New Cross 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

There were not always clear governance processes in place to ensure women and their babies were safe. For example, the trust did not audit decision to delivery interval and indications due to it no longer being a national requirement. However, most staff were positive about the culture of the service. Leaders were able to identify the top risks on the risk register and their mitigations. There was a strategy alongside a set of values and a leadership quad 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 completed various quality improvement projects as well as some that remained ongoing. However, some areas continued to fail to improve month on month.

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.

Leaders told us the trust was one of the first to undertake the national perinatal culture and leadership programme and that they have since trained 4 staff who undertake cultural conversations in the service. Most staff were positive about the culture of the service and felt able to speak up to their managers about any concerns without fear. A student midwife felt they would be able to speak up and that there was a good relationship between the service and their university. One manager spoke of some tensions between different units of the service due to feelings of inequity in workload and staff redeployment but told us that they are now sharing redeployment data to show staff the true picture. Results of the latest trust staff survey showed that staff morale in women’s and neonatal services was rated 5.76 out of 10, below the organisational average of 6.08. However, the score for ‘we each have a voice that counts’ was above the organisational average, and staff engagement was roughly in line with the organisational average.

There was a strategy in place “Our Strategy” 2022-2027.The vision was “to deliver exceptional care together to improve the health and wellbeing of our communities”. The strategy was based on the 4 strategic aims of Care, Colleagues, Collaboration and Communities. There were a set of values in place which included respect, compassion, professionalism and teamwork. There was a wellbeing dashboard in place, a pilot that has been funded for 2 clinical areas. This gave staff the opportunity to rate their day anonymously and was viewed on a weekly basis by the quad team. We also reviewed some slides from the 2023 NHS staff survey breakdown report. Areas looked at included we are a team; morale and we each have a voice that counts. The department scored above organisational average in all areas.

Most staff were positive about their leaders, particularly their ward managers and matrons. One midwife said their ward manager was “really good”, and staff felt able to share ideas as they would be listened to. They said the matron was approachable, “always smiling”, and felt they could go to them with anything if their manager was absent. Another staff member said that ward managers and matrons were very visible, and that senior leaders have recently become more visible in the service. A doctor said their consultants “took ownership” of the service, even when not on duty. A senior leader said they were trying to improve their visibility because of feedback from cultural conversations by spending more time in clinical areas and protecting time to meet with staff. They told us they supported future senior leaders by exposing them to activity such as report writing and presentation, so as to increase confidence for future roles. They told us that all matrons were currently on or had completed master's degree programmes.

There was a well-established leadership quad in place who oversaw the maternity department. Civility and respect training sessions had been held in maternity services with the team being early adopters and incorporating the training to the maternity training programmes from February 2023. The training was about how staff treat each other at work, provided practical guidance and resources to tackle bullying and harassment and create a civil, respectful and positive working environment that was kind, compassionate and inclusive for all. Leaders had completed various leadership courses such as master's in healthcare leadership and master's in digital leadership as well as restorative practice training.

We spoke with members of the Freedom to Speak Up team as part of the assessment. They told us champions in the Maternity service committed to at least 3 bi-monthly meetings a year and assist with activities such as pop-up stands and postering. They stated that 4 concerns had been raised within Maternity in the last year, some of which were concerning staff attitudes and behaviours, and others which were raised by students. They told us that as a result of students raising concerns with them, they now engaged with students during their induction sessions. They told us leaders took concerns seriously and were very responsive in trying to resolve them. Staff were aware of Freedom to Speak Up, but not always sure who their local champions were. One member of staff told us that colleagues tended to use their professional midwifery advocates more for support.

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. There was a Freedom to Speak up team which included 2 champions in the maternity service. We reviewed a Freedom to Speak Up report from October 2024 and noted it contained themes, dates of drop-in sessions and pop up stands as well as dates of upcoming presentations and teaching sessions. However, the report was trust wide and did not break down themes into specific departments.

We spoke with the Equality, Diversity and Inclusion (EDI) lead as part of the assessment. They told us about staff support networks including the Black and Asian employability group and lesbian, gay, bisexual and transgender +(LGBT+) network. They told us that they hosted events for staff throughout the year such as Diwali and Eid celebrations which were well-received, although recognised that funding could sometimes be a barrier to the events. They told us that they put on EDI training events for staff, such as the care of LGBT+ service users, but there were sometimes barriers to staff receiving training in not being able to be released from clinical duties to attend. A member of staff told us how the EDI lead supported internationally trained midwives to settle into their new surroundings, and during a recent period of national unrest, arranged for these staff to become ‘travel buddies’ to ensure they felt safe when travelling to and from work. One member of staff approached us to report that they felt that had experienced poor treatment which they felt was racially motivated, however, we did not receive any other feedback of this nature.

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 data and recorded this within a report. However, this was not maternity specific but trust wide data which looked 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. The hospital also had 7 employee voice groups and used cultural ambassadors on disciplinary and interview panel. The hospitals EDI journey was aligned with the public sector Equality Duty compliance requirements under the Equality Act 2019 taking into account national compliance drivers such as the Gender Pay Gap.

Leaders were able to describe the pathway of governance and assurance. They told us they discussed incidents, trends, inward reports and any other issues that flagged in local meetings at weekly assurance meetings (WAM). Matters could be escalated from WAM to the monthly Safety, Quality Assurance Research and Engagement Meetings (SqUARE) which was chaired by the director of midwifery (DoM). They told us that SqUARE was undertaken in the style of a board meeting, with the DoM providing confirm and challenge. They spoke in detail about the top risks on the risk register and their mitigations including the fragility of the scanning service, recent fire service enforcement, and risk around staff entonox exposure. Leaders told us there were a team of 2 governance leads, a lead on the saving babies lives bundle, a perinatal mortality lead, and that another band 6 governance post had recently been recruited to.

There were not always clear governance processes in place to ensure women and their babies were safe. For example, the trust did not audit decision to delivery interval and indications due to it no longer being a national requirement. However, they did review each case through the weekly risk meeting and reviewed delays in the patient journey. There was a governance and meeting structure in place as well as up to date policies and procedures. We saw examples where opportunities for learning had been identified. Detailed reports were available which gave clear oversight of themes and trends, for example, the Perinatal Integrated Quality and Safety Governance and matrons reports. There were maternity dashboards as well as action plans when compliance did not meet expected levels. There was a CQC action plan in place which continued to be reviewed on a regular basis. We reviewed the department’s risk register and saw it contained up to date risks such as staffing, reduced scanning capacity and delays in transfer to the delivery suite. Leaders participated in Safety Quality Assurance and Research meetings which included topics such as birth trauma and gap analysis, Maternity and Newborn Safety Investigations, new or emerging risks, maternity mortality reviews and quality committee reports. However, some areas continued to fail to improve month on month such as delays of time critical transfer, some audit data and staffing.

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.

A lot of quality improvement work had taken place in triage since the last inspection, and induction lists were all electronic. Leaders told us about the trust’s leadership of a national study around anaemia in pregnancy, and also a project looking at keeping babies who require continuous positive airway pressure treatment with their mothers, where they would normally be admitted onto the neonatal unit. A manager spoke about having recently been approved to provide a high dependency course for staff having recognised a gap in training.

The department was actively involved in various quality improvement projects. Projects registered in 2024 included a planned obstetric surgery improvement project, improving fresh eyes compliance to achieve the standard of saving babies lives intrapartum audit as well as improving the response rate of emergency maternity triage calls. There had been various maternity studies that the department had also participated in. There were 4 projects ongoing at the time of the assessment. These included primary prevention of maternal anaemia to avoid preterm delivery and other adverse outcomes, pregnancy antihypertensive drugs: which agent is best, smoking nicotine and pregnancy trial, and calcium supplementation for women and birthing people at high risk of pre-eclampsia. The department’s electronic system had the ability to import pathology results into patient records. This meant results could be reviewed much easier including specific test results and would improve the speed and safety of the results process. The maternity unit was now triaging all women and birthing people who attended with diminished foetal movements and was triaging 73 women and birthing people more each month since the service improvement. They were also triaging all women and birthing people who attended with spontaneous rupture of membranes.