Worthing 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.

At our previous inspection we rated this key question as requires improvement. At this inspection the key question has been rated as good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care. We assessed 7 quality statements.

The service was in breach of legal regulation in relation to the governance of the service. The breach was in relation to assurance through auditing systems, setting of targets and benchmarking processes.

Leaders and staff had a shared vision and culture based on listening, learning and trust. Leaders were visible, knowledgeable and supportive, helping staff develop in their roles. Staff felt supported to give feedback and were treated equally, free from bullying or harassment. People with protected characteristics felt supported. Staff understood their roles and responsibilities. Managers worked with the local community to deliver the best possible care and were receptive to new ideas. The service focused on continuous improvement across the organisation and local system.

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.

The evidence showed a good standard. 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 people and their communities.

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 with described the key components of the vision such as compassionate care and empowering women through their experiences.

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 saw key values displayed around the department which included ‘compassionate’, ‘teamwork’ and ‘kind’. Staff we spoke with throughout the assessment talked often about these values in their day to day work.

The service had a health and wellbeing board displayed, this included information and advice for staff including grounding exercises to complete when feeling overwhelmed, and advice for staff self-care on night shifts. The service also displayed thank you cards from users of the service which contained many positive affirmations about the team and demonstrated that the service wanted to celebrate the positive feedback.

The service had recently trialled the use of a wellbeing application that staff could access on their personal phones. This provided a live day to day check in for staff to give a ‘thumbs up’ or ‘thumbs down’ to indicate how they were feeling. This would then be shared with the matron who could offer support where needed or appropriate. The outcome of the trial was not known at the time of this assessment.

Women and staff were invited to contribute to the goals and vision. The trust used key words taken from the feedback from the Friends and Family Test, Maternity and Neonatal Voices Partnership (MNVP) quarterly survey, and MNVP walkarounds. Key words were also used from the clinical team staff survey, feedback given to the recruitment and retention midwives and following a culture event held in June 2024.

The assessment team were welcomed into the unit by all staff members. Staff were willing to talk to us and be open about what the service was like. This showed an open work force who welcomed review.

The evidence showed a good standard. The service had inclusive leaders who understood the context in which they delivered care and treatment. Leaders had the skills, knowledge, experience and credibility to lead effectively.

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 who covered both the Worthing and St Richards sites who reported to the Director of Midwifery. The Director of Midwifery 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 the head of midwifery 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 Director of Midwifery has 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.

A team of professional midwifery advocates (PMA) provided pastural support and restorative supervision to midwives and support workers. All midwives had an allocated PMA, support was also offered to support workers by the PMA team.

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 evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The service took part in the 2024 NHS Staff Survey which measured workforce satisfaction at a trust level. This was broken down into people promises, which were scored between zero and 10, where a higher score was more positive that a lower score. The Women and Children’s division scored 6.69 for the people promise ‘we each have a voice that counts’, which was above (better than) the trust score of 6.47, but below the national average of 6.74.

The trust level score for morale was lower than the average and the score for ‘Raising concerns’ had decreased from 6.21 in 2021 to 6.10 in 2022 and again to 6.09 in 2023. Staff in maternity told us they had not felt able to speak openly in the past. Staff now felt more able to raise concerns because the trust had employed an external and independent freedom to speak up guardian. Staff knew how to contact them and understood their role. We were given examples where staff had resolved issues by approaching managers and felt safe and supported to do so.

The trust monitored the number of freedom to speak up cases raised by staff on the maternity dashboard. In the last 12 months we could see that only 1 case had been raised.

The evidence showed some shortfalls. The service did not always value diversity in their workforce. Staff worked towards an inclusive and fair culture by improving equality and equity for people who work for them.

The service took part in the 2024 NHS Staff Survey which measured workforce satisfaction at a trust wide level. The results of the NHS Staff Survey were measured against the 7 People Promise elements and against 2 of the themes reported in previous years (Staff Engagement and Morale). For all areas apart from ‘We work flexibly’, scores at the trust were below the average of comparable trusts.

In the staff survey divisional section on Women and Children, the results were broadly similar to the organisation although slightly lower on being recognised and rewarded, being safe and healthy, always learning, working flexibly, working as a team and morale. However, it was noted by the trust that each of these areas had improved in score since the 2023 staff survey.

The trust took part in the Workforce Race Equality Standard (WRES) and the Workforce Disability Equality Standard (WDES). The results suggested people from ethnic minority groups and people with multiple health conditions had worse experiences.

There were poor scores from the Workforce Race Equality Standard (WRES) data. The trust scored below national average the Women and Children Division and Nurses and Midwives scored better than the trust and national average for 2024 in places.

Staff had access to monthly hypnotherapy and mini meditation sessions and financial wellbeing webinars were available to support staff if needed.

The evidence showed some shortfalls. Staff did not always act on the information about risk, performance and outcomes. However, the service had clear responsibilities, roles, systems of accountability and good governance. Staff used these to provide good quality, sustainable care, treatment and support.

There were risks identified during the assessment that were known to the service but not documented on the risk register. This included the lack of response the patient safety alert detailing ligature risk assessments. We requested evidence of environmental ligature and ligature point risk assessments and we were not immediately provided with this. There was no evidence of this being documented on the risk register. Following inspection, we were provided with evidence that a standard operating procedure (SOP) and risk assessment had taken place in July 2025.

The service did not have a comprehensive audit schedule and although one off audits were completed, there was a lack of continuation to gain assurance that the department was improving. For example, patient records audits and audits to identify if sepsis was being identified and treated appropriately.

The trust did benchmark against national targets for the required audits. These included compliance with MBRRACE, the MSSP and the response to Ockenden requirements. However, they did not effectively use targets and benchmarking to ensure that the department was maintaining or improving outcomes for women.

The trust recorded all birth information on the maternity dashboard. This covered organisational aspects, such as closures, activity, workforce and clinical indicators. The dashboard was reviewed at the monthly Maternity Safety and Quality meeting and reviewed monthly at board level during the Executive meetings. However, the trust did not benchmark the dashboard so had no clear indication if the department was performing well against trust wide or national targets. The data was not scrutinised in an effective way as there was no clear indication if the data reviewed was better or worse than the previous recorded data.

The divisions completed a monthly quality report which detailed performance against safety metrics. This was shared at divisional governance meetings and at the monthly Divisional Quality Governance Forum. However, some of the data was not benchmarked so the trust could not tell if the department was performing well against trust wide or national targets.

The divisional meeting structure fed into the executive performance and quality meeting where concerns were taken back to the divisional meeting the following week. We reviewed several meeting minutes and found that they had a clear role in the oversight of maternity services. However, we saw actions from meetings were not always managed in a timely way and often the same concerns were mentioned without a clear action plan. An example of this included was the substantial number of policies and procedures being outside of 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.

At the time of our assessment, the maternity service was part of the Maternity Safety Support Programme (MSSP) since January 2022. The MSSP is a national support programme provided by NHS England to maternity services where significant concerns have been identified regarding the safety and quality of services.

The MSSP improvement plan was monitored for compliance at bi-monthly meetings attended by the trust and relevant stakeholders. Following our assessment, the trust were advised that they could exit the MSSP programme, which meant they had improved sufficiently to transition to enhanced oversight and support from the Local Maternity and Neonatal System and Intergrated Care Board.

The trust used the Perinatal Mortality Review Tool (PMRT) and held meetings to discuss all cases. The trust planned to facilitate a merged meeting across the 4 hospital sites to ensure trust-wide oversight and allow comprehensive peer review, however this was not in place at the time of our assessment. The trust invited the Maternity and Neonatal Voices Partnership (MNVP) to attend these meetings, to learn from themes presented and share feedback from the people using the service.

The service had a post partum haemorrhage (PPH) proforma, however on assessment we found that staff were instead scribing directly into the patient notes and not using the proforma. This meant that there could be inconsistency in how PPHs were being recorded and documented.

The evidence showed a good standard. The service worked with system partners to make services work seamlessly for people. Staff shared information and learning to improve services.

Leaders worked with the local Maternity and Neonatal Voices Partnership (MNVP) to contribute to decisions about care in maternity services. A Maternity and Neonatal Voices Partnership (or an MNVP) is a group of parents, service users, maternity services, commissioners and the local maternity and neonatal system. They worked together to review and contribute to the development and improvement of local maternity and neonatal care and ensure that service users’ voices are at the heart of decision-making.

The evidence showed some shortfalls. Although we saw improvements throughout the service, there was still a lack of oversight. This was due to not establishing routine audits, not setting targets for the maternity dashboard data, and a lack of formal process for CTG fresh eyes auditing and understanding how improvement can be monitored. Due to staffing pressures and leadership instability there had been less focus on innovation.

Several audits were required to meet the standards of the UNICEF Baby Friendly Initiative. This initiative supported breastfeeding and parent infant relationships by working with public services to improve standards of care. The department were aware of what was needed to achieve the standard but currently it was reported that there was no capacity within the team to support this.

However, the trust had made many improvements since our last inspection. The trust told us they were on target to leave the Maternity Safety Support Programme by the end of 2025. The trust had implemented 264 out of the 272 requirements for the Ockenden (2020,2022) report recommendations.

The service had introduced maternity nurses, who were registered nurses, specifically trained to work in maternity units as part of the multidisciplinary team. Staff told us this had eased the pressure of midwifery staffing vacancies.

Improvement huddles were not embedded across the service. 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. We observed staff engaged in an improvement huddle on Bramber ward, however the delivery suite improvement board was blank, and when we spoke with staff, several of them did not know about the improvement huddle or why the board was there.

The service had introduced an ‘ImproveWell’ app which allowed staff to suggest ideas for improvement and keep everyone up to date with progress and implementation. It included a tracker which allowed staff to say how their day was going and launched quick surveys to see where improvements could be made. Staff uptake was slow at the start, but audits revealed staff were more active in the month before our assessment.