St Richard's 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 looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question as requires improvement. At this assessment the rating remains requires improvement. This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

We found a breach of regulation 17 good governance, in relation to the service not being assured auditing systems, setting targets and benchmarking processes were embedded.

There was a lack of oversight regarding risk. The service did not have an audit schedule, and audits were not routinely undertaken or embedded within the service.

Staff did not have access to up-to-date policies and guidance due to several being outside of the review date. We found safeguarding training levels were not aligned to national standards and there was no formal audit plan.

However, policies and guidance did reflect the current National Institute for Health and Care Excellence (NICE) guidance. To develop the vision the trust used key words from feedback received from women and their families through the friends and family test. Key words were also obtained from feedback from staff within the maternity and clinical teams via the staff survey. The trust told us they were committed to fostering an inclusive and equitable working environment and there had been an investment in workforce race equality standard.

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 scored the service as 3. The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of women and their communities.

Maternity services had co-produced with the local maternity and neonatal systems a vision and strategy ‘University Hospitals Sussex NHS Foundation Trust maternity vision and road map. The newly developed strategy was developed as part of the process of the trust coming out of the Maternity Support Programme (MSSP).

To develop the vision the trust used key words from feedback received from women and their families through the friends and family test, MNVP quarterly survey and MNVP walkarounds. Along with feedback from staff within the maternity and clinical teams via the staff survey.

Following the last maternity assessment, maternity services across the trust entered the Maternity Safety Support Programme (MSSP) in February 2022. The service had a maternity improvement plan, and the maternity improvement group monitored this the maternity improvement group.

The divisional vision was, “To be a leading provider of maternity care where supportive compassionate care and kind communication create a safe, empowering and personalised experience for all families”.

Staff we spoke to during the assessment could tell the team key words within the vision and key values were displayed on boards around the maternity department.

The divisional goals were aligned with the NHS Three Year Delivery Plan for Maternity and Neonatal Services (2023) and the trust Maternity Improvement Plan. The goals included delivering the highest standards of safety and quality of care, reducing health inequalities, workforce development, enhancing service user experience, increasing innovation, technology, community and partnership.

We scored the service as 3. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

The senior leadership team felt the executive team understood and supported their vision for the maternity service however, they acknowledged that there had been barriers to understanding and acting on risks.

There was now a clear leadership reporting structure with a head of midwifery (HOM) who covered both the St Richard’s and Worthing sites who reported to the director of midwifery (DOM). The DOM reported to the trust board. The service had recently implemented a new divisional clinical operating model which included overarching cross site clinical director roles alongside dedicated site-specific medical leadership.

Staff told us their ward managers, matrons and HOM were visible and approachable on the maternity unit. Some leaders worked clinically with the maternity unit team and staff told us this had improved communication and trust in the leadership team.

The DOM had direct and regular access to the trust board through a series of meetings and could routinely monitor information about quality, including safety and take necessary action to improve quality.

Maternity and obstetric teams reported they worked very well together and there was a sense of community between the teams where they would have lunch or breaks together.

Trauma and Risk Management (TRiM) trained practitioners from both medical and midwifery backgrounds, assisted with debriefing if there was an incident. Staff had access to individual support and counselling services. The TRiM practitioners were trained to provide psychologically informed responses to traumatic events.

The maternity service had a team of professional midwifery advocates (PMA), who provided pastural support and restorative supervision to staff. All midwives had an allocated PMA; support was also offered to support workers by the PMA team.

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where women felt they could speak up and their voice would be heard.

There were processes to promote the freedom to speak up guardians (FTSUG) to staff. The FTSU guardian reported back to the maternity leadership team to discuss themes and concerns. The FTSUG escalated directly to the director of midwifery or head of midwifery.

The NHS England peer review in August 2025 identified an increase in the number of staff contacting the freedom to speak up guardian (FTSU) to report concerns regarding maternity services within the trust. This raised concerns regarding a lack of confidence in the standard divisional processes of staff reporting directly to the maternity leadership team to address staff concerns.

The trust had rolled out civility training and promoted an open-door policy. The medical team had developed a questionnaire for staff, to find out more about their wellbeing and civility with other team members. Civility training promotes respectful and considerate behaviour from all staff members of the maternity and obstetric team.

There was a focus on providing a positive culture. However, some staff raised concerns regarding difficult working relationships between midwives working between night and day shifts. There were also reports of poor attitudes towards some junior midwives by more experienced staff. This was fed back during the assessment, and senior leaders were aware of the concerns raised and they told us the trust were working to address these concerns.

Women, and their families knew how to complain or raise concerns, and how to give feedback on the service and their treatment.

We scored the service as 2. The service did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who work for them.

The 2025 trust staff survey identified concerns regarding discrimination, and an action plan was developed. The service was developing succession planning for future leaders, ensuring ethnicity of the workforce was reflected.

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

The service told us they were committed to fostering an inclusive and equitable working environment and there had been an investment in workforce race equality standard (WRES) staffing. The service planned to establish a divisional equality, diversity and inclusion group to make sure the service were working alongside national guidance.

Some staff across the trust were taking part in the NHSE regional reverse mentoring programme. The programme was a reflective approach to cultural learning, leadership development and to increase diversity across the trust.

We scored the service as 1. The service did not have systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

Governance systems were not always operating effectively to ensure risk and performance issues were identified. Staff did not have access to up-to-date policies and guidance due to several being outside of the review date. We found safeguarding training levels were not aligned to national standards and there was no formal audit plan.

There were 108 policies and guidance that were outside of their review dates. 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. However, policies and guidance did reflect the current National Institute for Health and Care Excellence (NICE) guidance.

The trust reported they were experiencing challenge with reviewing and updating clinical guidelines. Updating maternity guidelines were currently on the women and children’s risk register. The trust reported that it did not have the resources to keep up with updating all current guidelines across all 4 locations.

Senior leaders described a risk-based approach to incident review, with targeted reviews undertaken in response to identified themes. For example, any possible incident linked to sepsis would be reviewed. However, audits were not routinely completed, which meant there was a lack of continuous and systematic review of potential safety incidents, themes and trends. As a result, the service could not be assured of the overall quality and safety of the maternity service.

The trust recorded all maternity safety and quality information on the maternity dashboard. This information covered organisational aspects, such as closures, activity, workforce and clinical indicators. However, some maternity dashboard data was not benchmarked against targets, so the trust could not always be assured that the service was performing well against trust-wide or national standards.

The divisional meeting fed into the executive performance and quality meeting. Meeting minutes were reviewed and although there was a clear oversight of maternity services identified within the minutes, we found there was not always a clear action plan.

The service maintained a risk register which was regularly reviewed; however, some risks had limited mitigation and there were ongoing delays in resolving them and no clear action for resolve.

The trusts maternity services were under a Maternity Safety Support Programme (MSSP) led by NHS England. The MSSP improvement plan was monitored as part of the maternity improvement group led by the chief nurse for the trust for compliance at twice monthly meetings attended by the trust and relevant stakeholders. This included action plan and workstream reviews of multiple aspects of governance, safety and outcomes. The action plan had 163 initial actions and following our assessment the trust told us 91 actions were completed and closed.

Staff could describe their role in the governance process and had regular opportunities to meet discuss and learn from the performance of the service. They knew how to escalate issues to the clinical governance team and divisional management team.

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for women. They share information and learning with partners and collaborate for improvement.

Service leaders attended regular meetings with the Local Maternity Network System (LMNS) to review governance and incidents.

Leaders worked with the Maternity and Neonatal Voices Partnership (MNVP) to contribute to decisions about care in maternity services. Meeting minutes showed current work being undertaken between the local MNVP, maternity service and the LMNS.

The maternity safety champion and non-executive director supported services to monitor safety and outcomes. Maternity safety champions worked closely with the maternity and neonatal voice partnership (MNVP) and undertook walk arounds of the department.

The maternity safety champions were leaders in maternity and neonatal care focused on improving safety and quality.

Information showed the team visited the maternity assessment unit (MAU) following its move to the main maternity unit in March 2025 to see how the service had improved and evolved since moving and to understand the issues the team have regarding the waiting area for women and their partners.

The maternity safety champion visit in September 2025 focused on the new elective theatre capacity and the use of the day surgery unit, to identify how this would improve capacity and safety for women.

We scored the service as 2. The service did not always focus on continuous learning, innovation and improvement across the organisation and local system.

The service did not consistently achieve effective and continuous learning, innovation, or improvement across the service.

Although, there were improvements seen throughout the service since our last assessment, we found a lack of oversight and improvement due to not completing maternity audits. A lack of clinical audits around sepsis and maternal readmissions meant the service could not identify any themes or trends to identify where learning is needed by maternity or obstetric teams.

Improvement huddles were well established on the postnatal ward, antenatal clinic and within the community midwifery teams. Improvement huddles are short, focussed team meetings used for various purposes such as patient safety, quality improvement and staff wellbeing. There were opportunities to suggest quick wins and celebrate things that had gone well.

The service introduced an electronic application as an alternative platform to enable staff to engage with quality improvement at any time and to share ideas more flexibly with the service.

To provide staff with the opportunity to provide feedback, share learning and be up to date with new guidance, the fetal well-being team had launched a newsletter.

Staff contributed to programmes, such as the patient safety incident response framework (PSIRF) and multidisciplinary review meetings, which provided reflection and learning.

The service had strong external relationships to support improvement and innovation. We saw evidence of regular engagement of leaders and service users, to review and improve the service such as the Maternity and Neonatal Voices partnership (MNVP) steering group. Additionally, the service participated in national research, and specialist midwives were proactive in developing training sessions for staff. For example, the pelvic health team had developed a pelvic health study day.