St Richard's Hospital

On this page

• 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 women and communities had the best possible outcomes because their needs were assessed. We checked that women’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring women 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 assessment this key question was not rated. At this assessment the rating was good. This meant the effectiveness of people’s care, treatment and support achieved good outcomes and was consistent.

The service worked with agencies involved in people’s care for the best outcomes and smooth transitions when moving between services. They monitored people’s health to support healthy living. Staff made sure people understood their care and treatment to enable them to give informed consent.

There were positive examples of person-centred care. Women were given information and advice about their health, prenatal and postnatal care. They told us during the assessment that they felt well supported by the multi-disciplinary team and felt they were involved in the assessment of their needs.

However, staff did not always have up-to-date guidance to follow legislation and current evidence-based good practice and standards. The trust did not effectively use benchmarking to ensure that outcomes were positive and consistent.

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 scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff told us they were supported by senior colleagues, and they worked together to make sure women made informed decisions based on best practice guidelines. Staff were able to describe how they assessed and reviewed women’s needs from the antenatal to postnatal period to provide holistic support. For example, birth plans were personalised and up to date.

We saw examples of feedback within the family and friends feedback such as, “Everyone went above and beyond to support and accommodate any of my needs from changing appointment dates to seeing specific consultants”.

Women were given information and advice about their health, prenatal and postnatal care. They told us during the assessment that they felt well supported by the multi-disciplinary team and felt they were involved in the assessment of their needs.

There were positive examples of person-centred care, and we saw feedback from women who had previous birth traumas and long-term health conditions who felt well supported and listened to when making decisions about their pregnancy and birth.

The Maternity survey 2025 reported women felt involved in decisions about their antenatal and postnatal care, with the trust scoring higher than the national average for this question.

During our assessment we reviewed 7 care records which showed examples of person-centred care. Staff carried out risk assessments for women during antenatal care in line with national guidance. These included social assessments, risk assessments for blood clots and mental health assessments. Staff made referrals to consultant led clinics for women with medically high-risk pregnancies. Risk assessments for women were in line with national guidance.

Staff attended maternity huddles, which were held twice daily 7 days per week. We attended maternity huddles which were well attended by the maternity and obstetric team. Staff used the Situation, Background, Assessment and Recommendation (SBAR) tool to communicate important information about a woman’s condition to the team. This ensured that assessments were informed by accurate and up‑to‑date information, supporting appropriate clinical decision‑making and enabling the service to respond appropriately to women’s assessed needs.

Consultant midwives worked between both St Richard’s hospital site and Worthing Hospital site. The consultant midwife led on the physiological birth working group. The group was collaborative initiative which involved midwives and obstetric staff from all 4 maternity locations. The working group focused on training of staff to support optimal maternal positioning during labour and strategies to improve care in the initial phase of labour.

We scored the service as 2. The evidence showed some shortfalls. The service did not always plan and deliver women’s care and treatment with them, including what was important and mattered to them.

The service reported the trust was experiencing challenge with clinical guidelines and the maternity service was working towards merging its current guidance across all maternity sites.

From October 2025 the safety and quality report showed 108 of maternity documents were out of date. This was on the maternity risk register due to the ongoing delay in updating guidance and the potential risk this may cause. For example, out of date documents may lead to poor decision making and non-compliance with regulatory requirements and inconsistencies in maternal and neonatal outcomes.

Key maternity guidance was out of date and not consistently aligned across the maternity locations. However, policies and guidance did reflect the current National Institute for Health and Care Excellence (NICE) guidance.

The guidance for postpartum haemorrhage (PPH) management was out of date. Staff currently used the University Hospital Sussex Obstetric Haemorrhage guidance which was also out of date and not aligned with the most recent National Institute for Health and Care Excellence (NICE) guidance. For example, using the correct dose of misoprostol and a flow chart which did not reflect the most recent safe actions and options for management of PPH a major obstetric haemorrhage over 1 litre. Out‑of‑date postpartum haemorrhage (PPH) may result in delayed or inappropriate clinical responses and poorer outcomes for women.

The service did not have a maternity bereavement policy. The bereavement team followed actions outlined in the Intrauterine Death Policy, however, this policy was also out of date in November 2023. We were told bereavement midwives instead followed the National Bereavement Care Pathway. The potential impact of not having a trust maternity bereavement policy could lead to a lack of ability to support women and their families and staff may not have the tools or information to provide compassionate care.

Staff used nationally recognised tools, such as the maternity early warning score (MEWS) and the newborn early warning trigger and track (NEWTT2) tool, to identify women and babies at risk of deterioration. The trust had not implemented a MEWS or NEWTT2 audit due to the current electronic record system being unable to capture all required data.

Senior leaders told us MEWS and NEWTT2 were discussed within the trust guidance ‘Recognition and Management of Severely Ill Pregnant women/women including Enhanced Maternal and Critical Care’. However, this guidance had not been updated and was out of date, expiring in November 2024. Senior leaders had drafted a standard operating procedure (SOP) to support staff completing MEWS and NEWTT2 prior to the upcoming electronic update. However, the SOP had not gone through the appropriate governance process therefore staff continued not to have guidance.

MEWS documentation was not currently audited by the trust. The service told us that the new version of the tool was due to be uploaded to the electronic notes system in March 2026. Without completing monthly audits, senior leaders were unable to identify areas of poor performance, reducing their assurance that women and babies were receiving safe care.

Maternal readmissions were not reported as location specific, with all 4 maternity locations reporting to the trust together. This meant it was difficult for the service to understand local performance and outcomes for women. The service did not provide us with the number of maternal readmissions to the service.

Monitoring readmission rates at individual hospital level allowed leaders to understand local performance and patient outcomes. Hospital‑specific data helps to identify variations, assess the effectiveness of care and discharge processes, and take targeted action where improvement is needed. Trust‑level data alone may mask risks at site level, reducing oversight and assurance that care is effective for women using maternity services at that hospital.

Sepsis audits were not completed by the service which meant the service could not be assured staff were recognising and managing the early onset of sepsis. Sepsis was identified via review of electronic incident reports. However, this did not provide adequate assurance regarding the monitoring of sepsis and early deterioration. The service did not provide any data to identify whether there had been any sepsis cases over the last 3 months.

The service did contribute to some national audits, such as perinatal mortality, and Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK).

Managers communicated changes in national guidance through monthly newsletters, departmental alerts, during huddles and through presentations to staff.

We scored the service as 3. The service worked well across teams and services to support women. They made sure women only needed to tell their story once by sharing their assessment of needs when women moved between different services.

Teams had effective working relationship, with staff reporting they worked well as a team and there was a good culture between midwives and obstetricians.

Staff considered patients’ individual needs and circumstances and we observed effective handovers. During safety huddles we observed maternity and obstetric teams actively having discussions around supporting women.

Leaders worked with the local Maternity and Neonatal Voices Partnership (MNVP) to contribute to decisions about care in maternity services.

There was a monthly service user workstream working group in place, chaired by the head of midwifery and MNVP. The group reported into the maternity and neonatal improvement group, which was chaired by the chief nurse and attended by stakeholders to support and advise the trust such as NHSE, LMNS, Maternity Safety Support Programme (MSSP), and MNVP. The MNVP provided friends and family feedback to improve antenatal appointments and discharge processes by identifying further information about women’s background and history to support their maternity journey.

There was a continuity of carer team for all women who used the service where there were safeguarding concerns, long term conditions, mental health needs, or other additional needs. During midwifery safety huddles we observed active discussions around women with complex care who required support to have the birthing experience they wanted. The service had worked with external agencies and local trusts to develop a multi-agency birth plan.

Bereavement services had links with mental health teams and external support agencies to support women following loss.

We scored the service as 3. The service supported women to manage their health and wellbeing to maximise their independence, choice and control. The service supported women to live healthier lives and where possible, reduced their future needs for care and support.

Staff assessed women's health when admitted and provided support for any individual needs to live a healthier lifestyle. Women were asked about their smoking status at their booking appointment, and all women were offered carbon monoxide screening.

The trust website had a page dedicated to advice and support during pregnancy. Information on the website included pregnancy advice and antenatal education.

Women could access information and advice about their health, care and support from the hospital maternity pages on the internet, printed leaflets and from staff during their appointments.

We scored the service as 2. The service did not always routinely monitor women’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of women themselves.

The perinatal quality oversight model (PQOM) measured current performance and maternity clinical indicators. These indicators were used to assess outcomes and overall performance. However, the PQOM did not add benchmark data or target indicators. This meant it was not clear whether the service was improving, meeting national requirements, or performing as an outlier.

The trust told us following the inspection, the PQOM dashboard was not a trust-controlled dashboard but one requested by the local maternity and neonatal systems (LMNS) for the trust to use. The trust reported they had requested to report via a benchmarking dashboard, although this had not been put in place.

The guidance for postpartum haemorrhage (PPH) management was due to be reviewed in April 2024, therefore was out of date. The service was due to complete a thematic review into postpartum haemorrhage (PPH) following continued high rates of PPH reported. The national rate for PPH levels was reported to be 32% per 1000 births and the figures given for the service during our data request were 37.43% for June 2025, 51.55% for July 2025 and 35.35% for August 2025. High postpartum haemorrhage (PPH) rates may indicate variation in the prevention, recognition, or management of bleeding following birth. This increases the risk of harm to women and highlights the need for review of clinical practice, training, and guidance.

Maternity services across the 4 sites did not meet the compliance to complete hip scans for babies who met the referral criteria within the required timeframe. This was due to issues with limited scan appointment capacity. Completing hip scans identified developmental hip conditions early, supported prompt treatment, and improved long‑term musculoskeletal outcomes for babies. When scans were not completed as planned, this increased the risk of delayed diagnosis, potentially affecting mobility, development, and future quality of life.

Trust compliance with saving babies’ lives (SBL) care bundle had gone from 97% compliance to 49%. The trust reported this was due to a delay in the service merging and ratifying guidelines required by SBL. Poor compliance with the SBL Care Bundle reduced the effectiveness of preventative measures, led to missed or delayed identification of risks, and contributed to variation in care. This negatively affected perinatal outcomes and increased the risk of harm to babies.

Women’s smoking status at 36 weeks was not always completed by maternity staff. The trust target for completion was 80%, however, the service was only 62.5% compliant. Monitoring smoking rates in pregnancy identified a key preventable risk factor for poor birth outcomes. This enabled services to target higher‑risk groups, assess cessation support, and reduce avoidable harm.

However, there had been improvements in the number of women who had, had a 3rd or 4th degree tear. The trust had been working with staff to implement the obstetric and sphincter injuries (OASI bundle) and to work on the correct technique and optimising maternal position. Between March 2025 to August 2025 the service had showed improved rates and the service were below the national average.

The service learned from neonatal deaths via a child death oversight panel. These were presented to the board through a series of meetings. Learning was also shared system wide via the LMNS quality and safety forum and the board. Neonatal outcomes across the trust had shown an improvement within neonatal mortality rates which were below the national average.

We scored the service as 3. The service told women about their rights around consent and respected these when delivering person-centred care and treatment.

Women we spoke with felt they had been given enough information, including risks and benefits, to make an informed decision about their care and treatment and that they were able to give informed consent.

Midwives understood how to assess women’s capacity to make decisions. On our review of women’s record’s, we found completed consent forms for caesarean sections as well as when gaining verbal consent when completing care.

Staff had access to mental health/deprivation of liberty safeguards (DoLS) guidelines on the trust intranet. Staff were able to talk about DoLS and how this would impact a woman on the unit. Staff were aware of their responsibilities under the Mental Capacity Act 2005.