Maternity programme showed short term leadership improvements but limited reach and sustainability

A national programme designed to improve leadership and culture in maternity and neonatal services showed potential in improving teamworking among local leaders, but structural barriers prevented wider benefits across perinatal services in NHS Trusts, a new report reveals.

University of Birmingham academics conducted an independent evaluation of the Perinatal Culture and Leadership Programme (PCLP), examining its effectiveness in addressing persistent challenges identified in perinatal services, which incorporate maternity care from the start of pregnancy and neonatal care for children born premature or sick.

The PCLP spanned all 156 maternity and neonatal services in England and was designed to improve leadership, culture and collaborative working between maternity and neonatal clinicians by training and supporting a ‘quad’ of senior midwifery, neonatal, obstetric and operational leaders.

The evaluation, which was commissioned by NHS England, was undertaken between October 2023 and July 2025. Academics conducted 53 interviews, surveyed hundreds of senior leaders and other perinatal staff, and carried out rapid ethnographic research across a cross-section of English NHS Trusts.

The team found:

• Evidence that the quad model and programme of support improved relationships, collaboration and shared vision among senior leaders but struggled to embed change beyond that group;

• Structural barriers — including workforce pressures, leadership turnover, limited trust-level buy-in and short-term funding — constrained sustainability and spread;

• Practical lessons for Trust executives and Integrated Care System leaders on what future culture and leadership programmes need to succeed, including more protected time for participants, longer-term support and clearer accountability for culture improvement within NHS Trusts; and

• A strong case for embedding academic expertise and evaluation at the start of large-scale NHS initiatives to improve value and learning.

Emeritus Professor Sara Kenyon MBE from the University of Birmingham, Co-Principal Investigator of the evaluation, said: “Efforts to address relationships between leaders in maternity care in the UK represent an important step towards improving the quality and safety of perinatal care. The Perinatal Culture and Leadership Programme has been an innovative attempt by the NHS to improve leadership and culture, and it is laudable that investment was put into addressing this aspect of improving perinatal services across the country.

“There were some clear benefits from the programme that we found in our evaluation. However, some of the barriers that existed in those Trusts hampered the spread of these benefits to staff, women and babies. Our recommendations for future culture and leadership programmes include a strong call to incorporate a longer-term package of support and stronger accountability for culture improvement. This would ensure the benefits of such a programme can be embedded in the wider culture across many different trusts across the country that are all individual.”

Boosting teamworking amid structural issues

The academic team which completed the evaluation found three main themes from the combination of interviews, surveys and ethnographic data.

First, the programme was effective at establishing a better working partnership amongst senior leaders from maternity and neonatal services. The ‘quad’ model and programme of support improved teamworking and helped develop a sense of shared vision among leaders, however, the academic team also found long-term limitations based on workload pressures and a high turnover among members. While there was some evidence of changes in leadership behaviours, this did not appear to extend beyond the ‘quad’.

Second, the evaluation found that there was limited evidence of more widespread impact beyond the ‘quad’ due to a lack of protected time for staff to dedicate to culture improvement, limited long-term support from the programme and insufficient board-level and human resources oversight. The team noted that assumptions were made about the stability of the ‘quads’ after their establishment and their ability to have capacity to engage with the programme. The team also noted the lack of culture- or behaviour-change theory embedded within the programme design, highlighting the need for academic expertise in large-scale NHS initiatives.

Third, specific structural barriers were identified which affected the impact of the programme. These included widespread issues such as workforce pressures and issues affecting certain types of Trusts, such as those which had maternity and neonatal services in different divisions, impeding perinatal working.

Dr Tommer Spence from the University of Birmingham said: “The evaluation provides a mixed picture of some benefits as well as barriers for the programme in improving perinatal services. Each Trust is a large and unique organisation, with distinct local issues within and across departments. We saw that a one-size-fits-all approach was ineffective at transforming leadership and culture, and that making successful change requires a long-term and deep commitment from both national bodies and local Trust boards.”

Dr Laura Noszlopy from the University of Manchester who was part of the research team while at the University of Birmingham, said: “This evaluation outlines some of the difficulties in creating a programme that can adequately address the complexities of improving leadership and workplace culture across the NHS. The PCLP made a positive step towards supporting greater collaboration between leaders in perinatal services, though its wider reach and impact were hindered by staffing pressures and other entrenched systemic challenges. We hope our findings will be useful to Trusts and policymakers when considering ways to progress and sustain this crucial aspect of perinatal care.”