St Mary's Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This is the first assessment for this key question. This key question has been rated Requires Improvement. This meant people’s needs were not always met.

We have not awarded this service a score for Responsive.

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

The evidence showed significant shortfalls. The service did not make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Staffing pressures at the main hospital site affected the service’s ability to consistently support women to give birth in their preferred place of birth, particularly within midwifery-led settings.

Staff told us giving birth at Portsmouth Maternity Centre (PMC) depended on staffing availability at the main hospital. To facilitate a birth at the centre, midwifery staff needed to be released from the main site, with decisions based on acuity, activity levels and operational pressures within the main obstetric unit. Staff told us that patient choices to labour and give birth at PMC were most commonly declined overnight, as there were no designated maternity staff based at the centre between 8pm and 8am. This meant a woman’s ability to give birth in their preferred setting was dependent on workforce availability rather than their informed choice or clinical need.

The service did not monitor declined place-of-birth requests and was therefore unable to demonstrate how many women were unable to access their preferred birthplace because of staffing or operational pressures. Staff told us women were sent to the main site frequently. Staff at PMC told us they actively advocated for women’s choices and were committed to supporting women to achieve their preferred birth experience. However, workforce pressures at the main hospital site routinely limited the service’s ability to facilitate those choices.

We reviewed transfer data for PMC which showed a woman in active labour was transferred to the main hospital site by ambulance due to staffing availability. This meant the service could not demonstrate that women were consistently able to receive person-centred care that reflected their preferences, values and informed choices when staffing and operational pressures affected service delivery. Following the inspection, senior leaders told us they would begin monitoring declined place-of-birth requests.

The trust faced continued operational and capacity pressures. Trust data showed the service operated at OPEL 3 (high operational pressure) on 267 out of 365 days between April 2025 and March 2026, with four occasions reaching OPEL 4 status. These pressures affected patient flow across maternity services and contributed to service diversions and temporary closures. The trust applied OPEL ratings across the maternity service as a whole and did not report pressures by individual location.

Between October 2025 and March 2026, 17 women were transferred from the main hospital site to neighbouring NHS trusts for induction of labour due to service pressures and delays. These cases were reviewed through regional maternity escalation processes. Senior leaders also reported an increase in moderate harm incidents during December 2025, which were attributed to high activity levels, increased acuity, temporary unit closures and delays in care.

This meant women were not always supported to receive care that reflected their individual choices and preferences. Women who had made informed decisions about where they wished to give birth could not always access their chosen setting because of workforce and operational constraints rather than their clinical needs. The availability of birth options was therefore determined by service capacity and staffing levels rather than women’s preferences.

Staff at Portsmouth Maternity Centre told us they advocated for women’s choices and wanted women to have the labour and birth experience they had planned. However, staffing pressures at the main hospital site routinely affected the service’s ability to facilitate those choices. While senior leaders had escalation processes in place, these were largely reactive and did not consistently ensure women could access their preferred place of birth. The service could not demonstrate that staffing risks were consistently mitigated in a way that protected women’s informed choices or ensured equitable access to all available birth settings.

This meant some women experienced changes to their planned birth pathway at short notice, or while in labour, which may have cause disappointment, anxiety and a loss of control over important decisions relating to their care. This reduced the extent to which care was person-centred and meant women did not always receive care that was fully aligned with their individual needs, preferences and birth plans. This was not in line with national guidance, which states that all women and pregnant people should be supported to make an informed choice about where to give birth and, wherever possible, be enabled to access their chosen place of birth.

We scored the service as 3. The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Senior leaders planned and organised services, so they met the needs of the local population. Facilities and premises were appropriate for the services being delivered.

The continuity of care teams were based at the service, this aligned with the demographics of the area. This meant the service had systems to help care for women in need of additional support or specialist intervention.

Staff monitored and took action to minimise missed appointments. Women who did not attend appointments were contacted by staff without delay.

There was minimal evidence on site due to low activity (MLU with 12 deliveries in 18 months), the majority of the information can be found in the (Main site) report.

We scored the service as 3. The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The maternity department had dedicated social media pages which provided a wide range of information on pregnancy, parenting and newborn care. There were videos which gave parents a chance to see the birthing centre before labour and make an informed choice on if this was their preferred place for birthing. There were also videos which discussed the equipment that may be used and present in clinical areas. This meant that people could be more informed about their options for birth and reduce anxiety around clinical environments.

Senior leaders communicated changes in national guidance through monthly newsletters, departmental alerts, during huddles and through presentations to staff. There were informative notice boards around the maternity unit displaying best practice guidance for breastfeeding.

Information on birth options and realistic expectations was provided to women and their partners during antenatal appointments, through the trust website and via antenatal education sessions.

Women had access to interpreting services so they could understand and make decisions about their care. Women confirmed they had been provided detailed information in a way they could understand. This included leaflets in multiple languages including those most commonly spoken by the local community.

We scored the service as 3. The evidence showed a good standard. The service made it easy for women to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

The service displayed information about how to raise a concern and give feedback on care or experience of the service on notice boards around the unit.

Patients and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs. Women were able to share their experiences with the maternity service through an online feedback form. The online feedback enabled the identification of themes, concerns and areas of good practice.

There was minimal evidence on site due to low activity (MLU with 12 deliveries in 18 months). All evidence supplied by the service for this key question related to the trust as a whole therefore the majority of the information can be found in the (Main site) report.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure that women could access the care, support and treatment they needed when they needed it.

There were no on‑call staffing arrangements for community midwives based at the midwifery led units for the majority of patients. The only midwives operating an on-call system were those working within the Continuity of Carer (CoC) teams. This meant women who went into labour out of hours and were not under the CoC team, could not always birth at the midwifery led unit. Staff at the service told us they would support on call working if it empowered women to attend their designated place of birth.

Women could directly refer themselves to the community maternity services at the trust if their pregnancy had been confirmed by a positive pregnancy test via a maternity self-referral form before 10 weeks of pregnancy. Women did not have to refer through their GP first. Community midwifery teams worked across a large geographical area and worked flexibly to meet the needs of the service.

Women deemed low risk were given the option to birth at home, at midwifery led birth centres, or the labour ward at the main site. Feedback from women told us they 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.

There was minimal evidence on site due to low activity (MLU with 12 deliveries in 18 months), the majority of the information can be found in the (Main site) report.

We scored the service as 3. The evidence showed a good standard. Staff and leaders actively listened to information about women who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Staff within the service and the wider organisation promoted a culture in which the women using the service felt empowered to give their views. The service worked closely with the MNVP and the local maternity and neonatal system (LMNS) to ensure that the voices of women experiencing discrimination or inequality were heard to improve service user outcomes and drive improvement to the service.

The trust worked alongside the MNVP & LMNS towards a 3-year equity and equality report. The trust had a maternity equality and diversity steering group who analysed data from saving babies lives, continuity of care and ethnicity data collection to identify and reduce inequalities.

The provider had undertaken equality impact assessments of their policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage.

The service used women’s feedback and other evidence to improve access for women more likely to experience barriers or delays in accessing their care. The service made sure maternity information leaflets informed women of their choices and integrated core equity and equality values. Following on from feedback from the MNVP the service introduced more photos and images using women and families from a diverse background.

CoC teams provided 24 hours on call cover for intrapartum care which included nights and weekends. The team’s self‑rostered and worked autonomously, which enabled more flexibility. Continuity of Carer midwives based at this location worked with women identified as benefitting from dedicated midwife care to offer personalised antenatal care and improvements.

However, the trust did not provide evidence that staff were trained in equality, diversity, inclusion and human rights.

We scored the service as 3. The evidence showed a good standard. Women were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Women could get information and advice that was accurate, up to date, and provided in a way they could understand to plan for their birth. The service supported women to make informed choices about their care. This was achieved through health promotion information, antenatal classes, appointments with midwives, birth plan documents, information leaflets, and resources available on the maternity page of the trust’s website.

Women were supported to make decisions to improve their overall health. This included stopping smoking and making healthy eating choices.

Women were clear about discharge plans and who to contact with any concerns. Discharge summaries were shared electronically with health visitors and GPs and follow up arrangements were made prior to discharge.