Harm at risk of being normalised in maternity care

September 19, 2024

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 the Care Quality Commission said these problems were also being seen elsewhere.

Its 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 said: “These findings are cause for national shame.

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

And the government would be working with struggling trusts to make rapid improvements.

Blame cultures

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 overall rating than when last inspected. On the single issue of safety, 65% were judged to be failing.

Details have also emerged about the findings of a separate investigation into two of those units that were judged as 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.

An ongoing review into maternity failings at two hospitals in Nottingham has become the largest in NHS history, with nearly 2,000 families included within the investigation.

'Unbearably painful'

One woman told the CQC review she had requested pain relief but had had to give birth with none.

"My labour was unbearably painful,” she said.

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 now face having another baby.

While stillbirths and deaths shortly after birth have been falling over the past decade, about one out of every 20 mothers reports developing post-traumatic stress disorder.

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

Last year, 13% of all the claims against the NHS were in this area, with huge payouts being made to families where babies have been left with brain injuries.

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

'Failings uncovered'

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

“Failings uncovered in recent high-profile investigations are not isolated to just a handful of individual trusts," she said.

“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.

NHS England was providing “intensive support” to services and the report would be used to improve care, she added.

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.

BBC