Queen Alexandra Hospital

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked that senior leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

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.

At our last assessment we rated this key question good. At this assessment the rating was requires improvement.

We have not awarded this service a score for Well-led.

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

We scored the service as 2. The service shared a vision and strategy. However, there was a lack of evidence to show that the strategy had driven improvements and there were ongoing concerns within the culture within the service.

The service had a shared vision for maternity and neonatal services across the two organisations within the trust. The vision was to provide equitable maternity care, be inclusive, create a safe place to work, and support the organisation's commitment to delivering national ambitions.

The mission statement was to provide compassionate, high-quality maternity and neonatal care to families across the organisations through dedicated multidisciplinary teams. The overarching goal was to ensure every pregnancy and birth were safe, supported, and personalised. There were 6 core enablers identified to support delivery of the maternity and neonatal vision: leadership, safety, quality and governance, culture, effectiveness, person-centred care, and learning and improvement.

An overarching safety improvement plan was in place to provide assurance to the board regarding ongoing maternity strategies. A traffic light system was in place to identify whether actions had been completed. The action plan was reviewed and showed that most actions were completed, however, there was no information to evidence how this had been achieved or how the service planned to continue to monitor.

The Director of Midwifery (DOM) told us there had been several structural changes to leadership since the last inspection. From April 2025 the trust implemented a new model for maternity and neonatal services to strengthen leadership across two trusts, to provide consistency in standards across the organisation and to deliver a shared vision for safe, high quality and person-centred care.

The changes to the maternity leadership structure aimed to provide a better oversight of maternity services across the organisation with the Director of Midwifery overseeing all organisations within the trust, with a head of midwifery at each Trust alongside matrons and specialist midwives.

A newly developed perinatal culture leadership programme was in place to support cross-professional collaboration between obstetrics, midwifery, neonates, anaesthetics and women who use the service. With the group focusing on role-modelling positive behaviours, building mutual understanding between staff groups and strengthening a psychological safe environment.

However, throughout the inspection we heard from staff about continued problems within the culture of the service.

External independent support had been commissioned by the trust to provide objective advice and guidance on how to support all staff. However, this was not in place and there appeared to be a lack of information and further follow up on the culture issues which were impacting on staff.

We scored the service as 2. Although there had been a remodeling of the leadership structure to revise the midwifery senior leadership team across two trusts. We found there were several senior midwives on long term sickness. The Director of Midwifery worked across two large NHS trusts, whilst managing the ongoing pressures within the maternity unit.

Senior leaders within the service demonstrated the necessary skills and credibility to lead effectively and the DOM ensured leadership consistency and oversight of improvement work.

However, most senior leads were new to their role and the DOM worked across 2 large maternity trusts. There were several senior leads who were on long term sick leave. This meant there were gaps in the level of leadership to oversee and support the service development as well as ongoing culture issues.

Staff told us there was an unease across some more experienced midwives regarding the employment of some maternity leads. The trust reported there was a newly established maternity management team, with an expected period of transition during which members were acquiring the experience and confidence.

We also had reports of senior leads not feeling respected or listened to and felt they were consistently challenged. This behaviour was reported to put pressure and strain on staff throughout the service.

Challenging behaviour had been ongoing for a long period of time with some leads reporting they found it difficult to challenge behaviours. There had been in place meetings and discussions to address culture issues, but they were described by some staff as unproductive.

There were plans to support a culture improvement programme, however, some staff we spoke to felt there was a lack of information and feedback given to staff, with relationships and behaviours becoming worse. Some senior leaders reported they found it difficult to challenge some of the difficult behaviours exhibited within the unit.

The maternity safety champions last visited the maternity unit in February 2026 to engage with staff and gain assurances regarding safety for maternity services. However, staff reported they were unclear as to who the maternity safety champions were or their role.

Some community staff told us they had not met the HOM, and they told us the senior leadership team rarely visited community services. However, they spoke highly of the community matron and felt well supported.

A listening and engagement programme included staff listening events and anonymised feedback from staff so their voices could be heard. The service reported leadership coaching, supervision and development for senior midwives had been strengthened.

The maternity service had a team of professional midwifery advocates (PMA), who provided pastural support and restorative supervision to staff. All midwives and maternity support workers were supported by a PMA. A PMA of the day supported staff daily with the aim to cover 7 days a week. PMAs had implemented initiatives, such as supporting maternity staff to congratulate each other and to recognise great work. Staff reported they liked the initiative and it felt positive to congratulate colleagues.

We scored the service as 3. The service fostered a positive culture where most women and staff felt they could speak up and their voice would be heard.

There was freedom to speak up (FTSU) available for maternity staff and the service had 2 FTSU champions to support maternity teams.

There was an external freedom to speak up (FTSU) service available for maternity staff and the service had 2 FTSU champions to support maternity teams

The service fostered a positive culture where staff could speak up to senior leaders, however, there were culture issues between some staff.

Senior leaders and staff demonstrated openness, honesty, and transparency, with many staff reporting their immediate managers were approachable, and listened. While most staff felt encouraged to raise concerns, a few expressed they did not always feel there were actions taken to concerns raised regarding the ongoing culture issues.

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who work for them.

The trust supported a programme to support staff from black, Asian and ethnic minority backgrounds to develop their roles. The ‘Beyond Boundaries’ programme helped staff develop skills, including coaching, understanding themselves and others through compassionate and inclusive leadership and positive influencing.

We scored the service as 1. Governance systems were not always effective at ensuring the safety and quality of the service for women and babies. The service was operating under pressure which meant women did not always receive the same quality of care.

Governance systems did not always identify and reduce risks to safety and quality care for women. We found several safety concerns during our assessment which had not been identified by the service. The fetal monitoring action plan was RAG rated as yellow which indicated the action was in progress. The plan identified actions were 100% completed. However, there were ongoing concerns around the gaps within fetal monitoring and this remained on the risk register to monitor.

Safety and performance dashboards did not support the service to identify key areas of concern. The dashboards were kept manually on individual documents, such as spreadsheets and therefore it was difficult to get a live view of the service. We requested performance data following our assessment and the information received did not contain detail to show what the information was or how it was being used.

Senior leaders and the executive team claimed the maternity service establishment was as per the birth rate plus recommended requirement and currently staffed above the recommended establishment. However, persistent poor staffing and daily, severe operational pressures (OPEL level 3) showed there was a continuous inability to meet national staffing standards. These frequent escalations indicated a chronic, widespread failure rather than temporary surges.

Staff did not always act on the best information about risk, performance and outcomes to ensure safe care for women. Governance meetings were not effective at addressing areas of concern. Senior leads held regular meetings focused on improvement plans, safety, audit, quality, and governance. Most meeting minutes showed concerns were identified, and actions were developed, but no action logs were provided. This meant there was no evidence that actions were acted on, and improvements made. However, meeting minutes showed there was a multidisciplinary approach with midwives, obstetricians, anaesthetists, neonatologists and other relevant professionals attending to support decision‑making and continuity of care.

Although maternity governance meetings were held regularly to review clinical quality, safety, risk, and compliance we found these were not effective with ongoing issues with staffing, acuity and the high number of times the service has been in high operational pressures.

Training data was presented on a maternity dashboard and were provided as a trust board level measure. The dashboard showed staff were meeting mandatory training targets. Senior leads told us it was difficult to assess accurate training compliance for medical staff and safeguarding compliance.

Electronic staff records recorded training for job roles rather than individual staff. For example, a midwife with 2 different job roles was showing as non-compliant unless they had completed the same training twice for each role. The workforce analyst team had reported that this issue was unable to be rectified, even though this was negatively impacting on staff training data.

The maternity practice education team reported to mitigate the risk through manual oversight for key training such as MDT emergency training.

The service voluntarily entered an enhanced support oversight framework, to provide stabilisation of maternity services whilst the new maternity leadership team embeds and aligns between Portsmouth and the Isle of Wight trust.

We scored the service as 3. The service understood their duty to collaborate and work in partnership, so services work seamlessly for women.

Senior leaders attended regular meetings with the LMNS to review governance and incidents and worked with the MNVP to contribute to decisions about care in maternity services. Meeting minutes showed current work being undertaken between the local MNVP, maternity service and the LMNS.

MNVP attended meetings with the maternity and neonatal safety champions and patient experience meetings were embedded into the service.

We scored the service as 3. The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

The service focused on continuous learning, innovation and improvement across the organisation and local system. Staff were encouraged to get involved and develop creative ways of delivering equality of experience, outcome and quality of life for people and actively contributed to safe, effective practice and research.

Trauma-informed care was included as part of the mandatory annual trust update for all staff. This meant staff across maternity were trained to recognise trauma, respond sensitively, and adapt care to reduce the risk of traumatisation. This training was in line with national practice in perinatal mental health care. However, we were not supplied with evidence to determine how many staff had completed this training.

The community team had a monthly forum for sharing local experiences and themes, to provide consistency across the community services. Benefits from the forum included learning from experience, identifying themes to allow for systemic improvements and share best practice.

The maternity booking appointments had been extended to make sure a perinatal mental health assessment had been undertaken and reviewed. The change was implemented as part of a quality improvement action from the perinatal mental health working group to demonstrate responsive governance and safeguarding psychological wellbeing in pregnancy. The aim of the extended booking session was to complete a detailed history, identify any potential risk, have a trauma informed discussion and to put a plan in place to support their care.

Most staff we met were committed to learning and improving services. They had a good understanding of quality improvement tools and had the skills to use them. Senior leaders encouraged innovation and research.

The perinatal pelvic health and physiotherapy service was part of a commissioned programme to provide physiotherapy to support all women who clinically requires physiotherapy during their pregnancy and up to 12 months postnatally.

However, during the inspection we were told not all staff were receptive to new interventions introduced by specialist midwives or senior leadership team due to the ongoing negative culture identified within inpatient services.

Medical staff were to attend MAU handover to identify clinical decision making, ongoing reviews for women and ensuring the safe flow and prioritisation for within the MAU. Doctors were rostered to cover the peak times women would mostly attend.

The second QI project was a focus on a third midwife to be rostered onto the MAU during peak MAU times. However, at the time of the inspection we did not observe an improvement in performance and although there was a strong medical presence within the unit over both days of inspection. There was not a third midwife during peak times due to being redeployed into other areas of the maternity unit due to high acuity and poor staffing, this meant the target for women to be seen within 15 minutes of arrival was not met.

Bereavement midwives contributed into the governance processes around learning from deaths and lead on the implementation of the National Bereavement Care pathway standard.