‘Deep concerns’ as maternity services in England deteriorate to lowest level, CQC warns

In a new report, the Care Quality Commission (CQC) said it was seeing maternity services worsen and saw issues with the leadership and culture within maternity units “time and again”.

Ian Trenholm, the CQC’s chief executive, said the failings were “systemic” in the NHS, with two in five maternity services now ranked as requiring improvement or inadequate. He said: “I don’t think any of us could think that’s an acceptable number”, adding that the regulator thinks the issues in maternity are a “national challenge”.

The new CQC state of care report shows there has been a deterioration in maternity services overall and in relation to their safety, describes progress on improving services as “slow”.

The proportion of maternity services ranked inadequate (6%) or requires improvement (47%) for safety is the worst it has been since maternity specific ratings were introduced in 2018. The proportion of maternity services rated inadequate (6%) or requires improvement (32%) overall are also at their worst levels.

Just 4% of maternity services have been ranked as outstanding this year, while 57% are good, a drop on the 64% the previous year.

The report said, “we have deep concerns” about care and that the “quality of maternity care is not good enough”. It added: “The findings of recent reviews and reports… show the same concerns emerging again and again.

“The quality of staff training, poor working relationships between obstetric and midwifery teams, and a lack of robust risk assessment all continue to affect the safety of maternity services,” said the report.

The report comes just two days after an inquiry found up to 45 babies could have lived if they had been given better care by East Kent Hospitals University NHS Foundation Trust. Some mothers died or were left injured, while other babies were left brain damaged, by a trust that ignored criticism of its services.

Shrewsbury & Telford Hospital NHS Trust and Morecambe Bay have also been involved with maternity scandals. An upcoming review of services in Nottingham is also expected to be highly critical.

Mr Trenholm said: “We’re not seeing the rate of improvement that we would like to see. I think what we see, time and again, is issues about leadership and culture and, on a practical level, that’s about the degree to which the professionals working in that maternity service work together in a collaborative way.

“Also, the degree to which those people listen to women who are speaking up and talking about their experience – and those experiences, those concerns that women are raising, are not being heard by those professionals in the way that they should.

“That is the essence of what the Kirkup report said and (Donna) Ockenden before him, so I think we do think this is a national challenge.”

Louise Ansari, national director at Healthwatch England, said: “In the wake of the Ockenden review and this week’s report on East Kent Hospitals Trust, it is deeply troubling that CQC’s findings suggest the troubles in maternity care could be much wider spread.”

The government committed to implementing the Ockenden recommendations, but has yet to commit to ones from Dr Kirkup. It said it is considering the report and expects to respond soon.

What has the government and NHS said?

A Department of Health and Social Care spokesman said: “The Care Quality Commission’s report identifies the same priorities for improvement set out by the Health and Social Care Secretary in Our Plan for Patients. “The plan - ABCD - is designed to address ambulance pressures, bust the backlog, support care and discharge from hospital and improve access to doctors and dentists.”

On maternity, he added: “It is vital NHS trusts focus on safe, personalised care across maternity services. We want NHS staff of all professions and disciplines to work together with women and families to deliver co-produced personalised and safe care.

“The NHS is investing £127 million in maternity services in the next year to help increase the maternity NHS workforce and improve neonatal care. This is on top of £95 million invested into the establishment of 1,200 midwives and 100 consultant obstetricians.

“The Care Quality Commission has begun a new maternity inspection programme to help services improve, both at a local and national level.”

An NHS spokesman said: “Despite improvements to maternity services over the last decade - with significantly fewer stillbirths and neonatal deaths - we know that further action is needed to ensure safe care for all women, babies and their families.”