- NHS hospital
Nottingham City Hospital
Report from 10 February 2025 assessment
Ratings - Maternity
Our view of the service
Nottingham City Hospital is operated by Nottingham University Hospitals NHS Trust. The maternity service sits within the division of family health and provides a range of services from pregnancy, birth and postnatal care. There are inpatient antenatal, intrapartum and postnatal beds available for women. Bonnington ward is a 27 bedded mixed antenatal and postnatal ward which has a dedicated four bedded bay for induction of labour. Lawrence ward is a 27 bedded mixed antenatal and postnatal ward which has a dedicated four bedded bay for induction of labour.
The Labour Suite has 13 beds with a separate four bedded midwife led unit called the Sanctuary Birth Centre. There are also two obstetric theatres within the labour suite with 24-hour anaesthetic cover, a bereavement suite and direct access to the neonatal unit. There is a five bedded combined maternal and fetal surveillance (ABC) triage unit located on the ground floor where women requiring urgent care outside their routine clinical appointments were seen.
Nottingham City Hospital welcomes on average 5,300 newborns each year. Community midwifery services are provided by teams of midwives and there was a separate homebirth team.
The on-site inspection of the service took place on 20 and 21 May 2025. The inspection team visited all areas within the maternity service and spent time with both the community and homebirth teams. We spoke with 30 members of staff and reviewed 15 patient records.
The inspection team comprised of a senior specialist, three inspectors, 2 midwifery specialist advisors and one consultant specialist advisor.
Our rating of maternity services remained the same. We rated them as requires improvement. We found breaches of regulations relating to security; organisational culture, staff wellbeing; engagement; visibility of leadership; consultant staffing and safeguarding training requirements.
Safe:
We rated safe as requires improvement. Learning was not always based on openness and was not always shared effectively. Security arrangements did not always keep women and their babies safe. There were not always enough staff, there were gaps in the consultant staffing. Managers did not always make sure staff received training and regular appraisals. However, staff understood how to manage risks as far as practicable. Facilities met the needs of people and were clean and well-maintained. Staff managed medicines well.
Effective:
We rated effective as good. Women were involved in assessments of their needs. Staff reviewed assessments taking account of women’s communication, personal and health needs. Care was based on latest evidence and good practice. Staff worked with all agencies involved in women’s care for the best outcomes and smooth transitions when moving services. They monitored women’s health to support healthy living. Staff made sure women understood their care and treatment to enable them to give informed consent.
Caring:
We rated caring as good. Women were treated with kindness and compassion. Staff protected their privacy and dignity. They treated them as individuals and supported their preferences. Women had choice in their care and were encouraged to maintain relationships with family and friends. Women consistently had nothing but praise for their experience throughout their pregnancy, birth, and postnatal experience. Staff responded to people in a timely way. However, leaders did not always support staff wellbeing.
Responsive:
We rated responsive as good. Women were involved in decisions about their care. The service provided information which women and their families could understand. Women knew how to give feedback and were confident the service took it seriously and acted on it. The service was easy to access and worked to eliminate discrimination. Women received fair and equal care and treatment. The service worked to reduce health and care inequalities through training and feedback. Women were involved in planning their care and understood options around choosing to withdraw or not receive care.
Well-led:
We rated well-led as requires improvement. Leaders were knowledgeable but they were not always visible within the service and sometimes perceived as unsupportive. Staff were encouraged to feedback but were not always heard. However, the trust had a shared vision and culture based on listening and learning. Staff understood their roles and responsibilities. Managers worked with the maternity and neonatal partnership to deliver the best possible care and were receptive to new ideas.
People's experience of this service
During our onsite inspection, women and any family or carers with them were mostly positive about the staff treating them, with warmth and kindness and providing effective care and treatment. They said they were seen quickly upon arrival by trained midwifery staff to find out more about why they had attended.
Patient records we reviewed onsite showed they were seen in a timely manner. We observed the service providing mutual aid between sites to reduce the risk of delays in triage or induction. Women understood why they may deliver at a different site and accepted this.
Some women expressed concerns about receiving their maternity care in a service that was under so much scrutiny due to the well-publicised historical failings in care. We heard women had considered free-birthing (the intentional act of giving birth without the assistance of any medical or midwifery professionals) or homebirth. However, they all stated they had positive experiences of the care they received and praised the staff for their kindness.
We refer to women in this report, but we recognise that some transgender men, non-binary people and people with variations in sex characteristics (VSC) or who are intersex may also use services and experience some of the same issues’.