Two-thirds of England’s public maternity units need to improve their safety standards, the country’s healthcare regulator has found.
Of 131 units investigated by the Care Quality Commission, just 35% have ‘good’ safety levels, with 47% requiring improvement and 18% rated ‘inadequate.’
Inspectors found issues such as long delays to triage and failures to properly report incidents of serious harm at many sites.
When other factors like leadership quality and the effectiveness of services were taken into consideration, just under half of services either “required improvement” or were considered “inadequate.”
The CQC periodically inspects all public and private healthcare providers to assess their quality and issue recommendations for approval when necessary.
These latest results stem from inspections taking place between October 2022 and December 2023.
Deteriorating Quality
England’s midwife-centric maternity services had long been compared favorably to those in the U.S.
But the country’s services are now experiencing something of a reckoning, with inquiries reporting shocking and persistant issues at several hospitals.
Major themes from reports into care at hospitals in Morecambe Bay in the northwest, East Kent in the southeast and Shrewsbury and Telford in the west include toxic relations between different groups of staff on the units and an apparent reluctance to perform Cesarian sections.
Perhaps the most prominent concern across the inquiries has been a failure to listen to women and their families during care.
Racism In Healthcare
Senior midwife Donna Ockendon, who led a damning inquiry into Shrewsbury and Telford Hospital National Health Service trust, is partway through an investigation into care at Nottingham University Hospitals NHS trust in the midlands.
This inquiry has already shone a light on issues like racism in maternity care. In July, Ockendon described numerous incidents of “racist and discriminatory behavior” from staff toward patients in the trust’s care.
Racism is a factor in the dramatically worse outcomes women of color face on England’s maternity wards. Like in the U.S., Black and Asian women are far more likely to experience complications and even die when they give birth.
The Lucy Letby Case
The Lucy Letby case has also put England’s maternity services under serious scrutiny.
Last week, an inquiry began into circumstances at the Countess of Chester Hospital, which employed the former neonatal nurse. She was convicted of killing seven babies and attempting to murder several more while working at the hospital.
Numerous concerns have already been raised over the length of time it took managers to remove her from the neonatal unit, has have concerns the unit was overstretched while the deaths took place.
A National Problem
As the CQC’s latest review shows, quality issues can be found across the country, with the same themes cropping up again and again.
Previous reports by the regulator, including annual survey of 20,000 women who use public maternity services, suggest the quality of maternity services has been falling for several years.
Staff seem to be less available to women under 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, promised to “robustly support” failing maternity services “into rapid improvement” in a manifesto published ahead of a landslide electoral victory this summer.
The party promised to train thousands more midwives and set a target to close the mortality gap faced by Black and Asian women.
Attempts have already been made to improve safety in the country. In 2022, the National Health Service told public hospitals to drop “normal birth” targets because they may disencentivize C-sections.
Need For “Urgent Action”
CQC Director of Secondary and Specialist Care Nicola Wise said the latest maternity inspection program was “further evidence” that “urgent action” was needed to address the country’s maternity prolems.
Although inspectors saw examples of “good care” and “hardworking, compassionate staff doing their best,” the regulator remains concerned over quality and safety, she added in an emailed statement.
“Disappointingly none of those issues are new,” she said. “Poor management of incidents with limited learning when things go wrong, failure to ensure safe and timely assessment, unsuitable estates and access to essential equipment, a lack of oversight from trust boards, varied efforts to tackle inequalities in outcomes for Black and ethnic minority women, chronic staffing shortages and a need for better engagement with families.”
