What has gone wrong with maternity and neonatal care? It is a question that, even after numerous high-profile cases of failure and the sometimes life-changing experiences of many thousands of mothers and their children, remains frustratingly unclear.
It is not the case that care for mothers and babies is uniformly bad, but neither is it the case that really poor results are sufficiently rare to be treated as exceptional.
Outstandingly fine examples can also be found, but not enough. The severity of the shortcomings ranges widely – from unclean wards and hungry patients, to women left to “bleed out” in bathrooms, to brutally unsympathetic staff, to the avoidable deaths of infants.
The picture thus painted in the latest report into England’s maternity wards and specialist units points to inconsistency, and to far too many cases of “unacceptable care” leading to “tragic” consequences.
Valerie Amos, who is leading the national maternity and neonatal investigation (NMNI), says that she does not yet have all the answers to what has gone so appallingly awry in this particular sector of the NHS – but at least the scale of the challenge has been identified.
Coming from outside the NHS, Baroness Amos, whose background is in government and academia, is to be congratulated on working with such impressive speed to highlight an everyday – but still astonishing – story of neglect and mistreatment that can amount to abuse.
Such unfamiliarity, she admits, meant that “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”.
One failing is clearly a matter of bureaucracy and lack of managerial and political drive in the face of obvious problems. The media, including The Independent, have broken stories on a depressing series of scandals in NHS trusts in recent years. Each has shocked the nation. Even now, the situation in the Leeds Teaching Hospitals NHS Trust remains so serious that it has had to be dealt with separately by the health secretary, Wes Streeting, and taken out of Baroness Amos’s remit.
The same goes for the Shrewsbury and Telford Hospital NHS Trust, a place where matters are so serious that the trust is still being investigated by West Mercia Police.
Inquiry after inquiry, all thorough and professional, have been conducted into various trusts, and yet, as Baroness Amos notes, it is itself a scandal that the NHS machine has failed to implement a total of 748 recommendations for improvements made by various audits. She rightly asks why the managers and clinicians are struggling to provide safe, reliable maternity and neonatal care.
Part of the reason may be that children’s and maternity services have suffered from underinvestment compared to other services. This may, in turn, have stemmed from a deep-seated but invisible tendency towards unconscious misogyny on the part of those, usually men, who allocate funding and resources into a system largely run by women for women.
It is also disturbing, in this context, that Baroness Amos has already detected discriminatory treatment against women of colour, working-class women, younger parents and women with mental health problems.
It is not the first time that an official inquiry has seen this sort of issue – it was also a disparity that came into focus during the pandemic, and it obviously begs some uncomfortable questions about what’s happening on the wards. This unfair treatment is a discovery that cannot be accounted for by lack of investment in staffing or equipment – but points perhaps to more insidious cultural factors at play.
The NMNI has not tried to duplicate previous investigations into individual trusts, still less act like a police force, but has visited 12 trusts to try and assess what routine maternity and neonatal care looks like, and it appears they have been open and transparent about their problems.
Care can be exemplary, but is too often not. Issues such as uncaring staff, mothers’ protests being ignored, and a certain tendency to be complacent are things that every NHS trust can address immediately. The Royal College of Midwives, for example, say that they have been warning for years about the dangers and the lack of “ring-fenced” funding for specialist care.
The maternity taskforce that Mr Streeting has assembled should already have a pretty good idea of what action needs to be taken, and they have an energetic and forceful secretary of state to back them up. By the time Baroness Amos publishes her final report next year, the taskforce should be in a position to demonstrate tangible improvements. There is no time to waste.
What’s more, it would be one of the defining boasts of Mr Streeting’s career if he could make a guarantee that every woman will feel safe to have a child at an NHS hospital. It doesn’t feel like a big promise, but it would be a great one.
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