Perhaps the most dismaying thing about the interim maternity care report commissioned by the health secretary, Wes Streeting, is how little of it is new: entrenched cultural and leadership failures; staff shortages and crumbling facilities; stark racial and socioeconomic disparities, with black women nearly three times more likely to die than white women; and hospitals still covering up mistakes. These grave and painfully familiar shortcomings apply to England, where health policy is devolved; Scotland is conducting its own maternity review.
So far there is little indication of how Lady Amos, the Labour peer leading the inquiry, believes that this failing system can be sorted out. This is a descriptive rather than a prescriptive document, which draws heavily on the 8,000 consultation responses received so far. But some overlap in her final report – expected in the next few months – with the 748 recommendations already placed before ministers over the past decade is inevitable. The question facing her team, and Mr Streeting, is what they can try that hasn’t been tried before, or how they can do similar things differently.
Mr Streeting’s pledge to chair a new taskforce gives reason to hope that this issue will remain a priority. Repeatedly, he has stressed his shock after meeting families who have lost babies through inadequate care, and gone on to become campaigners. But the problems are wide as well as deep. While gross failings leading to multiple deaths in trusts including East Kent and Shrewsbury and Telford are notorious, many other hospitals do not meet acceptable standards. In a Care Quality Commission (CQC) review of 131 units between 2022 and 2024, almost half were judged to be unsafe.
Tackling this situation, so that high-quality care becomes the norm, and mistakes are quickly dealt with, is a daunting challenge. Under successive Tory governments, the backlog of repairs spiralled. In his 2024 rapid review of the NHS, Lord Darzi pointed to a £37bn capital investment shortfall compared with peer countries in the 2010s. But austerity’s grim legacy of decrepit buildings is just one of several factors holding back maternity care, with chronic workforce issues probably the most important.
This means shortages, in some cases, with Lady Amos finding evidence of disruptive redeployments. But it also includes conflicts between midwives and doctors and a failure by leaders to manage these, and disturbing examples of racism. By withholding or falsifying records, hospitals compound trauma and obstruct the learning needed to prevent repeat mistakes. Somehow, bosses must find ways of addressing such behaviour while also raising morale, in order to attract ambitious, committed people. Issues arising from an increasingly complex caseload must also be acknowledged. Childbirth is never risk-free, but the rise in older and obese mothers adds to the dangers.
NHS England’s maternity and neonatal board is in a state of flux, which will have to be resolved if it is to play an active role in future. Mr Streeting’s participation in the taskforce guarantees much-needed ministerial oversight, and raises the political stakes. But quick or easy wins are unlikely. The CQC’s most recent survey of new mothers found some cautious grounds for optimism in improved communication. Lady Amos and her colleagues should look for ways to build on this, and to understand why previous reviews have not succeeded in bringing about improvements.
Do you have an opinion on the issues raised in this article? If you would like to submit a response of up to 300 words by email to be considered for publication in our letters section, please click here.
