How did NHS maternity care get into such a state?

A series of high-profile scandals and independent reviews has painted a bleak picture of NHS maternity services. But Baroness Amos, who is leading the National Maternity and Neonatal Investigation into 12 NHS trusts, said “nothing prepared her” for the “unacceptable care families were receiving”. “I have been shocked”, she told Sky News, discussing her initial findings.

A “staggering” 748 recommendations have been made about maternity services in recent years, she said. “Why are we in England still struggling to provide safe, reliable maternity and neonatal care everywhere in the country?”

What did the commentators say?

Amos found common themes: women being “disregarded” when they raised concerns, or not given the right information to make informed choices, as well as “discrimination against women of colour”, leading to far higher rates of maternal deaths, and similar prejudice against working-class and younger parents.

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The problem is “systemic”, said Hannah Barnes in The New Statesman. The Care Quality Commission found last year that nearly two-thirds (65%) of England’s maternity units required improvement or were inadequate. 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 with inadequate maternity units provide good care in other departments. “This is a problem of culture.”

One hospital under investigation for poor maternity care spent a decade pursuing a “normal birth” ideology, said The Sunday Times. Leeds Teaching Hospitals Trust’s maternity strategy directed services to “actively promote” vaginal births with “minimal medical interventions”. This has been “repeatedly blamed for contributing to poor care”, with staff waiting “too long to intervene”.

Between 2012 and 2023, the trust had “the lowest rates of caesarean sections in the country” – and its rate of stillbirths and newborn deaths “soared” to the highest. Other NHS trusts where inquiries into poor maternity care uncovered “catastrophic failures” have similar patterns.

The Royal College of Midwives abandoned its “normal birth” campaign in 2017. But a Sunday Times investigation last month found that almost two-thirds of universities still promote “normality” in midwifery courses. “It’s become like a religion,” said a senior midwife at a teaching hospital.

Public inquiries have “repeatedly exposed systemic issues such as poor communication, a reluctance to learn from mistakes and knee-jerk defensiveness”, said lawyer Sara Stanger in The Times. The Ockenden review also noted that “midwives and obstetricians too often work in silos”, while concerns from families are “routinely downplayed or dismissed”.

But in my experience as health secretary, said Jeremy Hunt in The Guardian, “the biggest barrier to safer care in the NHS” was “a blame culture that stopped people being open about mistakes”. More than a third of NHS staff say they “don’t feel comfortable speaking up about safety concerns”. “That prevents professionals from learning from tragedies and condemns the system to repeating them.”

What next?

Amos’ investigation is due to publish its full report in the spring. But some victims say they are “disappointed” by the interim findings, said Sky News.

It appears to be “a bullet point list of failings that actually we’ve seen time and time again in independent reviews”, said Rebecca Matthews, who leads a campaign for families who claim they were failed by Oxford University Hospitals, one of the trusts Amos is investigating.

It seems as though it will lead to “some recommendations but no teeth”, she said. “We need some mechanisms that are going to hold people and systems to account.”

Previous reports have a “common message: policies and protocols alone cannot change outcomes”, said Stanger. Change “must start with trust and the freedom to speak up without fear of reprisal”.