Take action to avoid poor maternity care becoming normalised, watchdog warns

Poor quality NHS maternity care will become “normalised” if action is not taken, according to the healthcare watchdog.

A Care Quality Commission (CQC) report, which brings together the findings from 131 inspections, also highlighted that many failings identified in recent high-profile investigations into NHS maternity services are “more widespread”.

It has called for “increased national action” and ring-fenced investment into services in order to tackle shortfalls.

Of the 131 units inspected as part of a national programme between August 2022 and December 2023, almost half (48%) were rated as requires improvement or inadequate.

Only 4% were classed as outstanding and 48% were rated as good.

The CQC said the safety of maternity care “remains a key concern”.

No services inspected as part of the programme were rated outstanding for safety, with 47% requiring improvement, 18% rated inadequate and 35% rated as good.

NHS maternity care has been under increased scrutiny in recent years after several high-profile inquiries, such as the Ockenden Review into more than 200 baby deaths at the Shrewsbury and Telford Hospital NHS Trust, and the investigation into maternity services in East Kent.

The report said: “Many of the factors apparent at East Kent and Shrewsbury and Telford are more widespread.

“Key issues continue to impact quality and safety – and disappointingly, none of them are new.”

Nicola Wise, director of secondary and specialist care at the CQC, added: “Sadly, our latest maternity inspection programme has further evidenced the need for urgent action with continued problems indicating that the failings uncovered in recent high-profile investigations are not isolated to just a handful of individual trusts.

“Although we’ve seen examples of good care and seen hardworking, compassionate staff doing their best, we remain concerned that key issues continue to impact quality and safety.”

It added that complications such as postpartum haemorrhages, which are “well recognised” by maternity staff, can have a “significant impact” on women, who do not always receive information on what they have been through.

Not all patients received a safe and timely assessment when being triaged, the report claims, with instances of triage phones going unanswered and some women discharging themselves before being seen by a midwife or doctor as delays were so severe.

There are also concerns about how maternity staff communicate and engage with women and their families.

Some NHS estates were described as “not fit for purpose”, lacking the “space and facilities and, in a small number of cases, appropriate levels of potentially life-saving equipment”.

The CQC has made a number of recommendations to NHS trusts, NHS England and integrated care boards to address the issues, and has also called for the Department of Health and Social Care (DHSC) to invest more in maternity services and work with NHS England to ensure this is ring-fenced.

“We cannot allow an acceptance of shortfalls that are not tolerated in other services. Collectively, we must do more as a healthcare system.

“This starts with a robust focus on safety to ensure that poor care and preventable harm do not become normalised, and that staff are supported to deliver the high-quality care they want to provide for mothers and babies today and in the future.”

Speaking at an Institute for Public Policy Research (IPPR) event in London on Wednesday, Health and Social Care Secretary Wes Streeting said: “When it comes to the crisis in our maternity services across the country, it is one of the biggest issues that keeps me awake at night worrying about the quality of care being delivered today at the risk of disaster greeting women in labour tomorrow.

“I think that what we have seen, in the case of specific trusts, are problems and risk factors that exist right across maternity services across the country.

“We’re keen to make sure that when it comes to the work that Donna Ockenden has already done, we make sure that those lessons are applied, not just in the case of those specific trusts, that actually right across the country. We are determined to get this right.”

Mr Streeting also described the CQC’s findings as a “cause for national shame”.

“Women deserve better – childbirth should not be something they fear or look back on with trauma,” he said.

“It is simply unacceptable that nearly half of maternity units the CQC reviewed are delivering substandard care.”

NHS chief midwifery officer Kate Brintworth added: “Despite the hard work of NHS staff, we know that, for large numbers of women and families, NHS maternity care simply isn’t at the level they should expect and there is a lot to do to improve.”

Commenting on the report, Ranee Thakar, president of the Royal College of Obstetricians and Gynaecologists, said: “The Government will have a long list of NHS priorities after last week’s Darzi Review, but this CQC report should propel maternity care to the top.

“It signals loud and clear that urgent, multi-pronged action is needed to tackle the complex, deep-rooted issues facing maternity services.”