3 days ago
We need a culture change in maternity services
Photo by Matthew Cheetham / Getty Images
The Health and Social Care Secretary is staking his reputation on providing safe care to women giving birth. 'Maternity safety will become the litmus test for all safety in the NHS,' Wes Streeting said on 23 June, as he announced a rapid investigation into maternity and neonatal services. He will take 'personal responsibility for it', noting that successive governments have failed to grip this national scandal adequately.
Streeting has said the government's long-awaited ten-year plan for the NHS, which will be published on 3 July, will tackle maternity's 'safety crisis at its root, with an overhaul of the wider patient safety landscape'. The Health Secretary has already placed new personnel at the top of the Care Quality Commission (CQC) to turn around the 'failing organisation' – part of an attempt to 'declutter' the regulatory landscape in which more than 150 bodies will be scrapped. A shift from analogue to digital will be seen first in maternity, too, where AI technology will flag higher than expected rates of stillbirth, neonatal death and brain injury, triggering inspections. A focus on tackling inequalities in health outcomes – another theme of the plan – is also hugely relevant to maternity care: black women are two to three times more likely to die during pregnancy or shortly after birth than white women.
While Streeting's aim to tackle 'the biggest patient safety challenge facing our country' is admirable, the task is mammoth. The rapid investigation will look at up to ten English maternity units that give ministers and NHS bosses the 'greatest cause for concern'. How will they be chosen? In its National Review of Maternity Services in England 2022 to 2024, the CQC found nearly half of all units either required improvement (36 per cent) or were deemed inadequate (12 per cent). Not one was rated outstanding for safety. Nearly two thirds (65 per cent) either required improvement or had inadequate safety provision. Streeting is right: the problem is systemic. 'It's not just a few bad units up and down the country. Maternity units are failing. Hospitals are failing. Trusts are failing.'
Streeting could limit his choices to the 20-plus units that are currently rated inadequate by the CQC: from Scarborough and York hospitals in the north, to Poole in the south; Great Yarmouth's James Paget Hospital in the east, or Somerset's two failing units in the west, one of which was closed in May for at least six months. This approach would still leave half the services acknowledged to be unsafe unexamined.
The units to be investigated will be chosen after analysing various NHS data sets. But each data set provides different answers. In the 2024 maternity survey, the CQC found two trusts performing 'much worse than expected': University Hospitals Birmingham NHS Foundation Trust and Milton Keynes University Hospital NHS Foundation Trust. Six trusts were 'worse than expected'. While some run inadequate maternity services, the majority do not.
Then there's the danger of putting too much faith in the CQC when the regulator is facing heavy criticism. It has been accused of failing to heed concerns about maternity services until long after they've been raised by whistleblowing staff and by families who have been harmed. In Leeds, for example, where a BBC investigation found that the deaths of two mothers and 56 babies could potentially have been avoided between 2019 and 2024, maternity services were not rated inadequate until May – at least five years after concerns were first raised. In Oxford, where more than 500 families are calling for an inquiry, maternity services are not judged inadequate. Nor are Nottingham's, where around 2,500 families are taking part in the former midwife Donna Ockenden's independent investigation into failings.
The Health Secretary could look at data on deaths. Leeds Teaching Hospitals Trust had a neonatal mortality rate nearly twice the average of similar services in 2023. Among smaller hospitals, Sandwell and West Birmingham Hospitals NHS Trust appears to be an outlier in the rate of stillbirths. But official data sets can be flawed. As Streeting acknowledged to doctors, 'some services don't even record incidents that have resulted in serious harm'. Other information indicating poor maternity care doesn't exist at all: there are no recent, reliable data on the life-changing injuries women can suffer during childbirth.
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Behind every number, every set of statistics, are real lives – and deaths. Too many babies are dying and being harmed because of poor maternity care. Too many women are receiving life-changing injuries. Too many mums and dads are being left traumatised. And we are spending an eye-watering amount compensating families for that poor maternity care. In the financial year 2023-24, maternity payouts comprised 41 per cent of total NHS clinical negligence payments: £1.15bn of £2.8bn. The NHS predicts that 49 per cent of the £5.1bn it will pay out in future as a result of care delivered in 2023-24 will be to maternity cases. To put that into perspective, NHS England spends around £3bn a year in total delivering maternity and neonatal services.
It is vital that maternity services are not seen as just another part of the NHS that needs improving. For there is something bigger going on – something unique that cannot simply be explained by staff shortages, low morale or a lack of funding. Many hospitals provide good care in all other departments but have an inadequate maternity unit. This is a problem of culture. And with the best will in the world, that is the hardest thing of all to change.
[See also: Cover Story: Just raise tax!]
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