Poor care and preventable harm are at risk of becoming “normalised” in England’s maternity services, says the healthcare regulator in yet another damning indictment of the treatment of women and their babies.
The Care Quality Commission (CQC) found too many maternity units were “not fit for purpose” and that the issues raised about poor care discovered in the landmark reviews into maternity services at East Kent and also Shrewsbury and Telford not only persisted, but were widespread across the NHS.
Inspectors found staffing shortages, with nurses fresh out of university taking on tasks better suited to more senior midwives and doctors; delays to emergency caesareans because operating theatres were unavailable; discrimination against women from ethnic minorities; poor leadership which created a culture of blame; and women not being treated with dignity.
The CQC’s findings come from inspections of 131 maternity units between August 2022 and December 2023. None had been inspected since 2021 and many were low on the list of regulator’s concern. And yet not one received the highest rating of outstanding for being safe. In fact, Sixty-five per cent of these units were failing on this measure. Close to half were rated as either requiring improvement or inadequate, and just four per cent judged outstanding.
Behind these appalling numbers are women and babies. The report is littered with their stories. Women described being unable to contemplate having another baby because they had been left so traumatised by the arrival of their firstborn. “I am now undergoing therapy for PTSD,” one woman said, “I find it incredibly traumatic to explain what happened in detail.”
One mother described being placed in a storage cupboard with her baby after an emergency C-section because there was no space on the postnatal ward, while others spoke about being left in blood-stained sheets. Women were repeatedly not listened to, and had their pain dismissed. For some women from ethnic minority groups, the denial of pain relief was combined with racism. One reported that she was told: “You are African, you are tough – you don’t need pain relief, get on with it.”
The most recent data on maternal mortality, published in January 2024, showed that black women were 2.8 times more likely to die during or up to 6 weeks after pregnancy, and Asian women were 1.7 more times likely to die during the same period.
“We cannot allow an acceptance of shortfalls that are not tolerated in other services,” Nicola Wise, the CQC’s Director of Secondary and Specialist Care, said.
These findings are, as health secretary Wes Streeting has reflected, a “cause for national shame.” He pledged that the government would work with struggling trusts to make rapid improvements.
Will those in charge of these services co-operate? CQC inspectors said leaders often challenged their findings, and that they “heard an overwhelming message from trusts’ maternity leaders that they did not want any more recommendations on what they need to do to improve.” We cannot go on like this, for as the CQC says, until these issues are addressed, “women and babies will not consistently receive the level of safe care they should be entitled to and the level of care that staff want to be able to deliver every time”.
