Damning report highlights key failings in maternity care across England

Nicholas Leahy

The Care Quality Commission (CQC) has recently carried out a national review of 131 maternity inspections between 2022 and 2024, finding that failures identified in maternity care across England are more widespread than previously thought.

Most people will be familiar with the high-profile investigations into maternity failings at the Shrewsbury and Telford NHS Trust, and more recently at Nottingham University Hospitals NHS Trust. But concerningly, 48% of maternity services across England have been rated as inadequate or requiring improvement, with just 4% being classed as outstanding. This shows that poor maternity care is a national issue, and not just isolated to a few trusts.

The CQC report identifies a number of examples of poor practice, including:

• Incidents of serious harm not being reported or being graded inconsistently.
• Women choosing to discharge themselves because of long delays whilst waiting for assessments.
• Units lacking space, facilities and occasionally life-saving equipment.
• Women experiencing discrimination because of their ethnic background.

As solicitors with expertise in dealing with clinical negligence claims following poor maternity care, the above examples are unfortunately something we see very often. It is evident to those who frequently advise mothers and their families following poor maternity outcomes that these issues are widespread and we often see the same mistakes happening time and again, with seemingly no improvement even after individual cases have been investigated, and recommendations made for change.

What is clear is that without concerted national action, led by the government, and further funding being ring-fenced to improve maternity services, maternity care is unlikely to improve, and the cost to the NHS over the long term is likely to increase. The CQC’s director of secondary and specialist care, in response to the report, called for:

“a robust focus on safety to ensure that poor care and preventable harm do not become normalised, and that staff are supported to deliver the high-quality care they want to provide for mothers and babies today and in the future”.

Whilst the report makes for concerning reading, particularly in its assertion that many of the issues identified are systemic, it does offer some hope that with “the right culture, services can improve and learn from one another”.

Specifically, the CQC report identifies a number of areas where improvement needs to be made, as follows:

Responding and learning from incidents

The CQC highlights a ‘potential normalising of serious harm in maternity’, with women not always receiving the information they need to process what happened to them, or to make informed decisions about future pregnancies. This is something that clinical negligence lawyers see very frequently in practice, with many of our clients complaining that they were simply not told what went wrong in their case, or not offered any follow up appointment to discuss how what has happened to them may impact any future pregnancy. We also act for clients where their complaints have been dismissed even when their child has suffered significant harm and notwithstanding this, the Trust has failed to properly investigate the cause of this. A further example we have seen are where Serious Incident Reports prepared by the Defendant NHS Trust have denied there have been failures in spite of compelling evidence that there have been fundamental failures in their advice and treatment.

Risk assessment and triage

The CQC found significant variation for maternity triage as there are no national targets or standards for this area. This meant guidance on how and when to contact triage was not clear or consistent between services. At Osbornes we are currently instructed on a number of cases in which women were either given incorrect advice on when to contact maternity triage, or not triaged properly when they did so, leading to poor outcomes.

Recruitment and retention of staff

Whilst this is a problem across the NHS, the CQC report found chronic issues around recruitment and retention of the maternity workforce as a key issue affecting the quality of care that women receive. A key problem was found to be maternity staff leaving the profession due to current pressures, which could potentially be alleviated with better support and training.

The CQC found that some maternity units were not fit for purpose, as they lacked space and facilities and, in a small number of cases, appropriate levels of potentially life-saving equipment. The report calls for more capital investment to alleviate this issue.

Inequalities and racism

The report found significant differences in the way trusts collect and use demographic data to address health inequalities in their local populations, in addition to some trusts where both staff and people who were using the service experienced discrimination because of their ethnic background, or issues associated with having English as a second language. Again, these issues are something we see very frequently in practice. Osbornes is currently instructed in a number of maternity cases where families from ethnic minority background, or with English as their second language, have experienced poor maternity outcomes. A frequent complaint we hear from families with English as a second language, or with no English, is that no interpretation/translation services were offered to them, even during vital discussions about whether to proceed with caesarean section delivery or induction of labour and when communicating failures related to brain damage suffered by their baby during delivery.

Communication with women and families

The CQC found communication with women and their families is not always good enough, particularly for those with protected equality characteristics. It highlights that this affects their ability to consent to treatment and can perpetuate levels of fear and anxiety. It is vital that women are able to give their informed consent to treatment, both to protect their right to patient autonomy and safety, but also in more practical terms to ensure that Trusts are complying with their own legal obligations.

It is hoped that this report will draw the crisis in maternity care to the government’s attention and that addressing these issues will move to the top of the new government’s agenda. Without further action, it is likely that we will see the same issues repeating themselves as they have to date, more negative outcomes for women and their families, and as a result more clinical negligence claims which come at a huge cost to the NHS.

Contact us

To speak with one of our solicitors, contact us by:

• Filling in our online enquiry form; or
• Calling us on 020 7485 8811