Born into a broken system – why the Health Secretary is taking on maternity failures.

Having met families with heart-breaking stories of loss and avoidable harm, Wes Streeting has announced a national investigation into maternity care at ten NHS Trusts. It’s not the statutory public inquiry some families want, but it should have the advantage of being much quicker to identify what’s gone wrong and – more importantly – why.  

It will be followed by a system-wide look at maternity and neonatal care across England, bringing together lessons from past inquiries to create one clear, national set of actions to improve care across every NHS maternity service. That sounds good, but it’s a bigger piece of work and a longer timescale. 

It also sounds very familiar…

Shortly after the scandal at Morecambe Bay, we at Luther were part of the National Maternity Review team, commissioned by NHS England’s CEO, (now Lord) Simon Stevens. This too was a national review, not into specific failings in NHS maternity units, but into the maternity care system as a whole. The review team was a super-group of leading clinicians, policy experts, and people with lived experience of maternity care and baby loss.

But we were clear that it was not this auspicious group who should be in the driving seat, deciding what to recommend; the drivers should be people at the sharp end of maternity services. So, in what we believe was a first for NHS England, we embarked on a nationwide listening exercise, visiting communities across the country to hear what mums and dads, mums and dads-to be, midwives, obstetricians and other staff wanted from maternity services. 

We met people who had lost babies, people who had joyous births, people excited by the prospect of starting a family, and dedicated and exhausted staff. We asked them what was needed to improve maternity care and make it safer. What they told us became the Review’s recommendations in its report, Better Births.

At its heart was continuity of care: the simple but surprisingly radical idea that a woman should be cared for by the same, small midwifery team throughout her pregnancy and neo-natal journey. A team, working closely together, that would get to know her and her family, understand their needs and wishes, and be able to spot issues of concern. Evidence shows that continuity improves outcomes for mums and babies.

Today, almost a decade later, continuity is more likely to be the exception than the rule in maternity services in England. True, it’s not easy, neither is it the magic wand. Other changes are also urgently needed. 

For one thing, the poisonous battle between the proponents of natural birth and those who advocate intervention, and the toxic culture that has created in some hospitals, needs somehow to be resolved. Deal with that problem, find ways to make continuity work in practice, and we’d be heading towards better, safer maternity services. Improving outcomes and safety is, quite rightly, the goal for the Secretary of State. And if he can make that happen, he will also do Rachel Reeves a favour because it could mean that the bill for maternity negligence claims – well over £1 billion a year, or 40% of all NHS negligence costs – might just start to come down.

Luther’s experience of advising and supporting organisations across the healthcare world is unparalleled. To find out more about how we can help you, please get in touch at health@luther.co.uk