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Women hold and look at a baby in the hospital.
Two-thirds of public maternity units in England need to improve their safety standards, the country’s health regulator has found.
Of the 131 units surveyed by the Care Quality Commission, only 35% have a ‘good’ safety level, with 47% requiring improvement and 18% rated ‘inadequate’.
Inspectors found problems such as long delays in triage and failure to properly report incidents of serious damage at many locations.
When other factors, such as the quality of leadership and the effectiveness of service delivery, were taken into account, just under half of services were found to “require improvement” or were considered “inadequate”.
The CQC periodically inspects all public and private healthcare providers to assess their quality and make recommendations for approval if necessary.
These latest results come from inspections that took place between October 2022 and December 2023.
Deteriorating quality
The midwife-oriented maternity services in England did compared favorably for a long time for those in the US
But the country’s services are now experiencing a reckoning of sorts, with surveys at several hospitals reporting shocking and ongoing problems.
Key themes from reports on care in hospitals in Morecambe Bay in the north-west, East Kent in the south-east and Shrewsbury and Telford in the west include toxic relationships between different groups of staff on the units and an apparent reluctance to perform caesarean sections.
Perhaps the most prominent concern in the studies is the inability to listen to women and their families during care.
Racism in healthcare
Senior midwife Donna Ockendon, who led a damning research at Shrewsbury and Telford Hospital National Health Service Trust, is midway through an investigation into care at Nottingham University Hospitals NHS Trust in the Midlands.
This research has already shed light on issues of racism in maternity care. In July Ockendon described numerous incidents of “racist and discriminatory behaviour” by staff towards patients in the trust’s care.
Racism is a factor in the dramatically worse outcomes women of color face in England’s maternity wards. Just like in the US, black and Asian women are much more likely to suffer complications and even die during childbirth.
The Lucy Letby case
The Lucy Letby case has also brought English maternity care under serious scrutiny.
An investigation into conditions at the Countess of Chester Hospital, where the former neonatal nurse was employed, began last week. She was convicted of killing seven babies and trying to kill several more while working at the hospital.
Numerous concerns have already been raised about the time it took for managers to remove her from the neonatal unit, as well as concerns that the unit was overloaded while the deaths were taking place.
A national problem
As the CQC’s latest review shows, quality issues can be found across the country, with the same themes emerging again and again.
Previous reports from the regulator, including: annual survey of 20,000 women who use public maternity care point out that the quality of maternity care has been declining for several years.
Staff appear to be less available to women in their care and women have less confidence in staff than in previous years, the latest survey results show.
The country’s current ruling party, Labour, pledged to ‘strongly support’ the failing maternity care ‘towards rapid improvement’ in a manifesto published ahead of a landslide election victory this summer.
The party pledged to train thousands more midwives and set a target to close the mortality gap faced by black and Asian women.
Efforts have already been made to improve security in the country. In 2022, the National Health Service told public hospitals to drop the ‘normal birth’ goals because they can discourage cesarean sections.
Need for “urgent action”
Nicola Wise, director of secondary and specialist care at the CQC, said the latest maternity inspection program was “further evidence” that “urgent action” was needed to tackle the country’s maternity problems.
While inspectors saw examples of “good care” and “hardworking, compassionate staff doing their best,” the regulator remains concerned about quality and safety, she added in an emailed statement.
“Disappointingly, none of these issues are new,” she said. “Poor management of incidents with limited knowledge if something goes wrong, the inability to ensure safe and timely assessment, inadequate estates and access to essential equipment, a lack of oversight from trust boards, varied efforts to address inequalities in outcomes for black women and women ethnic minorities, chronic workforce shortages and the need for better engagement with families.”