Princess Royal Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that women and communities had the best possible outcomes because their needs were assessed. We checked that women’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring women were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last assessment this key question was not rated. At this assessment we rated effective as good. This meant the effectiveness of people’s care, treatment and support achieved good outcomes and was consistent.

The service worked with agencies involved in people’s care for the best outcomes and smooth transitions when moving between services. They monitored people’s health to support healthy living. Staff made sure people understood their care and treatment to enable them to give informed consent. There were positive examples of person-centred care. Women were given information and advice about their health, prenatal and postnatal care.

However, staff did not always have up-to-date guidance to follow legislation and current evidence-based good practice and standards. The trust did not effectively use benchmarking to ensure that outcomes were positive and consistent.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

We scored the service as 2. The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing, and communication needs with them.

The ongoing issues within the obstetric theatre meant there were frequent delays for women. Women’s needs were not always met at the planned time and care delivery was influenced by theatre availability rather than clinical planning.

Women were not always reviewed in line with national guidance. Women’s needs were assessed in triage by experienced midwives and doctors using the recognised triage review tool, but it was not always within the trust target of 15 minutes.

The risk register identified capacity risks within both fetal medicine and diabetes clinics at PRH. Women attending fetal medicine clinics with complex care were referred to other tertiary centres due to limited clinic capacity. This meant, that women were seen quickly to ensure safety, however, this did impact on continuity of care and the women’s overall experience. Tertiary centres are specialist hospitals that provide advanced care for patients with complex, high‑risk, or rare conditions, typically receiving referrals from primary and secondary care services.

Staff told us they were supported by senior colleagues, and they worked together to make sure women made informed decisions based on best practice guidelines. Staff were able to describe how they assessed and reviewed women’s needs from the antenatal to postnatal period to provide holistic support.

Women were given information and advice about their health, prenatal and postnatal care and had access to specialist clinics where required, including women who had specific medical needs.

During our assessment we reviewed 6 care records which showed examples of person-centred care and women were supported in choosing their birth options. Birth plans were personalised and up to date.

Leaders attended two cross site risk meetings each morning. Staff attended maternity huddles, which were held twice daily 7 days per week. We attended 2 huddles which were attended by midwives, midwifery support workers and doctors.

Staff were observed sharing key information using the Situation, Background, Assessment and Recommendation (SBAR) tool to communicate important information about a woman’s condition. This made sure assessments were based on accurate and up‑to‑date information, enabling appropriate clinical decision‑making and improving the service’s ability to respond effectively to women’s assessed needs.

The maternity team used the National Perinatal Mortality Review Tool (PMRT) to review perinatal deaths and the quality and safety committee and maternity safety champions meetings. The maternity safety champions were leaders in maternity and neonatal care focused on improving safety and quality.

We scored the service as 2. The evidence showed some shortfalls. The service did not always plan and deliver women’s care and treatment with them, including what was important and mattered to them.

The service reported the trust was experiencing challenge with clinical guidelines and the maternity service was working towards merging its current guidance across all maternity sites.

From October 2025 the safety and quality report showed 108 of maternity documents were out of date. This was on the maternity risk register due to the ongoing delay in updating guidance and the potential risk this may cause. For example, out of date documents could lead to potential safety issues and risks, inconsistencies in maternity care given and differences in maternal health outcomes.

Staff were able to access guidelines on the trust’s intranet system. Although guidance was available there continued to be key maternity guidance which was not in date or aligned across the maternity locations.

The guidance for postpartum haemorrhage (PPH) management was out of date. Staff currently used the University Hospital Sussex Obstetric Haemorrhage guidance which was also out of date and not aligned with the most recent National Institute for Health and Care Excellence (NICE) guidance. For example, using the correct dose of misoprostol and a flow chart which did not reflect the most recent safe actions and options for management of PPH a major obstetric haemorrhage over 1 litre.

The service did not have a maternity bereavement policy. The bereavement team followed actions outlined in the Intrauterine Death Policy, however, this policy was also out of date in November 2023. We were told bereavement midwives instead followed the National Bereavement Care Pathway.

Throughout the maternity unit noticeboards with posters to show current learning and to share best practice and national guidance with maternity staff.

Maternity services did not have an audit schedule, and staff did not routinely carry out local audits alongside current national guidance. This meant there was a risk of not identifying areas for improvement, deterioration in care as well as a lack of overall learning.

Staff used nationally recognised tools, such as the maternity early warning scores (MEWS) and the newborn early warning trigger and track (NEWTT2) tool, to identify women and babies at risk of deterioration. The trust had not implemented a MEWS or NEWTT2 audit due to the current electronic record system being unable to capture all required data.

Senior leaders told us MEWS and NEWTT2 were discussed within the trust guidance ‘Recognition and Management of Severely Ill Pregnant women/women including Enhanced Maternal and Critical Care’. However, this guidance had not been updated and was out of date, expiring in November 2024. Senior leaders had drafted a standard operating procedure (SOP) to support staff completing MEWS and NEWTT2 prior to the upcoming electronic update. However, the SOP had not gone through the appropriate governance process, therefore staff continued not to have guidance.

MEWS documentation was not currently audited by the trust. The service told us that the new version of the tool was due to be uploaded to the electronic notes system in March 2026. Without completing monthly audits, senior leaders were unable to identify areas of poor performance, reducing their assurance that women and babies were receiving safe care.

Maternal readmissions were not reported by maternity location but instead reported as trust wide figures which included all 4 maternity locations. Sepsis cases were not reported to not be audited due to the low number of cases.

However, during a data review of the information provided by the trust following the inspection showed there was conflicting data reported in regard to both maternal readmission and sepsis rates. This meant the service could not be assured they were actively collecting the right data and information to identify any themes, trends or possible causes as to why women were being readmitted.

For example, it was reported there were no reports of sepsis on the cases of maternal readmissions between May 2025 to October 2025. A review of meeting minutes showed there was 1 maternal readmission to the service with sepsis found on admission.

The service did not routinely carry out local audits. Not completing local audits, limited the services ability to identify learning from adverse outcomes and national trends. This reduced opportunities to strengthen risk identification and clinical assessment, meaning women’s and babies’ needs may not be consistently informed by the most up‑to‑date evidence and learning. As a result, learning may not always be used as effectively as possible to support ongoing improvement in maternal and neonatal outcomes.

However, the service did contribute to some national audits, such as perinatal mortality, and Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK).

We scored the service as 3. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Teams had effective working relationships, with staff reporting they worked well as a team and there was a good culture between midwives and obstetricians.

Staff considered patients’ individual needs and circumstances and we observed effective handovers. During safety huddles we observed maternity and obstetric teams actively having discussions around supporting women.

There was a continuity team for all women who used the service where there were safeguarding concerns, long term conditions, mental health or other additional support needs. During midwifery safety huddles we observed active discussions around women with complex care who required support to have the birthing experience they wanted. The service had worked with other agencies to develop a multi-agency birth plan.

The service worked collaboratively with system partners through the Local Maternity and Neonatal System (LMNS). The trust and LMNS were working to produce a training programme to support midwives to train for the high dependency course. The course gave midwives the advanced knowledge and skills required to care for critically ill and high risk pregnant or postpartum women.

Leaders worked with the local Maternity and Neonatal Voices Partnership (MNVP) to contribute to decisions about care in maternity services.

There was a monthly service user workstream working group in place, chaired by the head of midwifery and MNVP. The group reported into the maternity and neonatal improvement group, which was chaired by the chief nurse and attended by stakeholders to support and advise the trust such as NHSE, LMNS, Maternity Safety Support Programme (MSSP), and MNVP. The MNVP provided friends and family feedback to improve antenatal appointments and discharge processes by identifying further information about women’s background and history to support their maternity journey.

Bereavement services had links with mental health teams and external support agencies to support women following loss.

We scored the service as 3. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Staff assessed women's health when admitted and provided support for any individual needs to live a healthier lifestyle. Women were asked about their smoking status at their booking appointment, and all women were offered carbon monoxide screening.

The trust website included a dedicated page with advice and support during pregnancy, including antenatal education. Women could also access information about their health, care and support via the maternity pages online, printed leaflets, and from staff during appointments.

Posters were displayed around the unit for the ‘swap to stop’ campaign. The campaign promoted switching to an alternative as a step towards stopping smoking. The service monitored this using a dashboard which showed women were taking this advice and less women were smoking at delivery than at booking.

We scored the service as 2. The service did not always routinely monitor women’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of women themselves.

The perinatal quality oversight model (PQOM) measured current performance and maternity clinical indicators which measured maternity outcomes and performance. However, the trust did not add benchmark data or target indicators to identify whether the service was making improvements or significantly not meeting national requirements and were an outlier.

The number of 3rd and 4th degree tears between April 2025 to August 2025 showed there was a significant increase above the national average. The trust had been working with staff to implement the obstetric anal sphincter injuries (OASI) bundle and to work on the correct technique and optimising maternal position. However, the rates at Princess Royal Hospital continued to be high. The Oasis bundle refers to interventions designed to improve outcomes for women experiencing OASI.

Maternity services across the 4 sites did not meet the compliance to complete hip scans for babies who met the referral criteria within the required timeframe. This was due to issues with scan appointment capacity. Completion of hip scans supported early identification of developmental hip conditions, enabled timely intervention, and improved long‑term musculoskeletal outcomes for babies. Where scans are not completed as planned, there was an increased risk of delay in diagnosis, which could affect mobility, development, and future quality of life.

The trust did not meet the compliance with saving babies’ lives (SBL) care bundle. Compliance had gone from 97% compliant to 49% over the four trust maternity locations. This was due to a change within the SBL guidelines and new requirements added. Compliance was low in improving the monitoring smoking status of women at 36 weeks of pregnancy and there was a delay in accessing ultrasound scans. The trust was currently exploring options to work toward a 7-day scanning service to meet the needs of women and the requirements of SBL. The service had put in place urgent mitigations to improve the compliance rate by November 2025.

The national rate for PPH levels was reported to be 32% per 1000 births and the figures given for the service during our data request were 21.28% for June 2025, July 2025 31.58% and 11.90% for August 2025. Recognition and management of postpartum haemorrhage supported timely intervention and contributed to improved recovery and postnatal outcomes for women.

The service learned from neonatal deaths via a child death oversight panel. These were presented to the board through a series of meetings. Learning was also shared system wide via the LMNS quality and safety forum and the board.

Neonatal outcomes across the trust had shown an improvement within neonatal mortality rates which were below the national average.

We scored the service as 3. The service told women about their rights around consent and respected these when delivering person-centred care and treatment.

Women we spoke with felt they had been given enough information, including risks and benefits, to make an informed decision about their care and treatment and that they were able to give informed consent.

Midwives understood how to assess women’s capacity to make decisions. On our review of women’s record’s, we found completed consent forms for caesarean sections as well as when gaining verbal consent when completing care.

Staff had access to mental health/deprivation of liberty safeguards (DoLS) guidelines on the trust intranet. Staff were able to talk about DoLS and how this would impact a woman on the unit. Staff were aware of their responsibilities under the Mental Capacity Act 2005.