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

At our last assessment we did not inspect or rate this key question. At this assessment effective was scored as good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff were able to describe how they assessed and reviewed women’s needs from the antenatal to postnatal period to provide holistic support.

The service operated a green, amber and red system to guide assessment and decision‑making when supporting women with their birth choices. All risk factors were assessed at booking and reviewed throughout their pregnancy.

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.

Staff carried out risk assessments for women during antenatal care in line with national guidance. These included social assessments, risk assessments for blood clots and mental health assessments. Staff made referrals to consultant led clinics for women with medically high-risk pregnancies. Risk assessments for women were in line with national guidance.

The service had continuity teams focused on women living in areas of deprivation and women from the black, Asian and ethnic minority population. The continuity teams carried a geographical caseload which included women with a mixed level of needs. The community matron told us if women requested to be supported by the continuity team this would be supported if this could be facilitated by the team. An example of women would be those who had experienced previous birth trauma or had felt not listened to in a previous pregnancy.

Referrals to the perinatal mental health midwives were made directly by the antenatal booking midwife when a need was identified. However, a referral could be made at any point during the pregnancy or postnatal period if there was an emerging or escalating mental health concern.

Women’s nutrition and hydration needs were met in line with current guidance. Women told us they were regularly offered drinks.

We scored the service as 3. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff provided up to date evidence-based practice in line with national guidance to make sure patients had good outcomes. Staff followed up-to-date policies to plan and deliver high quality care according to evidence-based practice and national guidance. These included National Institute of Health and Care Excellence (NICE) and Royal College of Obstetricians and Gynaecologists (RCOG). Staff had access to guidelines on the trust’s intranet system.

During a review of women’s records we found there were gaps within the documentation reviewed, which showed a lack of completion of the World Health Organisation (WHO) surgical checklists. Following the inspection the service told us immediate actions were taken to reinforce the completion of safety checks during team briefings and mandatory training. The WHO checklist was audited monthly and the learning from audits was identified through the maternity governance processes. The service reported they were currently simplifying their digital documentation process to improve the workflow, to support consistent completion of the WHO checklist.

Most staff we spoke to told us they were supported by senior leaders, and they worked together to make sure women made informed decisions based on best practice guidance.

Midwifes had access to specialist midwives for support and guidance and there were specialist midwives to meet the needs of women. For example, the service was able to refer women to the perinatal mental health midwives or maternal mental health services.

Senior leaders communicated changes in national guidance through monthly newsletters, departmental alerts, during huddles and through presentations to staff.

The service had completed targeted education to pregnant women and their families with a direct aim to reduce perinatal mortality rates. This included teaching women the importance of reporting reduced fetal movements.

The trust participated in the maternity incentive scheme. The scheme is a financial incentive program designed to enhance maternity safety within NHS trusts. The trust was fully compliant with the safety actions.

The service had worked with Portsmouth Down Syndrome Association to develop a Down Syndrome specific maternity pathway for families expecting a baby with Down Syndrome. The pathway included an initial appointment with a screening specialist midwife to discuss test results and to explain the antenatal care pathway. There was a direct referral to the Portsmouth Down Syndrome association, antenatal appointments with the community paediatricians to discuss potential development needs and services as well as ongoing.

We scored the service as 2. The evidence showed some shortfalls. The service did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Several staff told us that not all maternity teams had effective working relationships. Staff described consistent challenging behaviour from senior staff. This spanned all levels of clinical staff. Junior midwives reported being unable to escalate concerns or ask for support from these staff members and experienced midwives and managers reported challenging behaviours such as not listening to senior leaders and providing a negative environment for others to work. This meant there was a potential risk of key information and escalation being missed between staff and teams.

The Director of Midwifery reported the service was taking action to develop a bespoke culture programme to support staff to improve attitudes and behaviours at a senior level across all midwifery, medical and nursing staff groups. However, discussions and meetings that had taken place prior to the inspection had shown no improvement in staff behaviours and we found this to have impacted some staff we spoke to.

However, there were reports of positive working relationships within other areas of inpatient and community services. Staff reported that they had access to the information they needed to appropriately assess, plan, and deliver care and treatment.

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.

Medical handovers took place twice daily and were framed using the SBAR tool, all staff introduced themselves. Handovers included the obstetric, anaesthetic, midwifery and patient safety team. Activity in all areas of the maternity unit was discussed including elective caesarean sections and inductions of labour.

The bereavement midwife educated maternity staff around supporting women through their loss.

We scored the service as 3. The evidence showed a good standard. 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.

The service had relevant information promoting healthy lifestyles and support on wards. Staff assessed each woman’s and birthing person’s health when admitted and provided support for any individual needs to live a healthier lifestyle.

During our assessment we saw health promotion and advice throughout the maternity service for women and their families on information boards.

The service regularly met with local doulas and birth workers to share information on informed choice, accessing birth centre and continuity of carer.

A bespoke bump clinic was in place for women who had a body mass index (BMI) of above 50. Women invited to attend the clinic were seen by the same consultant and there was sensitive approach to how information on healthier lifestyles and a healthier diet was shared with women attending.

The Trust maternity website signposted parents to services for smoking cessation, safe sleeping, foods to avoid during pregnancy, and advice on vitamins and supplements. There were also details on the vaccinations that were recommended for pregnant people.

Parents were also signposted to services that supported emotional wellbeing such as national maternity charities. There were also links to the NHS England perinatal pathway website which can be used by parents to find services and helpful information to support emotional wellbeing.

Postnatally the trust recognised the difficulty for women and their families to access the registrar to register the birth of a baby, this was due to the geographic location of the local registry office and known pressures of caring for a newborn. Therefore, a system was in place to book to register baby’s birth in the hospital to make the process easier for parents. We heard from staff that this had been well received by parents, it also supported the registrar service by reducing attendance pressures at their main site.

We scored the service a 2. The service did not always routinely monitor people’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 service used a maternity quality dashboard to measure current key performance, safety and outcome indicators across maternity services. Maternity quality dashboard and data were reported to the Maternity and Neonatal Committee and through to the trust quality and performance committee. However, on review of the maternity dashboard we found it did not identify where the trust was benchmarking against national data or target indicators. This limited our ability to identify whether the service was making improvements or significantly not meeting national requirements as an outlier.

Outcomes were reviewed monthly and trends were shared within staff engagement, learning and maternity safety meetings. This meant staff could understand performance and support on quality improvement priorities. For example, there was the daily safety spotlight in each area, which highlighted 4 safety points to be share with all staff. Three points were generic maternity information and 1 was ward specific.

The number of 3rd and 4th degree tears between October 2025 and March 2026 showed on average the trust had slightly higher rates than the national average.

Rates of post-partum haemorrhage (PPH) for the service between October 2025 to March 2026 were slightly above the national average.

However, staff were supported by senior leaders to take steps to improve patient outcomes, through a variety of methods. This showed the service regularly reviewed the effectiveness of care and treatment through local and national audits.

Daily huddles and multi-disciplinary handovers were in place to support safe transition of care between teams during shift changes. Potential and planned discharges were also supported through daily meetings, with referrals made prior to discharge. However, there was feedback from women and staff that at times discharges could be delayed.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centered care and treatment.

All 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 were able to give informed consent. The service carried out audits within the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS), to support best practice in MCA and the best interest decision-making for the woman and her baby.

Midwives understood how to assess women’s capacity to make decisions. When women lacked capacity, staff supported women to make decisions within their best interests.

Women’s records found consent forms for caesarean sections were completed, and verbal consent was gained when providing care.