New review highlights urgent need to modernise maternity and neonatal estate in England

Published by NHS England, the report is the first of its kind to bring together clinicians and estates professionals to assess the condition and suitability of acute maternity and neonatal facilities.

It responds to the Ockenden Review and Care Quality Commission (CQC) investigations, both of which raised serious concerns about how inadequate infrastructure impacts the safety and experience of parents, babies and staff.

A closer look at the key findings from NHS England’s Maternity and Neonatal Infrastructure Review

The review paints a clear picture:

• Over 14,500 incidents in the past three years directly disrupted clinical services due to estate-related issues such as leaks, power failures and faulty equipment.
• More than half of NHS Trusts in England report their maternity and neonatal estate as unsatisfactory, with 42% requiring major repair or replacement and 7% at risk of imminent breakdown.
• 69% of organisations failed to meet space standards, with overcrowded waiting rooms, undersized birthing suites and insufficient storage a recurring theme.
• Staff wellbeing is significantly affected, with inadequate rest facilities and poor maintenance contributing to low morale and increased turnover.

Although some investment has been made through refurbishment programmes, much of the 831,739m² maternity and neonatal estate remains out of date, undersized and not compliant with current technical standards.

Implications for healthcare estates across the UK

The findings highlight the direct link between estate quality, patient safety and staff experience. As the number and complexity of births continues to rise, facilities must adapt to support larger multidisciplinary teams, advanced equipment and more specialist care pathways.

The opportunity ahead

The report calls for immediate action:

• NHS England pledging capital funding to tackle critical infrastructure risks within their maternity and neonatal estate and launch a programme to modernise technical design standards to incorporate new clinical models and other changes aligned with new building programmes.
• The review also calls on NHS Trusts to assess the condition of all premises where maternity services are delivered – including community-based facilities, which were not covered in the survey. Where buildings fall short of the required standard, Trust boards must take immediate mitigating action to ensure safe, appropriate care environments.

How we can help

At AHR, we understand the pivotal role that healthcare estate design and condition plays in delivering high quality maternity and neonatal services. Our architecture and building consultancy teams work with NHS Trusts nationwide to:

• Assess and optimise existing facilities.
• Develop healthcare masterplans and business cases that align with NHS England standards.
• Design modern, safe and flexible environments that improve experiences for patients, families and staff.

We have supported NHS Trusts across the UK for many decades and has a long history of delivering women’s and children’s and maternity projects that prioritise safety, dignity and staff wellbeing. Our most recent completion, the Countess of Chester Hospital Women and Children’s Unit, replaces a RAAC-affected building and now provides modern maternity, neonatal and paediatric care for Chester and the surrounding communities, with the first patients already welcomed.

In another scheme, we are currently supporting Shrewsbury and Telford Hospital NHS Trust with its hospital transformation project, which places women’s choice at the heart of the maternity services offered within the new hospital.

For a deeper discussion on how thoughtful design can help shape a more responsive and empowering maternity experience, listen to our AHR podcast episode featuring our healthcare leads.

Moving forward

This landmark review reinforces the need for estates and clinical teams to work hand in hand. Investment in well-planned, well-designed healthcare environments will be essential to ensure that maternity and neonatal services across England can deliver on their promise – giving children the very best start in life.

Read the full NHS England report here.

Frequently asked questions

1. What is the NHS England Maternity and Neonatal Infrastructure Review?

It is a national assessment of maternity and neonatal hospital facilities in England, focusing on safety, condition, compliance and suitability. It was commissioned following the Ockenden Review and Care Quality Commission (CQC) reports into maternity safety.

2. Why is this review important for healthcare estates?

It highlights how poor-quality, outdated estates directly affect patient safety, staff wellbeing and service delivery – demonstrating the urgent need for investment in healthcare infrastructure.

3. What are the key findings?

Over 14,500 estate-related incidents in three years, with nearly half of NHS Trusts requiring major repair or replacement of maternity and neonatal facilities. Many do not meet current space or technical standards.

4. How can AHR support NHS Trusts?

AHR provides architecture, masterplanning, building consultancy, geomatic surveying and retrofit expertise across the full lifecycle of healthcare estates. We work with NHS Trusts to design, refurbish and future-proof maternity and neonatal facilities in line with NHS England standards.

5. Where does AHR operate?

We deliver healthcare architecture and building consultancy projects across the UK, with offices in Leeds, Huddersfield, Manchester, Birmingham, Shrewsbury, London, Bristol, Cardiff and Glasgow.