Royal Stoke University 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

Most staff were positive about the culture of the service. Leaders were able to identify the top risks on the risk register and of their mitigations. There was a strategy alongside a set of values and a leadership “quad team” oversaw the maternity department. Leaders completed various leadership courses and there was a Freedom to Speak up team which included 2 champions in the maternity service.

There was an equality and diversity lead and various support networks for staff. Processes were in place to improve the workforce and career experiences of the ethnically diverse workforce. There was a governance and meeting structure, and the department had various quality improvement projects including ongoing projects.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had an open culture where women, their families and staff could raise concerns without fear, staff were aware of who the freedom to speak up guardian was and were encouraged to speak with them or other specialist members of staff if they required support. Women, relatives, and carers knew how to complain or raise concerns. Leaders were aware of how health inequalities could affect the treatment and outcomes for women and birthing people and babies from ethnic minority and disadvantaged groups in their local population. Systems had been implemented such as smoking cessation to reduce unwanted outcomes for women and birthing people as a response to the needs of the local population. We saw evidence that 98% carbon dioxide (Co2) testing was offered to all pregnant women at the antenatal booking appointment against target of 90%; 92% Co2 testing offered to all pregnant women at the 36 weeks antenatal appointment against target of 85%; and 95% Co2 testing was offered to all other antenatal appointments to groups identified in NICE Guidance NG209 against target of 85%. This had helped the uptake of smoking cessation. We saw 100% of women had their smoking status recorded against 95% target; 98% of women where their smoking status at 36 weeks was recorded against target of 85% and 45% of smokers where smoking status was recorded at all antenatal appointments against target of 20%. Most staff we spoke with told us they felt respected, supported, and valued. However, some staff did not feel that all staff were treated equally and that disagreements between staff were impacting on patient care. Other staff told us they felt safe to escalate their concerns within a supportive culture, however some staff working for the trust expressed a lack of faith in the leadership team and told us they were not always treated with dignity and respect.

At the time of the inspection the leadership team had implemented several initiatives to address cultural concerns through a cultural improvement program and leadership development. The service clearly displayed information about how to raise a concern for women, partners and visiting areas. Staff understood the policy on complaints and knew how to handle them. Action plans had been created in response to the Ockenden findings and CQC post inspection, and progress was measured against them.

The service had a vision for what it wanted to achieve and a strategy to turn it into action. The service had developed the vision and strategy in consultation with staff at all levels. Staff could explain the vision and what it meant for women, partners, people and babies. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy. The service worked alongside the Local Maternity and Neonatal System (LMNS), Maternity Voices Partnership and Healthcare Safety Investigation Branch in addition to other services to better respond to the needs of the local population.

The trust focus for maternity was to provide safe, effective, caring and responsive maternity services that have all families at the heart of everything they do. To achieve this by creating a positive work environment; fostering excellence and innovation, in a culture of sustainable quality, build on team working that promotes respects and values individual contribution. Leaders and staff understood and knew how to apply trust values and monitor progress.

Each year the service developed an annual priority for workforce, governance and culture, using ‘you said we did’, maternity survey, staff survey, service user feedback MNVP. We saw examples and evidence of this during the inspection.

Maternity safety champions and non-executive directors supported the service.

The maternity education team had oversight of the maternity training programme. When we spoke with the team, they highlighted the positive fetal wellbeing training compliance, that included local learning from cases. Across the maternity training programme, the trust engaged in a peer review programme with other systems.

Good practice was noted within the multidisciplinary team (MDT) through the live skill drills, which included the neonatal team, and the future project plan with emergency colleagues. Overall compliance figures for the prompt training were currently at 89%.

The public health consultant midwife told us about the ongoing collaborative work with the maternity national voice partnership (MNVP), to develop resources for women and families, which included videos of the triage unit and the blossom unit.

We heard positive feedback about the planned research with women, birthing, people and families regarding their experience of Induction of Labour. The collaborative work from the trust and MDT working with the measles pathway group was also highlighted by the trust as positive, as was the reduction in smoking status at time of delivery (SATOD) rates from 12 to 8%.

The induction of labour midwifes were positive about some of the improvements made and the focus around prevention of breaches of care.

Staff working within the bereavement service gave a clear overview of the support provided across the maternity and neonatal services for women, partners and families, and the support for future pregnancies. Future plans included a contemplation area and rainbow clinic, which staff felt would be a great addition to the service they provide.

There was a well-established leadership ‘QUAD’ in place who oversaw the maternity department. (QUAD team included Director of Midwifery, the Directorate Manager; the Clinical Director for Maternity and Neonates, and the Neonatal Clinical Lead) They attended training sessions, the training was about how staff treat each other at work, provided practical guidance and resources to tackle bullying and harassment and to create a civil, respectful and positive working environment that was kind, compassionate and inclusive for all.

Staff we spoke with were aware of Freedom to Speak Up, but not always sure who their local champions were.

There was a Freedom to Speak Up policy with information for staff on the service such as who they could speak up to and speaking up internally and externally.

The trust had a Non-Executive Director Champion for freedom to speak up.

Leaders and staff actively and openly engaged with women and birthing people, staff, equality groups, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for women and birthing people.

Leaders worked with the local Maternity and Neonatal Voices Partnership (MNVP) to contribute to decisions about care in maternity services. Communication between MNVP and the service allowed for women raising concerns through social media to be flagged and addressed at the time of concern, including support for women struggling with anxiety whilst attending the service. The trust told us they were reviewing levels of literature and information leaflets representing the local diverse population in order to provide information to those population groups.

Senior staff told us that they put on EDI training events for staff, such as the care of LGBT+ service users.

The hospital had processes in place to improve the workforce and career experiences of ethnically diverse workforce, for example, they collated Workforce and Race Equality Standard (WRES) data and recorded this within a report. However, this was not maternity specific but trust wide data which looked at data such as overall ethnic representation, percentage of staff experiencing harassment, bullying or abuse from patients, relative or the public and the percentage of staff who believed that the trust provided equal opportunities for career progression or promotion.

Leaders identified and escalated relevant risks and issues through the incident management system and were reviewed and recorded in meeting minutes for the monthly risk assurance meeting. The leadership team identified and took actions to reduce the impact of identified risks through the use of a risk register.

Leaders monitored key safety and performance metrics through a comprehensive series of well-structured governance meetings. The trust had an up-to-date maternity dashboard which was used to monitor performance and key metrics.

Key staff took part in a quarterly perinatal mortality review tool (PMRT) meeting, which were held regularly as part of the Clinical Negligence Scheme for Trusts (CNST) these meetings were used to monitor the performance of the trust and identity any learning opportunities where improvements could be made and additionally monitored outcomes by ethnicity and deprivation.

Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service. Staff understood their role within the wider team and took responsibility for their actions. They knew how to escalate issues to the clinical governance meetings and divisional management team.

Information was shared back to sub-committees and all staff. Staff followed up-to-date policies to plan and deliver high quality care according to evidence-based practice and national guidance. Leaders monitored key safety standards of policies such as “Saving Babies Lives Care Bundle” through regular policy review every 3 years to make sure they were up to date.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them.

A team of specialist midwives were in place improve services through continuous learning and improvement. The service was committed to improving services by learning when things went well or not so well and promoted had plans in place to improve training and innovation. They had a quality improvement training programme and a quality improvement lead who coordinated development of quality improvement initiatives.

Community midwifery leads we spoke discussed the collaborative working across the five teams which included community safety huddles. A number of achievements were highlighted, which included the development of the Band 4 role across the service.

The department was actively involved in various quality improvement projects, for example culture within the service. We reviewed the service 3 year improvement plan, focusing on 4 themes, listening to a working with women and families with compassion, growing, retaining and supporting our workforce, developing and sustaining a culture of safety, learning and support, standards and structures that underpin safer, more personalised, and more equitable care.

Leaders told us that a lot of quality improvement work had taken place in triage since the last inspection.

The trust had been awarded external recurrent monies and fast follower status from NHS England to develop perinatal pelvic health services (PPHS), to achieve the NHS long term plan of ensuring that “women have access to multidisciplinary pelvic health clinics and pathways across England”.

The service participated in relevant national clinical audits, and we saw actions were taken to improve learning.