Bradford Royal Infirmary

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

At this assessment the maternity service group was rated good for well led overall in May 2024. Staff and leaders ensured that the vision, values, and strategy had been developed through a structured planning process in collaboration with staff and external partners. They demonstrated a positive, compassionate, listening culture and was focused on learning and improvement. The leadership team had recently been restructured which meant roles and responsibilities were in their infancy and had yet to be embedded. Senior leaders told us there was a new maternity governance structure. There were clear and effective governance, management, and accountability arrangements. There was a quality oversight system in place to evidence review of risk, learning, improvement, and assurance. Staff we spoke with reported managers and matrons were visible and approachable. In the last 18 months the acute service group (ASG) had recruited one full time recruitment and retention support midwife and one part time legacy midwife. Staff were aware of the multiple channels for freedom to speak up and felt supported by the pastoral midwives. The ASG collaborated, and worked in partnership, with relevant external stakeholders and key organisations to support care provision, service development and joined up care. Senior leaders and staff had a good understanding of quality improvement projects and provided positive examples of when they were encouraged to contribute to improvement initiatives. Staff and leaders ensured that women using the service and their relatives were involved in developing and evaluating improvement and innovation initiatives.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

In April 2024 before the assessment a small number of staff escalated concerns with CQC regarding culture. Senior leaders acknowledged cultural concerns regarding issues such as bullying and harassment and inequalities within staffing. They told us they had worked hard to change the culture. They had also worked with the local maternity system (LMS) to educate staff. Staff and leaders reported there was now a positive, compassionate, and listening culture which was focused on learning and improvement. They reported being supported by the two new pastoral support roles. Senior leaders ensured there was a shared vision and strategy. This had been developed through a structured planning process in collaboration with staff and external partners. Senior leaders told us there was a new maternity structure. To achieve compliance with the Ockenden recommendations, the service had introduced, and recruited into, the posts of deputy head of midwifery and head of midwifery. Senior leaders informed us a business case had been submitted to support the uplift of 4 speciality doctors. This was to allow the service to move to a 19 person rota with 2 tier cover for acute services. There was a collective shared mission to support women and families within the community. Staff told us the acute service group (ASG) had supported the "coat rack" for donated coats for members of the public to take if they needed. Staff told us the next future initiatives would be for "school uniforms". Staff who had bilingual language skills offered support to women and families in their first language rather than using a translator service.

Leaders ensured there was a process to work towards the vision and they had a strategy to turn it into action. The outstanding maternity strategy (OMS) transformation programme had been in place since 2020. The methodology was based on service user and workforce involvement. The key improvement priorities were based on 3 key questions • What would Outstanding Look Like? • Where are we now? • What does our improvement journey look like? There were five work streams which included; • Investing in our workforce • A building fit for our future • Moving to digital • The woman's journey and clinical excellence • Streamlining our systems Whilst we observed improvement and sustainability within the service it was apparent that improvement was ongoing. Building and refurbishment work was under way.

Senior leaders informed us the leadership team had recently been restructured in line with Ockenden and Royal College of Midwives recommendations. Whilst roles and responsibilities were in their infancy and had yet to be embedded this showed continued investment bothy in the service and at trust level. Staff reported managers and matrons were visible and approachable. They felt supported and listened to and said managers acknowledged special requests for annual leave. Staff were openly encouraged to attend governance meetings and incident meetings and report and escalate any staffing concerns. Clinical educators told us they supported staff by rostering study leave, mandatory training, and core specific training into their shifts patterns. Senior leaders we spoke with were knowledgeable about issues and priorities for the quality of services.

Senior leaders followed trust wide initiatives called thrive (people promise) to ensure that staff felt supported for their health and wellbeing. They developed a culture where staff felt heard, were always treated with dignity and respect, and trusted to do their job. The leadership team was aware that redeploying staff to work on different areas was a trigger point for anxiety and worry. Therefore, these discussions were handled with empathy and sensitivity and the decision was only every made to ensure that a safe service was maintained. Staff who were redeployed were easily identifiable on the roster, therefore enabling managers to monitor the frequency to ensure equitable redeployment. Senior leaders informed us of the "hot desk" bed manager rotational band 7 role who visited each area Monday to Friday 8am to 5pm. They would review and manage any short falls in staffing but would also be visible and approachable to staff. Leaders told us civility at work training was embedded and the trust had launched the "People Charter and the civility toolkit". The trust had changed practice to embed the "Just Culture Approach". A reward offer had been instigated with the introduction of "Greatix", "Employee of Month" and "Team of the Month".

In April 2024 before the assessment a small number of anonymous whistleblowers escalated concerns regarding bullying, harassment, and culture. We discussed these concerns with senior leaders and the freedom to speak up guardian. Leaders told us that they were aware of some concerns and acknowledged the long term impact of this had been on staff. There was a new leadership structure in place. In the last 18 months the acute service group (ASG) had recruited one full time recruitment and retention support midwife and one part time legacy midwife. Staff were aware of the multiple channels for freedom to speak up and felt supported by the pastoral midwives. Staff informed us there were maternity and neonatal safety champions. At this assessment staff we spoke with told us they felt confident to actively speak up and raise concerns without fear of detriment or reprimand. Following this assessment midwifery staff were encouraged to share their experiences anonymously online with us. We received a small number of concerns, and these were escalated to the trust for immediate awareness.

In April 2024 we inspected well led trust wide. Whistleblowing and freedom to speak up was reviewed as part of this process will be referred to in the trust well led section of the assessment. To date we continue to receive a small number of whistleblowing concerns. We escalated specific concerns with senior leaders. They provided assurances that individual concerns had been investigated and actions were being taken. There was a new leadership structure in place. There were several processes in place for staff to escalate any concerns. The acute service group (ASG) had introduced two new pastoral support roles which included one full time and one part time members of staff who were supernumery in these roles. They promoted freedom to speak up (FTSU) and encouraged staff to speak up. They acted as a resource for staff to raise concerns in confidence which were all then referred onto the Guardian. Two student midwives had also joined this FTSU team. There had been a small number of staff who raised concerns with CQC in the last twelve months. These had been raised from several midwifery staff groups and the themes of concerns were varied. The FTSU team regularly shared reports with the senior leaders and trust Board. There was a process for managers to follow when staff were redeployed, and discussions were handled with empathy and sensitivity. Redeployment was only instigated to ensure that a safe service was maintained.

We spoke with several midwifery students who confirmed they had received full support from the maternity teams with regard to their learning and development. Staff informed us there was a monthly ‘Tea Trolley’ wellbeing walk-around. This was supported by various teams including Spiritual Pastoral and Religious Care (SPaRC), people’s promise and professional midwifery advocates, practice educators and mental health awareness teams. During the assessment we observed a pop up prayer room which was accessible for all staff, women, and their families. It was also used as a quiet area if and when required for breaking bad news. We also saw a new staff room for staff to take rest breaks and staff dining facilities. This room was well equipped with a multipurpose kitchen. In addition, the site had 3 Muslim prayer rooms, complete with washing facilities and the provision of Jumma (congregational prayers) on a Friday afternoon. During Ramadan the trust employed extra Iman's so congregational prayers can be held daily. Leaders told us there was a process in place to take action to prevent bullying and harassment at all levels.

The Maternity acute service group (ASG) demonstrated there was a continuous quality improvement and transformation project to support the improvement journey towards becoming an outstanding provider of maternity care. This included 5 workstreams with focused activities to reduce inequalities within the workforce and in the community. The trust had processes in place to make reasonable adjustments to support disabled staff in order for them to carry out their roles. The service was actively recruiting staff which included newly qualified staff and international midwives. We were informed that 34 midwifery students had chosen this trust as their first choice across the local maternity system (LMS) region. There were maternity and neonatal safety champions which had a broad spectrum of representation including; gender, ethnicity, disability.

Senior leaders told us there was a new maternity governance structure with monthly business and performance meetings. Matrons informed us they met fortnightly to triangulate complaints / incidents and look at common themes. Senior leaders informed us there was a weekly maternity safety event review forum (MSERF). Staff reviewed and conducted exploratory investigations into patient safety events in order to learn and take action to keep patients and staff safe. Senior leaders acknowledged there were system issues with regards to sharing information to and from other trusts due to differing IT platforms and portals. They shared a recent example which included learning and action. Leaders told us they wanted to offer midwifery staff the opportunity to work within governance on a midwifery rotation. Medical staff confirmed that there was a dedicated time for clinicians to attend monthly governance meetings which were scheduled to rotate from Monday's to Friday's. All clinical practice was rescheduled for consultants on these dates. Staff told us they used funding from the local maternity system (LMS) for a recruitment and retention midwife. Leaders acknowledged they had a less experienced workforce which included many band 5s midwives and international midwifes. They ensured they offered the right level of support to junior staff. Staff understood their individual role and responsibilities.

The service had a formalised governance framework and processes to support the safe and effective delivery of care. We reviewed the Acute Service Groups (ASG) action plan to address the must’s and should do actions following the last inspection in 2023. These included 2 ongoing actions which related to the maintenance of equipment and completion of patient risk assessments. Senior leaders were sighted on the plans and continued to address known risks. Risks were tracked and monitored through the ASG's governance process. There was a quality oversight system in place to evidence review of risk, learning, improvement, and assurance. The ASG had a maternity ward to board meeting structure and a maternity dashboard. There was a process to investigate clinical incidents and refer cases to the Healthcare Safety Investigation Branch (HSIB) and NHS Resolution’s Early Notification Scheme. We reviewed several governance and risk meeting minutes which evidenced clear oversight and assurance of risk. There was a process to share practice and areas for improvement with Leeds Teaching Hospitals who undertook external peer reviews at perinatal mortality meetings. There was a process to share learning from incidents via the weekly quality and safety bulletin. These were also shared with the wider health care partnership system, MBRRACE-UK and CQC.

Senior leaders clarified that they offered placements for university trainee midwives. The service had recently recruited 34 out of 150 midwives who had requested to work in Bradford as their first choice across the local maternity system (LMS) network. The service completed Maternity and Newborn Safety Investigations (MNSI) following serious incidents. Safety huddles were completed every day Monday to Friday with all regional units. The service received and offered induction of labour (IOL) at other trusts as part of a mutual aid agreement to manage IOL delays where possible. The service collaborated with Bradford foodbank as a result of thematic reviews of still births. Data identified that some mothers had to work impacting on missed appointments. As a result of this the unit was now a hub of the foodbank giving 40 to 50 food parcels per month to women in need.

Leaders were actively involved with the Maternity Voices Partnership (MVP). This is a group of parents, volunteers and professionals who work together to help shape and develop maternity services in Bradford District and Craven. Meeting minutes from December 2023 evidenced discussions surrounding service user updates. Feedback was fairly balanced between positive and negative feedback. For example, “there should be space for dads after C-Section” and “really supportive midwife, good support regarding breastfeeding”. Themes and trends were shared with the ASG in order to improve the service. For example, designing new public unisex toilets block and a breastfeeding room. The acute service group (ASG) collaborated with partners of women to co-design information with them, and for them. They created focussed information and developed a class to help partners to be part of the birthing experience. Senior leaders clarified that the service actively engaged with the Yorkshire and Humber Clinical Maternity Network meetings including Maternity Dashboard Focus Group, Maternity Safety Learning Network, Yorkshire & Humber MatNeo Patient Safety Network. The ASG also contributed to all the local maternity and neonatal system work streams. This group meet monthly to share themes from learning. There was active engagement with many different steering groups and forums to streamline, improve and share learning across the region. One of the trusts key strategic objectives was to ‘collaborate effectively with local and regional partners’. The service was committed to doing this at a number of levels, both in Bradford and across West Yorkshire as working together in this way improves care provided to patients and improves the health of people in Bradford and across West Yorkshire.

Senior leaders and staff had a good understanding of quality improvement projects and provided positive examples of when they were encouraged to contribute to improvement initiatives. For example, staff were involved in the planning of the brand new purpose built facility which would incorporate the maternal assessment clinic and the day assessment unit. Staff told us about the work that had been completed with the Birmingham Symptom Specific Obstetric Triage System (BSOTS) and triage times at the Maternity Assessment Unit (MAC). Staff told us about an individual quality improvement (QI) project on balloon catheters which was part of the induction of labour QI project. Staff involved said they had recognised for this work and had been presented an award from the trust's chief nurse. Senior leaders told us they had planned to visit another trust to learn and improve on the use of balloon catheters. In addition, staff told us about a "Time on Labour ward" individual quality improvement project which focussed on personal care, delays with induction of labour and patient flow. Staff and leaders ensured that women using the service and their relatives were involved in developing and evaluating improvement and innovation initiatives. For example, they worked with partners of women to co-design information with them, and for them. They created focussed information and developed a class to help partners to be part of the birthing experience.

The Outstanding Maternity Service (OMS) Transformation programme was launched in November 2020 and 5 project work streams were agreed following engagement events with staff and service users. Staff were involved in some of these quality improvement projects and would meet monthly to discuss the progress of their improvement work, ensure consistency and any outcomes. The service had created a “Qi Practitioner” role to enable both individual development and sustainability of projects. We reviewed story board cycles and feedback posters for each of the QI projects. These evidenced that staff ensured women and their relatives were involved in developing and evaluating improvement and innovation initiatives. The feedback learning posters were easy to read and demonstrated how improvements would be made as a result of QI work. Leaders held debrief sessions with staff following any serious incidents. Managers encouraged staff to speak up with ideas for improvement and innovation.