Maternity care improvement ‘too slow’ with two in five services not performing well enough – CQC

Steps to improve maternity care have been “too slow”, health inspectors have warned as new figures show that two in five services are not performing well enough.

A total of 41% of maternity services are rated as either “inadequate” or “requires improvement” by the Care Quality Commission (CQC), according to figures from July.

There have been multiple deep dives into issues affecting maternity care, with various safety improvements recommended by leading experts.

But a new CQC report states that despite an emphasis on maternity services in recent years, the “pace of progress has been too slow”.

The authors warned that action to ensure all women have access to safe maternity care “has not been sufficiently prioritised to mitigate risk and help prevent future tragedies from occurring”.

The new report from the CQC is based on nine inspections from March to June.

Inspectors picked out some thematic issues from their visits, including:

• Evidence of poor working relationships between obstetric and midwifery teams
• Poor teamworking
• A lack of clear leadership and in some instances a “culture of bullying” where maternity staff feared that if they raised concerns about poor practice they would lose their job
• At one trust, maternal death had not been investigated as a serious incident
• Staff at another service made allegations of “cover-ups” when things went wrong

Inspectors also warned that risks faced by women from black and minority ethnic groups have been “exacerbated” during the pandemic, highlighting the “urgent need to improve equity in maternity”.

They stressed that while the death of a mother is rare, death rates are “significantly higher” among women from black and minority ethnic groups.

Mortality rates also remain higher for black or black British babies and Asian or Asian British babies.

CQC analysis also shows that during 2020 black women were significantly more likely to be readmitted to hospital in the six weeks after giving birth.

In June 2020, the chief midwifery officer wrote to all NHS midwifery services calling on them to take action to minimise the additional risks faced by women and babies from black and minority ethnic communities.

The authors warned that in many cases the actions – including offering increased support, recording risk factors and ensuring they provide information on vitamins, supplements and nutrition in pregnancy – had been “interpreted quite narrowly”.

Ted Baker (pictured), the CQC’s chief inspector of hospitals, said: “This report is based on a small sample of inspections carried out in response to evidence of risk so does not present a national picture, but we cannot ignore the fact that the quality of staff training; poor working relationships between obstetric and midwifery teams, and hospital and community-based midwifery teams; a lack of robust risk assessment; and a failure to engage with and listen to the needs of local women all continue to affect the safety of some hospital maternity services.

“The death or injury of a new baby or mother is devastating and something that everyone working in the health and care system has a responsibility to do all they can to prevent.

“We also must do more to tackle the disparities in outcomes that exist for black and minority ethnic women. Addressing inequalities and tailoring maternity services to best meet the needs of the local population is a critical area for action and something that good services are prioritising.

“Safe, high-quality maternity care should be the minimum expectation for all women and babies, and it’s what staff working in maternity services across the country want to deliver. We have seen good progress in some services, but we must now accelerate the pace of change across all services to prevent future tragedies from occurring and ensure that women and babies get consistently safe care every time.”

James Titcombe, patient safety and policy consultant for Baby Lifeline, whose baby Joshua died after midwives missed chances to spot and treat a serious infection nine days after he was born at Furness General Hospital in 2008, said: “Today’s report highlights that in too many maternity units, concerns around leadership, oversight of risk, teamwork and culture are still negatively impacting the care of women and families.

“Avoidable harm during childbirth can have a truly devastating and life-changing impact on families and staff, it’s crucial that there is now a commitment from everyone involved in delivering maternity care to come together with a shared purpose and goal – and that we work together to address the issues today’s report highlights with a renewed sense of urgency and pace.”

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