Nottingham City 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 rated well-led as requires improvement . We assessed 7 quality statements on leadership and governance. Staff told us leaders did not always understand and embody the culture and values of the workforce and the organisation. They had the skills and knowledge however, did not always have the experience and credibility to lead well. Some staff demonstrated their integrity and honesty which was recognised in some areas . There was an improved system of governance and risk management based around delivering safe and good quality care and treatment. However, all areas required time to continue to embed new processes.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Most of the staff we spoke with told us overall the "culture was improving and they don’t see as much bullying at the service." However, some staff told us the service does not have any team meetings and that they felt there was a lack of understanding of individual roles and responsibilities. This led to staff not necessarily understanding each other's challenges.

There were processes in place, staff were aware of the Freedom to Speak Up Guardians (FTSUG) in the trust and had started to use them regularly to escalate their concerns. The service recorded the number of contacts staff had on the maternity dashboard.

The ongoing review of the trusts maternity services had led to a number of new processes which were being embedded into the service. The senior leadership team had a focus on many areas in order to drive sustainability and improvements in care.

All staff we spoke with mentioned disappointment in the lack of care, visibility, and communication from senior leaders. However leaders felt they were much more visible as a senior leadership team. This disconnect was shared by a number of staff during our assessment onsite.

We were told leaders had support and opportunities to develop and maintain their credibility and skills. The roles of staff and leaders were clear, and they understood their responsibilities and accountabilities. However, staff still reported a lack of opportunity to develop.

There was inclusive recruitment and succession planning for the future. However, staff were concerned about the number of newly qualified and overseas midwives that were being recruited and raised concerns about how they were going to be supported.

During our assessment we were told the service was in the process of arranging regular meetings with the Chief Nurse, the Chief People Officer and the Medical Director.

The Freedom to Speak Up Guardian, (FTSUG) service was in the process of finalising their reflection and planning tool, and all divisions had been asked to complete the section for senior leaders.

We were told the service met with the Chief Executive, the Chair and Non-Executive Director for Freedom to Speak Up quarterly and monthly with the Director of Corporate Governance.

The Guardian Team presented to the board. A Freedom to Speak Up Development session was in the process of being rolled out to the operational leadership team and then divisional leadership teams.

There were processes in place to allow FTSUG to support staff to raise concerns.

The FTSUG Team produced a quarterly newsletter that was included in the trust briefing, this was cascaded out to divisions and was included in Divisional People Committee papers.

The FTSUG attended new staff inductions and a number of regular meetings, for example all divisional people committees, maternity engagement calls and the neonatal improvement work stream in order to raise awareness of the process.

Key performance indicators (KPI’s) were used to measure the FTSUG response times, and feedback to individuals throughout the process.

Leaders we spoke with told us they value diversity in the workforce. They were working towards an inclusive and fair culture by improving equality and equity for people who work in maternity services. We were told the service had designated diversity and inclusion leads. Diversity and inclusion leaders ran specific training for staff which was engaged with well. The trust had established equality networks for staff.

Staff we spoke with were aware of the improvements being made but told us they felt there was still a along way to go before improvements would be fully embedded.

There had been an introduction of dedicated leads for diversity and inclusion and equality networks for all staff. The service had an ‘Equality, Diversity and Inclusion Policy’ in place which had been ratified on 9 May 2024. The policy outlined the training requirements for staff and included equality impact assessments which were carried out for new or changing policies, procedures, services, projects or functions.

Staff we spoke with understood the governance structure and understood where to find specific policies. Staff praised the band 6 midwives, nurses, and matrons on the ward. However, were mostly negative towards more senior management of the department, reporting that 'they rarely saw senior leaders stating that some staff had never seen them on the ward before'.

There was a range of accurate and timely data and information available to understand performance and quality, and improvements were made as needed. Staff and leaders acknowledged there was "still a long way to go," to ensure staff felt fully supported.

There were regular meetings led by the senior leads for safety, audit, quality, and governance. These monitored and addressed key areas of performance, risk, audit, culture, and workforce. Minutes showed areas of concern were identified and actions were taken to learn and improve. Changes continued to be made when needed to improve the service. However, a number of improvement areas still required embedding into practice.

People we spoke with shared mixed experiences as a result of some being involved in the maternity review programme currently taking place at Nottingham University Hospitals Trust. However, the trust leaders have committed to improving care and its maternity service.

Most staff that we spoke with told us that they felt that there was limited involvement locally from management above senior level. We were told that there was a disconnect between staff and senior management.

However, service leaders we spoke with told us that they engaged with stakeholders in multiple ways. For example, with the maternity neonatal partnership, part of Nottinghamshire LMNS (local maternity and neonatal system), work with Muslim women’s network and links with the Maternity Voices Partnership (MVP). Trust leaders, safety champions and the MVP had developed good relationships and spoke about ambitions for service user voices driving forward changes and improvements.

We received mostly positive feedback from partners which identified an openness and willingness to learn. There was also a recognition that work on improvements still required embedding before staff would feel improvements could be maintained.

There were a number of processes in place focused on fostering connections with local charities and communities in Nottingham to enhance healthcare access and outcomes. The trust had prioritised a number of key initiatives. For example, specialist clinics (including support for diabetes and female genital mutilation,) were being moved from hospitals into the community to improve attendance and access, the establishment of an Inclusive Maternity Task Group, dedicated to reducing inequalities and improving outcomes, collaboration with charities and community groups and partnerships with local organisations including church groups, universities, the Muslim Women’s Network, and the East Midlands Ambulance Service (EMAS).

Staff told us that information was sent mostly by email, which staff did not regularly access. This meant that staff often felt misinformed, and some staff did not appear to know what was happening in the division.

Staff told us that when they were informed of changes, they were not always involved in the discussions to facilitate this. However, some staff told us that they are encouraged to put forward change suggestions. the mixed feedback identified methods of staff engagement were not always effective.

Leaders we spoke with had a clear focus on the challenges and improvements that were being made across the service and identified the trust’s vision and strategy for the current service which identified commitment to continuous improvement and learning through a number of projects, driven by the Maternity Improvement Programme.

Current processes in place to review outcomes and develop learning and improvement included for example, maternity governance reporting to the board to drive learning and improvement, data driven maternity dashboard and a perinatal improvement and over sight group.

Incident themes were also reviewed and debriefed .This learning was shared within 'tea trolley' learning sessions daily at 10 am in all areas in order to share learning and actions.