Queen Alexandra Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that safety was a priority for everyone, and senior leaders embedded a culture of openness and collaboration. We checked that women were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination.

At our last assessment we rated this key question as good. At this assessment the rating requires improvement. This meant there were aspects of the service which were not always safe.

There was a breach of regulation 12 safe care and treatment, in relation to the continued non-compliance in safeguarding training.

We have not awarded this service a score for Safe.

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

We scored the service as 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff knew what incidents to report, raised concerns and reported incidents and near misses in line with the trust policy. The service used national risk tools, such as the Patient Safety Incident Response Framework (PSIRF) and a Perinatal Quality, Safety Risk Framework to review and monitor risk.

Outcomes and themes of incidents were communicated to all staff through daily safety huddles, handovers and via emails.

The perinatal mortality review tool (PMRT) was used to support objective and standardise local reviews of care when babies die. The service reported all PMRT cases to the national program focusing on improving maternal and infant health. The national programme was called, Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries (MBBRACE). All cases were reported to MBBRACE within 7 days of incident.

A quarterly maternity mortality report was completed and presented to the trust mortality review group meeting. From January 2025 to December 2025 the mortality rate for the service was 2.48 per 1000 births. This was below the national average. The maternity and neonatal national target to reduced stillbirth rates to 3.6/1000 births by 2025. Portsmouth hospitals achieved the lowest rate nationally

Between January 2026 and February 2026 there was an increase in still birth deaths, with 3 cases reported. Themes identified within the cases were women experiencing reduced fetal movements and women being from black, Asian and minority ethnic communities and lower socio-economic background.

The service completed a multidisciplinary rapid review of each still birth case and presented at the trust patient safety incident review group (PSIRG). A rapid review proforma was used to present each case and detailed all aspects of maternity care as well as an MDT summary alongside actions required. Actions taken by the service were to complete targeted education for staff on reducing the still birth rate. Training included encouraging staff to highlight the importance of reporting reduced fetal movements to women.

The service was compliant with all eligible standards for the maternity incentive scheme (MIS), clinical negligence scheme for trusts (CNST). The maternity incentive scheme was a financial incentive programme aimed at enhancing maternity and neonatal safety with NHS trusts. CNST provided requirements for trusts to use the PMRT to review all perinatal deaths within specific timeframes. Actions within the scheme aimed to identify clinical risk management, staff training, learning from incidents, robust governance processes, and the delivery of personalised, safe, and effective maternity care.

The service reported they were compliant with 1 to 10 of the CNST safety actions. Assurance regarding the schemes safety actions came through quarterly check and challenge sessions with the local maternity and neonatal system (LMNS). All evidence was formally approved at the Maternity and Neonatal Committee and the quality and performance committee meetings before information was submitted to the trust board.

There were 7 incidences reported to the maternity and neonatal safety investigations (MNSI) for investigation between July 2025 to February 2026. MNSI investigated 6 of the cases reported. Patient safety investigations were completed by the service and identified where areas for improvement could be made, actions and review date.

Learning from safety incidents and examples of good practice were identified and shared between maternity teams to support a culture of openness, learning and continuous improvement. For example, the service shared each month a women’s story of maternity services. We saw 3 examples of women’s experiences and each story gave information of the incident, the mother’s journey and what learning took place following the incident. A maternity patient safety newsletter reported updates, training information, maternity risks and learning.

A safety learning event took place twice yearly for all staff from each maternity location across the trust. The last event took place in January 2026 and was called ‘Empowering safer maternity and neonatal care’. The event covered recent safety alerts and studies undertaken within maternity. This included improving the management of postpartum haemorrhage, caesarean section wound care and learning from inquests.

We scored the service as 1. The service did not always make sure care was provided in line with guidance. There were ongoing concerns within maternity triage, and this was not an improvement from the last inspection.

Systems and processes within maternity triage were not fully embedded to ensure women were safe.

There were a high number of women booked for an induction of labour (IOL), with 27% of the births taking place having an IOL. Due to the high numbers of women having an IOL a working group was established in March 2026 to identify reasons for ongoing IOL delays. The working group identified delays of IOL were mostly due to high acuity of the maternity unit, which resulted in a lack of maternity beds. This meant there were delays for women transferring to the labour ward.

The 2025 CQC maternity survey collected data from February 2025. The CQC maternity survey 2025 asked, “Before you were induced, were you given appropriate information and advice on the risks associated with an induced labour?”. The trust scored 6.5 which was worse than the national average of 7.6.

The service reported between October 2025 to March 2026 there were 17 cases where women were transferred to a neighbouring trust for their IOL due to operational pressures. This meant there was an increased risk of complications during IOL, loss of continuity of care and a delay in induction of labour and the risk of labour progressing.

The IOL pathway identified how delays were identified, monitored and escalated to ensure safety. Delays were recorded on two occasions during the day and documented on the dedicated team’s escalation log. Evidence confirmed that the log was reviewed by the manager on call, who provided appropriate operational oversight and support. However, transferring women to neighbouring trusts for IOL due to operational pressures introduced risks relating to delays in care, continuity of treatment and impacting on the birthing experience for women.

Completion of safety checklists in maternity theatres was inconsistent which could pose a risk to patient safety. During our time in theatre, we saw the maternity theatre team had completed all stages of the World Health Organisation (WHO) safer surgery checklist. However, during a review of women’s records we saw there were several gaps when WHO checklists were being completed. Following feedback, the trust provided us with the immediate actions taken.

Maternity triage was called the maternity assessment area (MAU) and provided emergency assessment and triage for women.

The service provided a 24-hour service to assess and treat pregnant women where there were urgent concerns. Midwives used a nationally recognised tool to rate risks consistently. Monthly audits were completed to determine how long women waited for initial assessment and if they required a medical review.

The service was not meeting the trust target of 80% of women to receive an initial review within 15 minutes by a midwife. Monthly audits showed 70% of women were seen within 15 minutes between January to February 2026.

The audit data for the times women were seen for an obstetric review within the MAU, was for February 2026 results only. This meant we were unable to assess the compliance of medical review timeframes over an extended period.

The February 2026 audit reported positive timescales for obstetric reviews. However, we found that the data contradicted the trust's MAU policy. For example, the audit highlighted a 100% success rate for reviewing critical "red" category women within four hours. However, trust guidance actually requires these high-risk women to receive an immediate review and an immediate transfer to the labour ward. This meant the audit failed to prove that practice met the trust's expected standard of care for the times women received an obstetric review.

The MAU was part of a quality improvement project to protect the peak midwife's role during peak hours, for doctors to attend MAU handovers, and to guarantee medical staff were available in the unit during peak times.

The CQC coordinates a national survey annually to look at the experiences of pregnant women and new mothers who used NHS maternity services in 2025. The survey is CQC coordinated with other stakeholders, but it is reported by us at CQC. We reviewed the latest findings of the Maternity survey 2025.

In relation to triage, women answered more negatively when asked about the length of time they had waited to be seen. The service scored 5.7, which was below the national average of 6.4 when compared to all other trusts in England.

The maternity telephone triage line was a dedicated telephone line outside of the trust and was a single point of access for all maternity referrals for local NHS trusts within the local maternity and neonatal systems (LMNS). The CQC national survey question for maternity telephone triage scored better with women for the question “Thinking about the last time you contacted the telephone triage line, did you feel that you got the advice you needed?” the service scored 8.4 which was slightly below the national average of 8.5.

We scored the service as 1. The evidence showed significant shortfalls. The service did not work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. The service did not provide safeguarding training to all staff, and we found safeguarding questions were not always asked during each antenatal contact.

The service could not demonstrate all staff had up to date safeguarding children level 3 training. This posed a risk that staff would not have up to date knowledge. Medical and anaesthetic staff were significantly below the trust target with only 29% compliance. Maternity support workers were 78.5% and midwives 80.3% compliant.

The service did not provide the training figures for medical and anaesthetic teams for level 3 adult safeguarding training. The service reported that figures for medical and anaesthetic teams could only be identified using manual intervention.

Low safeguarding training compliance and not providing safeguarding training figures were a continued issue as this was raised as a concern in the previous CQC maternity inspection which took place in 2024. This meant the trust continued to not provide the requested data to the inspection team and the service could not be assured prior or since our last CQC maternity inspection that staff were up to date and competent with the current safeguarding practices.

Low compliance was reportedly due to virtual safeguarding training sessions being cancelled without prior notification as well as access to links not being available outside of the trust. This had been escalated to the safeguarding team for action, however, there was no plan on how to improve the access issues.

Staff did not always ask routine safeguarding questions to keep women and families safe. We reviewed 6 women’s maternity records which showed safeguarding questions were not routinely asked during each antenatal contact. Staff were aware of the safeguarding process and were confident in reporting safeguarding concerns.

Some staff we spoke to did not know when the service last undertook a baby abduction drill. However, evidence showed the last baby abduction drill was in March 2025. Baby abduction drills are important so that in the event of an attempted baby abduction. However, staff we spoke to were confident and were able to explain what they would do in the event of an attempted abduction.

We spoke with staff at the entrance to the unit who had the names of all mothers on the unit and any known safeguarding information such as involvement of social care agencies and restrictions on who could visit women and babies. This meant they could alert security or seek support if a person attempted to enter the unit who was not permitted to do so. Visitors were restricted to 2 persons, and we saw this was strictly enforced.

Staff reported they had access to the safeguarding lead midwife and felt well supported by the safeguarding team. There were clear escalation pathways to make a safeguarding referral.

We scored the service as 1. The evidence showed significant shortfalls. The service did not work well with people to understand and manage risks. Staff did not provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff did not always assess women’s health or complete monitoring to keep women and their baby safe. Fresh eyes audits showed compliance between January 2026 to March 2026, was only 60 to 67%. Cardiotocograph (CTG) and intermittent auscultation was a method of fetal monitoring during labour that involves listening to the fetal heartbeat with a doppler ultrasound. ‘Fresh eyes’ provides an independent and objective assessment, which is essential for improving patient safety, reducing the risk of errors in the interpretation of fetal wellbeing during labour, and supporting safe and timely clinical decision‑making.

Fresh eyes monitoring was also on the maternity risk register due to ongoing non-compliance and was being monitored by the foetal monitoring lead. To improve compliance the delivery suite was awaiting a new electronic handover board to provide a centralised fresh eye monitoring system. The fetal monitoring lead and senior leaders told us there had been initiatives introduced to improve compliance, such as boards on the delivery room doors to add the time a fresh eye review was required. However, there were reports that not all midwives were receptive to the interventions introduced and this had negatively impacted women receiving a fresh eye review. This limited the services ability to improve compliance.

Incidents relating to a delay in CTG and fresh eye monitoring were reviewed within the patient safety forum and were being investigated by the fetal monitoring midwife. Findings were shared weekly with the forum and emerging themes were collated and used during foetal monitoring training, ongoing learning and monitoring.

Any incidents of stillbirths, early neonatal deaths, or cases of severe brain injury where intrapartum fetal monitoring was identified as a contributory factor were reported through the Maternity and Newborn Safety Investigations (MNSI) programme. Fetal monitoring non-compliance was also found as a theme within the MNSI cases reported.

At the time of the inspection the service did not audit data to show staff monitored, escalated and recognised signs of deterioration in women antenatally or postnatally using the modified enhanced obstetric warning score (MEOWS). However, following the introduction of the maternity early warning score (MEWS) in April 2026, the service undertook a formal audit of MEWS compliance to review the first month of implementation. The audit identified where there needed to be improvement. For example, staff completing observations, documenting additional concerns, and staff adherence to escalating concerns. Actions implemented following the audit included reinforcing staff education, emphasising the importance of escalating concerns and ensuring staff completed all areas of the MEWs documentation.

The digital MEWS tool was launched from NHS England in March 2026 forming part of a national change to strengthen the consistency of clinical assessment, escalation and recognition of deterioration.

Documentation audits were completed, which showed from November 2025 to March 2026 observations were routinely completed for women and babies on the delivery suite. However, the audit did not report whether observations were completed within the maternity assessment unit or antenatal or postnatal ward.

Therefore, senior leaders could not be assured staff recognised or escalated deterioration in women’s health. Assurance could not be provided by the documentation audit as although the observations were completed there was no information to state early recognition and escalation was completed or that the correct management process was followed.

The trust recognised the gap in auditing and was developing a formal audit process for MEWS, with an audit due to be completed by the end of April 2026 to review the first month of staff compliance.

We scored the service as 2. The service did not always detect and control potential risks in the care environment. They did not always make sure equipment, or facilities supported the delivery of safe care.

Resuscitaires were not available in every room on the midwifery led unit meaning in an emergency, mother and baby would be separated which may cause emotional trauma to both mother and baby.

The wards within the maternity unit were difficult to identify due to a lack of signage, colours or information boards. Areas were referred to B5, B6, B7 and B8 which were confusing as a first-time visitor to the unit.

There were birth pool evacuation nets and equipment in every room that had a birthing pool. However, there was some confusion from staff as to whether there was pool evacuation simulation training. Pool Evacuation, Skills and Drills, and ad‑hoc high‑fidelity obstetric simulations, were reported to be delivered routinely to support ongoing competency and team-based learning. Records identified that 95% of midwives and 93% of maternity support workers had completed waterbirth training, which included pool evacuation within the maternity trust update training programme.

The maternity unit was clean, tidy and free of clutter. Fire exits were clearly marked and unobstructed.

Staff completed daily checks of specialist equipment. Records showed these checks had been consistently completed.

The design of the environment followed national guidance. The maternity unit was fully secure with a monitored entry and exit system. Staff had secure access cards.

However, we did observe that oversight of the breast milk storage freezer was limited. This was due to the task previously being assigned in checklists to the overnight lead midwife and this role was no longer staffed.

We scored the service as 2. The evidence showed some shortfalls. The service short term sickness resulted in not enough qualified, skilled and experienced staff being available. Staff did not always make sure staff received effective support. However, staff worked together well to provide safe care that met women’s needs.

Staffing for registered midwives for January 2026 and February 2026 was often below the planned number of midwives with the service reporting high sickness absence rate.

This meant actual staffing delivery 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.

Maternity staffing was reviewed using the national midwifery staffing tool Birthrate Plus (BR+) to calculate Midwifery staffing levels. The tool identifies the total midwifery time required to care for women on a 1:1 basis, throughout established labour. The last BR+ report was completed recently in November 2025 and identified the service was only slightly below the recommended number of registered midwives, with approval to recruit 15 newly qualified midwives over establishment.

Although the trust monitored planned and actual staffing levels on a weekly basis, with variance reviewed through established divisional and executive governance arrangements. There were ongoing inconsistencies with the number of staff available on each shift and data provided by the trust showed there was instability within staffing.

The senior management team were working with the trust finance team to establish a clearer and more consistent process for recording the internal deployment of specialist midwives who provided clinical support during periods of escalation. This was intended to improve workforce visibility and strengthen assurance around actual staffing deployment.

Staffing red flags in maternity care can identify a lack of adequate maternity staffing, which can lead to unsafe care for women and their babies. Red flags may also occur due to staffing shortages, which can affect the ability to provide safe care. Red flags within the service were reported and monitored daily. Data reviewed showed most delays to the service were due to women experiencing delays during induction of labour (IOL). IOL is the process of artificially starting the birth process before it begins naturally. It is usually recommended if continuing the pregnancy poses a health risk to a mother or baby such as passing the due date, ruptured waters, or underlying medical conditions.

Maternity services recorded operational pressures escalation levels (OPEL) daily to monitor and manage pressures on the maternity service. With OPEL 1 being management of pressure, OPEL 2 moderate pressure, OPEL 3 high level of pressure and OPEL 4 extreme pressure.

During the 2-day inspection we found it difficult to talk to staff due to the pressures on the service. On day 2 of the inspection, the service declared they were in OPEL 4, extreme pressure. This meant all new admissions were redirected to local neighbouring trusts and internal maternity care continued until the unit could open safely.

Staffing unavailability was monitored closely, with formal reporting undertaken at divisional level on a fortnightly basis. Identified themes and risks were escalated to the Senior Management Team through weekly meetings to support ongoing oversight and risk management.

Maternity support workers (MSW) levels were consistently below planned levels throughout January and February 2026. Planned MSW unavailability ranged between 9% to 28%; however, actual unavailability exceeded this, reaching a peak of 34% in January 2026 and 33% in February 2026.

There were MSW vacancies within the maternity assessment unit (MAU), however, there was a recruitment review for MSW’s, the service reported this was due to the number of over recruited midwives across the maternity service.

We were told the MSW vacancies were to be prioritised within other areas of maternity. This meant there was a lack of support for midwives working within the MAU which impacted the length of time women were reviewed by a midwife.

The variance was attributed to persistent vacancies alongside sickness absence levels that were significantly higher than planned. Maternity staff sickness reached up to 7% compared to 2% planned. As a result, the service was not consistently able to deliver the full MSW component of the staffing template and relied on ongoing mitigation and escalation measures to manage these shortfalls.

The trust recognised staffing challenges and had implemented a range of mitigation actions. The director of midwifery (DOM) and the maternity workforce matron told us they had escalated the risk of the MSW vacancies through the Trust Executive Quality Impact Assessment process. This included the impact on staffing levels, how this affected service sustainability, and what training and development MSWs needed to carry out their roles safely.

Some inpatient and community staff told us they felt the continuity of carer (COC) model was not equitable between those staff working within the CoC teams and staff working within community and inpatients due to low staffing, capacity and the pressures of high acuity within those areas.

Following our inspection, we requested mandatory training data from the trust. The information provided demonstrated overall compliance with mandatory training requirements; The trust provided data for maternity, trust specific, mandatory training showing a compliance of 95% for midwives and 93% of maternity support workers. This provided assurance that compliance with MDT skills training was generally good across the maternity service.

The trust also provided multidisciplinary (MDT) skills training compliance data against a target of 90%. Data showed high levels of compliance amongst most staff groups. Compliance rates were reported as 88% and 94% for consultant obstetricians, 90% for resident obstetricians, 90% for consultant anaesthetists, 92% for resident anaesthetists, 97% and 98% for registered midwives, and 97% and 98% for maternity support workers.

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

All areas in maternity were visibly clean. Cleaning records were up to date and showed all areas were cleaned regularly.

Staff followed infection prevention and control principles and used personal protective equipment correctly (PPE). Staff were bare below the elbow, and we observed them cleaning their hands with alcohol-based hand gel. Staff prompted all visitors to clean their hands on entering the department, and we saw visitors using these throughout our assessment. There was sufficient supply of PPE such as gloves, masks and aprons.

The service had a hand hygiene policy in place. Hand hygiene audits were completed monthly. The audit completed for March 2026 showed across the maternity services including community hubs there was between 94% to 100% compliance.

Bathrooms and toilets were clean and there were laminated posters explaining hand washing technique. Privacy curtains were clean and labelled with their replacement date.

Staff were familiar with cleaning policies for the labour/birthing pools and cleaning records were up-to date and demonstrated all areas were cleaned regularly.

We scored the service as 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved women in planning, including when changes happen.

The service had a medicine administration guideline for midwives. Midwives had access to the full list of midwives’ exemptions, so they were clear about administering within their remit.

Staff were trained to administer medicines safely. Staff demonstrated good understanding of how to monitor for and manage medical emergencies that can occur in pregnancy, including post-partum haemorrhages and sepsis.

The service used an electronic system to prescribe and record administration of medicines. There were policies and procedures to support the safe and effective use of medicines. Staff completed medicines records accurately and kept them up to date.

The service did not complete routine prescription audits. The service reported that an annual maternity service-level review of medications administered by midwives was due. This had been previously completed alongside the pharmacy team. However, there had not been a review within the last 12 months. This meant the service could not be fully assured the correct checks and procedures was always completed.