Report identifies key failings in NHS maternity services

Independent regulator of health and adult social care services in England, the Care Quality Commission (CQC), has conducted a national review of maternity services over two years. A series of high-profile investigations has identified several key failings at specific NHS Trusts. Their national maternity inspection programme has also shown that many of the issues raised are widespread across the country.

Safety concerns have now been raised as no services inspected were rated as ‘outstanding’ for being safe. Almost half of the 131 locations inspected were also rated as ‘requires improvement’ (36%) or ‘inadequate’ (12%).

Julie Hatton, Partner on Coodes’ Personal Injury and Clinical Negligence team, explores some key findings from the report.

The report’s findings

Overall, the CQC’s report reviewed maternity services from August 2022 until December 2023. While their findings highlight systemic issues, they believe the right culture will encourage improvements.

Triage

The report found variations in the way services ran patient triage. Concerns highlighted were patient prioritisation, timelines for initial assessment, oversight of those waiting as well as staff training and competence.

Significant variations were also found in the information being provided to patients. Different services were developing their own tools, processes and standard operating procedures. This lack of consistency meant the CQC were unable to audit the effectiveness of each triage system.

Recommendations have been set for NHS England to oversee the performance of maternity triage services. This is in line with the Royal College of Obstetricians and Gynaecologists’ (RCOG) recommendation to introduce a national standard and reporting tool for triage.

Estates

In some cases, maternity services and units were found to be not fit for purpose. Services lacked space to accommodate the necessary equipment to meet people’s needs. In other circumstances, it was the general ageing of the environment and the facilities. This included issues with temperature regulations, ventilation, a lack of capacity in theatres and adequate bereavement provision.

The CQC has recommended that the Department of Health and Social Care (DHSC) provide additional investment for maternity services. Also to work with NHS England to ensure the investment is ring-fenced.

Inequalities and racism

The most recent MBRRACE-UK data shows that compared with women from white ethnic groups, black women were 2.8 times more likely to die during or up to 6 weeks after pregnancy. In addition, Asian women were found to be 1.7 times more likely to die during the same period.

Racism and racial stereotyping are a contributing factor to barriers to adequate care for people of colour. In addition, language barriers for those who do not speak English as a first language also contributes.

In some services, both staff and patients were treated unfairly for their ethnic background or English as their second language.

The CQC recommend that NHS Trusts and integrated care boards (ICBs) collaborate to create clear policies and procedures to collect better demographic data to improve outcomes for all women. In addition, this data should always be considered when reviewing patient safety incidents and that action is taken where risks are identified.

Staffing

Recruiting and keeping staff is a problem for some maternity services so there aren’t always enough staff for women and babies. It’s important to note that the people who were interviewed by the CQC appreciated that maternity staff were doing their best despite being overstretched. However, as a result, people felt they weren’t prioritised and didn’t get the help they needed.

Maternity teams were found to be under pressure, acting beyond the scope of their clinical practice and missing out on mandatory training and development. Staff also told CQC researchers that they were not always able to provide the care they wanted to deliver.

As a result, the CQC has recommended that NHS England has oversights of rotas, and the proportion of time spent by consultants covering them. In addition, working with the Nursing and Midwifery Council and the Royal College of Obstetricians and Gynaecologists to establish a “minimum standard for midwives delivering high-dependency maternity care.”

Maternity services

Overall, this report sheds light on some valid concerns and safety failings when it comes to England’s maternity services. With the recommendations in place, action must be taken to address systemic and other issues. People need to feel safe and supported during and after their pregnancy.

If you feel you have experienced poor care, Coodes Personal Injury and Clinical Negligence team are experienced with birth injury claims, pregnancy and gynaecology injury claims as well as medical malpractice and substandard care. We can help you in your journey to justice and compensation.

To find out more, contact Julie Hatton by emailing julie.hatton@coodes.co.uk or call 01326 214 036. Alternatively, fill in our online contact form and a member of the Coodes team will be in touch.