Harm at risk of being normalised in maternity care, regulator says

Many of the maternity failings at scandal-hit hospitals are becoming more widespread, England’s NHS regulator says.

Investigations into units in Shrewsbury and Telford and East Kent found poor care may have contributed to babies dying or having life-changing injuries.

But health and care regulator,  the Care Quality Commission (CQC) said these problems were also being seen elsewhere.

The commission’s review of 131 units across the NHS highlighted issues with staffing, buildings, equipment and the way safety was managed, warning preventable harm was at risk of becoming “normalised.”

Health Secretary, Wes Streeting, who said that the government would be working with struggling trusts to make rapid improvements, added: “These findings are cause for national shame. 

"Women deserve better, childbirth should not be something they fear or look back on with trauma.”

The CQC's 16-month investigation targeted maternity units not inspected and rated since March 2021 about two-thirds of the total and mostly those it had been least worried about.

Its review found examples of good practice but expressed concern about:

• staffing shortages, with nurses fresh out of university taking on tasks better suited to more senior midwives and doctors.
• problems with equipment, including call bells not working and poor pain management.
• delays to emergency Caesareans, because operating theatres were unavailable.
• limited access to toilets and showers and patients left lying in blood-stained sheets, compromising privacy and dignity.
• cramped, noisy and overheated wards.
• inconsistencies in the way safety incidents were monitored and recorded, including major emergencies such as significant loss of blood and internal injuries recorded as causing low or no harm.
• bad leadership and management creating blame cultures and low morale.
• triage problems, with women facing delays being assessed and not being prioritised properly.
• evidence of discrimination against people belonging to ethnic minorities, including a lack of support for women whose first language was not English.

Overall, 48% were rated as inadequate or requiring improvement with around a quarter receiving a lower rating than when last inspected. A total of 65% were judged to be failing on safety.

Details have also been provided about the findings of a separate investigation into two units that were judged inadequate, the Royal Derby Hospital and Queen's Hospital, which are run by University Hospitals of Derby and Burton NHS Trust. 

The review commissioned by the trust, but carried out by an independent midwife, found "care issues" may have affected losses of life after looking at more than 150 baby deaths. 

Meanwhile, nearly 2,000 families are now involved in a review into two Nottingham hospitals which has become the largest in NHS history.

One woman told the CQC review she had requested pain relief but had had to give birth with none.  She said: "My labour was unbearably painful.”

Another said her baby had become cold and ill after they had been placed in a storage room following an emergency Caesarean, because there had been no room on the ward. 

Others described being left traumatised, with one saying she could not face having another baby.

While stillbirths and deaths shortly after birth have been falling during the past decade, about one in every 20 mothers reported developing post-traumatic stress disorder. 

There is also concern around the number of clinical-negligence claims relating to pregnancy and childbirth.

Last year, these accounted for 13% of all claims against the NHS, with huge payouts to families where babies were left with brain injuries.

The CQC called on the government to invest more in buildings and equipment and recommended that NHS England improves the monitoring of safety-related incidents.

CQC specialist care director, Nicola Wise, said maternity care needed “urgent reform” as preventable harm was at risk of becoming “normalised.”

She said: “Failings uncovered in recent high-profile investigations are not isolated to just a handful of individual trusts. We cannot allow an acceptance of shortfalls that are not tolerated in other services. We must do more as a health system.”

NHS England chief midwifery officer, Kate Brintworth, said maternity care “simply isn’t at the level” it should be.     

She said NHS England was providing “intensive support” to services and the report would be used to improve care.          

But Gill Walton, of the Royal College of Midwives, pointed out there had been multiple reports like this over the past decade.

“Despite these recurrent themes, nothing has fundamentally changed," she said.

"We’re calling on the government to draw a line under this here and now, to work with us on resolving these problems and to build maternity services we can all be proud of.”

Sandra Igwe, chief executive of the Motherhood Group, which works to support black mothers, said maternity units were “notorious” for how they treat black women and families.

She told BBC Breakfast that she had first-hand experience and had heard from thousands of other black mothers who had their own examples of discrimination and unfair treatment.

“We are now seeing that maybe maternity care isn’t safe for anybody but especially for those who are disproportionality affected,” she told the BBC.

“If you have a higher proportion of unfair treatment, or higher disparities facing you, you must be even more scared going into some of these maternity services.”

Theo Clarke, a former Conservative MP who chaired the UK's first inquiry into birth trauma, told BBC Radio 4's Today programme it was "absolutely outrageous" that poor maternity care was not becoming the exception.

She has called for the new Labour government to commit to a "national maternity improvement strategy" led by a new maternity commissioner reporting to the prime minister.