A public inquiry into maternity services is welcome, but it is long overdue…
Wes Streeting’s announcement of a public inquiry into maternity services confirms what has been obvious for some time now – that maternity services nationwide are in crisis. A public inquiry is of course to be welcomed, but it is long overdue, coming as it does in the wake of a number of maternity scandals afflicting NHS Trusts in East Kent, Morecambe Bay, Shrewsbury and Telford, Nottingham and Leeds. He promises the inquiry will focus on the worst-performing maternity and neonatal services in the country, to conclude in December 2025, and he has already met families of babies who have tragically died or suffered serious harm which could have been avoided with competent and safe care.
He says:
“What they have experienced is devastating – deeply painful stories of trauma, loss, and a lack of basic compassion – caused by failures in NHS maternity care that should never have happened…”
Depressingly, reports of failings causing avoidable harm and death and a lack of compassionate care are not new. There is no doubt that a lack of funding and staffing in maternity care has significantly contributed to the ongoing crisis. There is currently a national shortage of midwives, obstetricians and gynaecologists, sonographers and neonatal staff in the NHS. More midwives and obstetricians and gynaecologists are desperately needed to ensure safe and compassionate maternity care can be delivered. In the context of maternity care, if there are too few staff, then they are, quite simply, too thinly spread. This means they cannot discharge their duties safely and competently. Understaffing contributes to difficult and highly stressful working conditions, causing staff to leave due to burn out. Every shift must feel like firefighting. These conditions are simply not conducive to attracting new talent, and so as people leave the sector, the conditions for those who remain get worse. And for junior staff entering the sector, the quality of the “on the job” training they receive will be compromised.
The startling lack of compassion that is being reported time and time again by the brave families affected cannot and should never be excused, but it can perhaps be explained by the considerable staff shortages prevalent in so many maternity units. When constantly stretched, stressed and exhausted, maternity staff may well not have the physical or emotional resources to offer kind, compassionate and competent care and may become desensitised to devastating events, with staff struggling to perform to the required standards in terms of both compassion and safety. This is a terrible and inexcusable state of affairs – birthing mothers should, at the very least, be entitled to kindness and compassion during such a vulnerable time in their lives.
But addressing the staffing crisis alone will not be enough. There has been a systemic failure within the NHS to embrace a culture of openness and transparency and to learn from mistakes to improve standards in patient care. Following the Francis report, commissioned to investigate the widespread failings at the Mid Staffordshire NHS Trust back in 2013, many NHS Trusts promised to prioritise patient safety, embrace the values of transparency and accountability and learn from their mistakes, to ensure they were never again repeated. But since that time, there has been a wave of maternity scandals…..
Urgent reform is now needed to eradicate the culture of fear that has been reported in so many struggling maternity units, and which acts as a barrier to improving patient safety and quality of care. As anticipated by the Francis report, the NHS needs to meaningfully promote a culture where healthcare professionals at all levels can openly and honestly speak out about concerns in patient care – it is only by doing this that lessons can be learned and standards improved. However, “whistleblowers” have historically been poorly treated in the NHS, when it is these very people, working directly with patients on the ground and seeing any difficulties first hand, who are best placed to flag any problems at the earliest opportunity so that swift action to improve standards can be taken. Those brave staff who do speak out, as well as the courageous families who report genuine concerns, talk of being ignored – with their concerns being swept under the carpet, when this vital and potentially life-saving information should be carefully considered and used to inform and improve patient care and safety. In an NHS setting, mistakes can cause harm and cost lives. Why is more not being done to learn from these mistakes and to avoid them from ever being repeated again? I hope that the national set of actions the maternity inquiry promises to create will address these issues once and for all.
The inquiry will also include an anti-discrimination programme to tackle inequalities in care for black, Asian and other underserved communities. Again, this is to be welcomed and is long overdue, given the concerning fact that maternal mortality rates are higher among black and Asian women than in white women. Urgent action must finally be taken to address these startling inequalities.
The public inquiry must now pave the way for urgent and meaningful action to be taken on a national scale to resolve the challenges which are crippling maternity units up and down the country and to avoid further avoidable harm and death to mothers and babies.
