey data showed that 92% of staff had not experienced harassment, bullying or abuse from managers. This was similar to the rest of the trust and showed improvement from 2023.

The NHS survey 2024 included trust specific data on Workforce Race Equality Standards (WRES) and Workforce Disability Equality Standards (WDES). This data is representative of the trust as a whole and not specific to maternity services.

Data showed that 61% of white staff and 49% of staff from other ethnic groups believed that the organisation provided equal opportunities for career progression or promotion. The percentage of staff experiencing discrimination at work from a manager or other colleagues in the last 12 months was higher for staff from other ethnic groups (20%) compared to white staff (7%).

Findings showed that 55% of staff with long-term conditions or illnesses and 61% of staff without long-term conditions or illnesses believed that the organisation provided equal opportunities for career progression or promotion.

We did not see evidence that leaders took action to review and improve the culture within the service in the context of equality, diversity and inclusion.

However, the trust had an equality and diversity policy, and staff attended mandatory equality and diversity training.

We spoke with external partners and stakeholders who told us that the trust was fully engaged with the recruitment of internationally educated midwives.

Managers we spoke with explained policy reviews, ratification and distribution processes were not always effective and timely. We saw two hard copies of out of date policies on emergency equipment trolleys and displayed in staff areas on the maternity day unit and staff we spoke with told us they were aware of 31 guidelines that were out of date. This meant there was a risk staff did not always have access to the most up to date best practice guidance and may not always practice in accordance with it. We made managers aware at the time and they ensured all out of date polices were removed and replaced following ratification.

Risks we identified during our assessment were not documented on the service’s risk register. For example, risks associated with (including but not limited to), staff access to out of date policies, incidents not reported, investigated and closed timely, inconsistent scoring of levels of harm, poor compliance by medical staff with mandatory training, lack of baby abduction drills, poor compliance with completion of WHO checklists, lack of records audits including documentation and escalation of NEWTTS and MEOWS, lack of pain management audits, ineffective utilisation of the day maternity day unit, midwives reviewing scans without appropriate training, lack of policy for formal induction of locum staff and lack of policy for women who wished to birth outside of guidance.

This meant we were unclear how the trust was assured leaders were fully aware of all key risks within the service and had suitable and sufficient oversight of risks and potential impact on the safety of women and their babies.

Partners and stakeholders we spoke with were aware of gaps in midwifery and obstetric leadership roles and the backlog of incidents. They told us there was a lack of assurance on how the service would manage this with the current resource and capacity. They recognised that an area of focus was to ensure that key clinicians involved in governance had clear roles and responsibilities.

We reviewed the trust’s compliance with the Clinical Negligence Scheme for Trusts (CNST) maternity incentive scheme. This scheme is designed as a financial incentive to support the delivery of safer maternity care. Data provided by the trust showed that the service was compliant with 97% of the 10 safety actions, with three sub-actions not yet fully compliant. One of the sub-actions related to ‘consultant presence for high risk births in line with RCOG guidelines’. The service had monitored consultant attendance through incident reporting and rapid review processes. However, they had not completed audits or action plans in response to learning. Leaders told us that audits were due to commence in June 2025 and they had developed an action plan to work towards full compliance for the following year.

Staff told us that managers supported them with clinical duties when there was suboptimal staffing. However, this meant managers had less time to fulfil their key roles and responsibilities in terms of governance.

Leaders told us that the restructured leadership and operating model for the FICC division had improved collaboration and communication. The director of midwifery and neonates attended the trust board of directors’ bi-monthly meetings to present updates on maternity and neonatal services. They were supported by the board level safety champions. Senior leaders attended trust management team meetings chaired by the chief executive and could access advice and support from the executive team.

Leaders attended quality assurance meetings, mortality governance meetings and clinical governance meetings that included reviews of serious incidents. They also attended trust wide safety and staffing meetings. Staff and managers attended bi-monthly maternity services meetings and held separate unit meetings.

The trust had developed a maternity and neonatal improvement plan and partners spoke positively about the actions and the assurance processes to board and external partners. They recogised that further work was needed to identify improvements and fully embed the changes.

The service used the Perinatal Mortality Review Tool (PMRT) and multidisciplinary meetings were held to review and monitor stillbirths, fetal loss, neonatal and post-neonatal deaths. The service did not have a dedicated lead but staff told us that there was a rolling rota to support medical consultant presence at PMRT meetings. The service monitored compliance against PMRT requirements as part of the maternity incentive scheme and the service had achieved compliance with this.

The service had recently recruited a quality and safety lead who had implemented new systems to review clinical incidents and identify learning. Some partners told us there had been an improvement in processes to reduce any backlogs and was supported by the trust patient safety team.

There was no dedicated risk lead and this was being reviewed as part of consultant job planning. However, leaders told us that all consultants supported quality and safety.

The service had maternity and neonatal processes in place following an adverse outcome that was clearly demonstrated in flow charts. For example, stillbirth, hypoxic ischaemic encephalopathy (HIE), neonatal death and emergency hysterectomy.

An assurance visit had taken place in January 2025 that involved LMNS and MSSP. Leaders reported that feedback was positive and partners had acknowledged progress made by the service. Actions had been identified around the caesarean section pathway and consultant job plans.

Most external partners and stakeholders spoke positively about the trusts collaborative approach. This included regular partnership working LMNS, MSSP, MNVP and MNSI. The service also partnered with Healthwatch to engage further with women and families within the community.

Partners told us that leaders collaborated well and were responsive to improvements that had been identified by MNSI, perinatal mortality reviews and external reviews. The service had regular meetings with LMNS and various stakeholders to provide assurances, discuss updates and share information. There were also multidisciplinary assurance visits that provided further observation and oversight. Partners told us that staff and leaders were very engaged during assurance visits.

Leaders had commissioned independent reviews for fetal medicine and category three caesarean sections in response to themes from incidents. Partners told us that findings from independent or external reviews were shared with them to enable monitoring.

In line with national requirements, the service had entered the Maternity Safety Support Programme (MSSP) in 2022 due to concerns regarding maternity care. This included partnership with an allocated maternity improvement advisor from NHS England. MSSP had worked closely with senior leaders to focus on three key areas; leadership, clinical pathways and governance. The service had an assurance visit in January 2025 from MSSP and an exit plan had been submitted following continued improvements within the maternity service. The exit plan consisted of six criteria and had been supported by an overarching perinatal improvement plan. The exit criteria included actions to strengthen the maternity leadership structure and maternity governance team structure. It also included the development of a maternity strategy, vision, and values. A review meeting had been scheduled for May 2025 to discuss progress and agree on the next steps.

The electronic patient record system allowed the service to share any alerts with other NHS trusts if a woman had been assessed as having complex needs. For example, mental health or safeguarding needs. This meant staff could track women who were accessing multiple services.

The service worked with MNVP who engaged with women in the community and in hospital. Feedback from MNVP was shared with leaders and the board through monthly reports. The reports had an overview of engagement activities that had taken place during the previous year and examples of feedback from women. However, we looked at monthly reports from November 2024 to February 2025 and they did not show what changes had been made or specific actions that had been taken in response to feedback.

The MNVP lead received two days of funding a week and this was funded by the integrated care board (ICB). Some staff and partners told us that further collaboration with members of the MNVP was an area that needed improvement and more timely actions in response to feedback from women.

All new starters and newly qualified midwives undertook their preceptorship in what was described as ‘a psychologically safe environment’. The service had established links with students and schools to help those thinking of a career in maternity or starting their career in midwifery.

We saw that there were quality improvement (QI) projects taking place across the service. Staff had reported improvements following a QI project into the acutely unwell. This included improvements in emergency drill simulations, equipment checks, and wound infection management.

We spoke with external partners and stakeholders who told us the service was fully engaged in regular quality assurance meetings and patient safety learning groups. This included shared learning and the impact from quality improvement projects.

The service had research midwives that helped recruit women to participate in research studies with the National Institute for Health Research (NIHR). This meant that women could access new and innovative treatments. Research midwives monitored and followed up women who had voluntarily participated in research studies. Studies included the role of self management of raised blood pressure after birth, ways to help prevent early stillbirth and prevention of anemia in pregnancy. Research midwives had presented at a national research conference and shared examples of positive outcomes for women such as improved blood pressure.

Staff told us that case review meetings involved staff and family more than they did previously. They told us that standard safety messages were shared in various formats such as social media and QR codes. We observed newsletters from February and March 2025 that showed safety messages were shared with staff. For example, an alert for staff to complete the PPH proforma for all women who sustain a blood loss of over 500mls.

Following transformation of the bereavement service, the bereavement midwife was nominated for ‘bereavement midwife of the year’ in March 2025.

The chaplaincy team also provided support through leading a weekly cremation service for lost pregnancies under 24 weeks gestation and products of conception. The chaplaincy team conducted a short, non-religious service and parents could attend if they wished. The team still provided the cremation service when no families were present, to remember the lives that were lost and the bereaved families. All the babies were cremated individually, and families could choose to either collect their baby’s ashes, or choose to have them scattered in the baby garden at the crematorium.

Staff told us they received emails asking for their opinions and ideas towards innovation and change.

The service participated in a national NHS staff award scheme that focused on innovation and recognition of staff that went above and beyond in their role.