The Royal Bournemouth Hospital

Date of assessment: 16 and 27 September 2025.

Maternity services at the BEACH building at Royal Bournemouth Hospital are delivered through a new maternity and neonatal unit that opened on 31 March 2025, replacing the previous maternity services provided by Poole Hospital.

We carried out the assessment of this maternity service at its new location at The Royal Bournemouth Hospital, which had not been inspected or rated. The service ‘new build’ was designed to deliver around 4,400 babies.

The focus on the new maternity services was to provide a complete journey through antenatal, intrapartum and postnatal care and to provide all emergency care at Royal Bournemouth Hospital. The aim was to provide fewer patient transfers between hospitals and better outcomes for expecting parents and their babies.

Maternity services were based in a purpose-built building and covered the first, second and third floor of the building. This included antenatal and ultrasound clinic areas, fetal medicine unit, vaccination centre, a day assessment, maternity triage area, antenatal and postnatal area, a co-located midwife-led birth centre, labour ward, bereavement suite and 2 maternity theatres. All elective and emergency caesarean sections were completed in the maternity theatres.

We rated the service as Requires Improvement.

During the assessment we found there were some concerns around safe care and treatment of women and babies. There were multiple unfilled shifts on maternity rotas and a high level of staff sickness due anxiety and stress, especially within maternity triage and the maternity advice line.

Staff told us they felt they were not always listened to when raising concerns, especially since the move of maternity services to The Royal Bournemouth Hospital. Staff felt there was a disconnect between managers and staff working clinically to the senior leadership team.

The policy around newborn security had not been updated to reflect the new building and there had been a lack of communication and training for staff on newborn abduction. There was no clear process or guidance to support staff in managing women who arrived out of hours in advanced labour and there had been no skills or drills carried out to safely manage women arriving to the building out of hours since the move to the new building.

Privacy and dignity were not always maintained within the maternity recovery unit.

The service monitored their performance through an electronic dashboard. The dashboard was reviewed and discussed monthly at the maternity governance meeting, with daily reviews of reported incidents. The outcome of these were also discussed at maternity performance meetings, with any learning shared as part of the weekly safety bulletin. However, the two months prior to the assessment we found there was an increase in rates of post-partum haemorrhage and 3rd and 4th degree tears. A review of data showed inconsistencies in rates reported.

At the time of the inspection, the service took immediate action to address the areas of concern.

However, women felt involved in planning and making decisions about their care which was responsive to their needs. They reported staff worked together and supported them to plan their care and the birth of their baby.

During the assessment we saw positive interactions between staff and women. Women told us they were happy with the care they received. The service gathered feedback from mothers regarding their care experiences, to drive improvements. This was carried out using a variety of sources, including patient feedback forms and through the maternity and neonatal voices partnership (MNVP).

Following the assessment and review of the information received there was a breach of regulation 17 for governance.

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.

Safe:

Our overall rating of safe at The Royal Bournemouth Hospital was requires improvement. We looked at maternity services only and rated safe as requires improvement.

Effective:

Our overall rating of effective at The Royal Bournemouth Hospital was good. We looked at maternity services only and rated effective as good.

Caring:

Our overall rating of caring at The Royal Bournemouth Hospital was good. We looked at maternity services only and rated caring as good.

Responsive:

Our overall rating of responsive at The Royal Bournemouth Hospital was good. We looked at maternity services only and rated responsive as good.

Well-led:

Our overall rating of well-led at The Royal Bournemouth Hospital was requires improvement. We looked at maternity services only and rated well-led as requires improvement.

We carried out this assessment on 28 and 29 January 2025.

We carried out this assessment as a responsive inspection, due to concerns we had about the service. We assessed 5 key questions: safe, effective, caring, responsive and well led. We rated surgery services as requires improvement overall because:

Safe

We found concerns in relation to keeping the environment safe, particularly regarding fire safety, the timely availability of emergency equipment and securing hazardous materials

While medicines management showed some effective practices, they were not always stored securely, and some were found to be out of date. Similarly, while infection prevention and control policies aligned with national guidelines, and some areas showed good practice, we observed some inconsistencies across the surgical services in cleanliness which was not always in line with these standards.

Effective

There was a clear emphasis on patient-centred care, evidence-based practices, and strong teamwork across various disciplines. Pro-active safety measures like surgical safety checklists, falls prevention strategies, and thorough pre-operative reviews indicated a commitment to maximising the effectiveness of care and treatment. The use of national guidelines, participation in audits showing positive outcomes in areas like cancer care, and the active monitoring of patient-reported outcomes for procedures like joint replacements, highlighted a dedication to delivering effective and evidence-based care. There was a pro-active approach to supporting healthier lifestyles for specific patient groups, such as those with vascular conditions.

Caring

There was commitment to caring for patients with kindness, compassion, and respect, as evidenced by positive patient feedback across various surgical areas. The service prioritised treating individuals holistically, considering their unique backgrounds and preferences to tailor care plans and actively involve patients in decision-making. While workforce well-being showed positive aspects like valuing staff and providing support networks, issues with break facilities and workload balance for some staff indicated areas for improvement to ensure the team was fully enabled to consistently deliver person-centred care.

Responsive

The service demonstrated a responsive approach to individual needs. People and communities were always at the centre of how care was planned and delivered. The health and care needs of people and communities were understood, and they were actively involved in planning care that met these needs. Care and treatment met people’s personal circumstances and protected equality characteristics. The service acted upon patient feedback and implemented changes based on what they were told.

Well Led

There were shortfalls in governance processes and how leaders identified and mitigated risks. The surgical leadership team did not do enough of their own checks (audits). This meant frontline staff did not always know the risks and leaders did not always have a clear picture of these risks. This led to safety problems like environmental hazards, timely emergency equipment availability, and basic safety mistakes. However, the service had a clear vision, capable leadership, a positive culture encouraging staff to speak up, and a commitment to equality, diversity, and inclusion.

The service was in breach of the legal regulations in relation to, safe care and treatment and good governance.