- NHS hospital
Queen Alexandra Hospital
Assessment report published 25 September 2026
Ratings - Maternity
Our view of the service
The maternity inspection took place between the 17 and 18 March 2026 and was a planned inspection of the service. At the last inspection the service was rated as Good in 2023. During this inspection the service was rated as Requires Improvement.
Queen Alexandra Hospital, part of Portsmouth Hospital NHS Foundation Trust provides care to the population of Portsmouth and the surrounding areas. Queen Alexandra hospital provided both obstetric maternity services and a midwifery led birthing unit. Between April 2025 and February 2026 there were 4413 births within Queen Alexandra Hospital, midwifery led units and home births.
We carried out a full comprehensive assessment of the service looking at all of the 5 key questions, safe, effective, caring, responsive and well led.
Maternity services included an outpatient’s area consisting of antenatal clinics and scheduled care. The delivery suite had two obstetric theatres and there was a midwifery led birthing unit B5. B6 and B7 provided antenatal and postnatal care as well as transitional care for babies.
The unit provides a 24-hour maternity triage service from within the Maternity Assessment Unit. We found the service was not meeting the trust target of 80% of women to receive an initial review within 15 minutes by a midwife. The service provided the data for February 2026, which showed women were seen within the required timeframes for women to receive a medical review within MAU. However, we could not be assured the service were meeting targets outside of this month.
There was a maternity support worker (MSW) vacancy within the MAU, however, this was currently on hold due to MSW vacancies across maternity services and the service reported the positions were to be prioritised within other areas of maternity.
The acute maternity service is a level 3 tertiary unit with an additional requirement of accepting extreme preterm births from out of area. This was reviewed within governance through maternity and neonatal regional safety huddles and during safety reviews. Between October 2025 to March 2026 there were 17 cases where women were transferred to a neighbouring trust for their induction of labour due to operational pressures and delays within the service.
There was continued non-compliance of safeguarding level 3 training for both adult and children, with no compliance reported for medical and anaesthetic staff for level 3 adult safeguarding training.
Community midwifery teams provided midwifery care to women throughout the antenatal and postnatal period. Community teams were based in local maternity birth centres.
The service worked closely and had positive relationships with the local Maternity and Neonatal Voices partnership (MNVP). The MNVP engaged regularly with senior leaders to ensure voices of women were heard and feedback was passed on, including a bi-monthly triangulation of feedback meeting.
There were 5 established maternity continuity of carer (CoC) teams as part of an ongoing model of care. These teams provided 25% of the births within the locality with teams delivering the full continuity pathway including intrapartum care. 30% of the CoC caseloads were women from black, Asian and ethnic minority backgrounds.
Staff knew what incidents to report, raised concerns and reported incidents and near misses in line with the trust policy.
Women were given information and advice about their health, prenatal and postnatal care. They told us during the assessment that they felt well supported by the multi-disciplinary team and felt they were involved in the assessment of their needs.
The service received positive feedback from the women and their families who used it. Feedback from women and their families was gained through the friends and family test (FFT) and the birth reflections service.
There was a breach of regulation 12: safe care and treatment, in relation to the continued non-compliance in safeguarding training.
A breach in regulation 17: good governance, in relation persistent poor staffing and daily, severe operational pressures OPEL level 3 and level 4, showed there was a continuous inability to meet national staffing standards. These frequent escalations indicated a chronic, widespread failure rather than temporary surges.
We refer to women in this report, but we recognise that some transgender men, non-binary women and women with variations in sex characteristics (VSC) or who are intersex may also use services and experience some of the same issues.
An action plan will be requested upon publication of the final report.
Safe:
Women were not always protected from avoidable harm. Safeguarding training compliance was significantly below target, safeguarding risk assessments were not consistently completed, and staffing levels did not always meet the needs of women safely.
Staff understood safeguarding processes, raised concerns appropriately, and responded to deterioration. Incidents were investigated, learning was shared, and medicines were managed safely.
Staff did not always assess woman’s health or complete monitoring to keep women and their baby safe.
Staffing did not consistently meet planned levels, despite mitigation and oversight, and represented an ongoing risk to staffing resilience within the service and the delivery of safe care.
Effective:
Women’s needs were assessed and reviewed, and care was delivered in line with evidence-based guidance. Women were involved in decisions about their care and supported to make informed choices. The service promoted healthy lifestyles and access to specialist support.
Caring:
Staff treated women with kindness, compassion, and respect. Women’s privacy and dignity were maintained, and they were involved in discussions about their care.
Responsive:
The capacity and flow of the maternity unit had a significant impact on women accessing the service and honouring choices in preferred place of birth, particularly for the midwifery led unit. This meant there was a significant impact on the flow around the maternity unit and a high number of cases requiring mutual aid from regional trusts and closures to the service.
Well-led:
Governance and oversight systems were not always effective. Senior leaders did not have sufficient oversight of safeguarding, staffing, access to women’s chosen place of birth, outcomes, and improvement actions. The culture was not consistently positive, and staff did not always feel listened to or supported by senior leaders.
Local senior leaders were visible and supportive. Staff were encouraged to speak up and contribute to improvement, senior leaders and staff understood the service vision and objectives.
People's experience of this service
All women we spoke with were positive about the service. Information from the maternity survey 2025 benchmarking report showed that women were positive about their birthing experience at Queen Alexandra Hospital. Women told us they felt safe, well supported and cared for by both the midwifery and medical teams. Staff explained risks and involved people in the decision-making process.
Staff were described as supportive and caring. Women had access to contribute and feedback about their experiences through the local Maternal and Neonatal Voices Partnership (MNVP) who also feedback to the trust regularly to drive improvement across the service.