Baroness Amos slams 'scale of unacceptable care' in NHS maternity services as care failings 'much worse' than anticipated
Victims of NHS maternity failings received “unacceptable care” leading to “tragic consequences”, the head of a probe into maternity care in England has said.
Changes within services have also been “too slow”, despite being necessary and urgent, according to a new report by Baroness Valerie Amos, who is leading the National Maternity and Neonatal Investigation (NMNI). The document shares her initial impressions after visiting seven trusts, talking with families and meeting NHS staff.
Baroness Amos wrote: “I expected to hear experiences from families about where they had been let down by the care they had received in maternity and neonatal units across the country, but nothing prepared me for the scale of unacceptable care that women and families have received, and continue to receive, the tragic consequences for their babies, and the impact on their mental, physical and emotional wellbeing.” The report shows that the NHS has recorded 748 recommendations relating to maternity and neonatal care in the past decade.
Baroness Amos describes this as “staggering”, adding: “This naturally raises an important question: with so many thorough and far-reaching reviews already completed, why are we in England still struggling to provide safe, reliable maternity and neonatal care everywhere in the country?”
The report highlights a number of issues which Baroness Amos said she has “heard about consistently”. These include women not being listened to, not being given the right information to make informed choices about their care, and discrimination against women of colour, working class women, younger parents and women with mental health problems.
Elsewhere, the probe also heard of cases of women who had lost babies being placed on wards with newborns, or instances when concerns about reduced foetal movement were disregarded. There were also reports of a lack of empathy from clinical teams when things go wrong, leading to women “feeling blamed and guilty”, the report said.
Baroness Amos thanked families, some of whom have criticised the probe and called for a statutory public inquiry, for “constructive and honest feedback” as part of the investigation. She added: “I do not understand why change has been so slow.
“It is clear from what I have already seen that change is not only possible, but also necessary and it is urgent.” The NMNI will focus on 12 NHS trusts, with full findings published in 2026.
Health Secretary Wes Streeting, who ordered the probe in June, said the update from Baroness Amos “demonstrates that too many families have been let down, with devastating consequences”. “Bereaved and harmed families have shown extraordinary courage in coming forward to share their experiences,” Mr Streeting said.
Mr Streeting is setting up the National Maternity and Neonatal Taskforce in the New Year, which he will chair. He added: “Harmed and bereaved families will remain at the heart of both the investigation and the response, to ensure no one has to suffer like this again. Because every single preventable tragedy is one too many.”