Maternity services have deteriorated to lowest level and getting worse, hospitals regulator warns

Maternity services in England have deteriorated to their lowest level, the hospitals regulator has said, as it expressed “deep concerns” about the quality of care given to mothers and babies.

In a worrying report, the Care Quality Commission (CQC) said it was seeing worsening services and, “time and again” saw issues with the leadership and culture within maternity units.

Ian Trenholm, the CQC’s chief executive, said the failings were “systemic” in the NHS, with two in five maternity services now ranked as requiring improvement or inadequate.

He said: “I don’t think any of us could think that’s an acceptable number”, adding that the regulator was of the view that the issues in maternity were a “national challenge”.

It comes just two days after a damning inquiry found up to 45 babies could have lived if they had been given better care by East Kent Hospitals University NHS Foundation Trust.

Some mothers died or were left injured, while other babies were left brain damaged, by a trust that shelved inspector reports and ignored criticism of its services.

East Kent is the latest in a long line of maternity scandals, including at Shrewsbury and Telford Hospital NHS Trust, Morecambe Bay and the upcoming review of services in Nottingham, which is expected to be highly critical.

Mr Trenholm said: “We’re not seeing the rate of improvement that we would like to see. I think what we see, time and again, is issues about leadership and culture and, on a practical level, that’s about the degree to which the professionals working in that maternity service work together in a collaborative way.

“Also, the degree to which those people listen to women who are speaking up and talking about their experience – and those experiences, those concerns that women are raising, are not being heard by those professionals in the way that they should.

“That is the essence of what the Kirkup report said and (Donna) Ockenden before him, so I think we do think this is a national challenge.”

The new CQC state of care report shows there has been a deterioration in maternity services overall and also in relation to their safety, describing progress on improving services as “slow”.

The proportion of maternity services ranked inadequate (6%) or requires improvement (47%) for safety is the worst it has been since maternity specific ratings were introduced in 2018.

Similarly, the proportion of maternity services rated inadequate (6%) or requires improvement (32%) overall are at their worst levels.

The report said, “we have deep concerns” about care, adding that the “quality of maternity care is not good enough”.

It added: “The findings of recent reviews and reports… show the same concerns emerging again and again.

“The quality of staff training, poor working relationships between obstetric and midwifery teams, and a lack of robust risk assessment all continue to affect the safety of maternity services.”

Just 4% of maternity services have been ranked as outstanding this year, while 57% are good, a drop on the 64% the previous year.

On the wider NHS, the CQC said health leaders now believe that the risk of patients coming to harm is the “new status quo”.

Furthermore, the “inability” of patients to access GP services is “exacerbating the high pressure on urgent and emergency care services.”

An online survey for the report found that 42% of patients felt their needs were definitely met at their GP appointments, and the same percentage said they were partly met.

Some 15% said their needs were ‘not at all’ met by their appointments.

Meanwhile, more than half of the people who responded (58%) said their access to GPs had worsened since the pandemic.

The report described emergency departments as “packed” out, while NHS hospitals told the regulator that people are presenting more acutely unwell and are therefore more likely to be admitted.

The CQC said that, overall, public satisfaction with the NHS and social care in 2021/22 has “plummeted”.

While the regulator found that 75% of NHS acute core services were good or outstanding, it said the ratings for urgent and emergency services in major NHS hospitals are still “unacceptably poor”, with more than half (54%, 109 services) rated as requires improvement or inadequate.

The CQC described the entire health and care system as “gridlocked” and “unable to operate effectively”.

It said: “Most people are still receiving good care when they can access it – although this is less likely to be the case for people living in deprived areas, disabled people and people from ethnic minority groups.

“Too often, however, people just can’t access the care they need…

“Only two in five people are able to leave hospital when they are ready to do so, contributing to record-breaking waits in emergency departments following a decision to admit, and dangerous ambulance handover delays.

“What this gridlock means for people is that they are stuck – stuck in hospital because there isn’t the social care support in place for them to leave, stuck in emergency departments waiting for a hospital bed to get the treatment they need, and stuck waiting for ambulances that don’t arrive because those same ambulances are stuck outside hospitals waiting to transfer patients.”

Louise Ansari, national director at Healthwatch England, said: “The report echoes many of the issues people have raised with us, such as difficulties getting through to their GP team or getting the care they need in a timely way.”

She added: “In the wake of the Ockenden review and this week’s report on East Kent Hospitals Trust, it is deeply troubling that CQC’s findings suggest the troubles in maternity care could be much wider spread.”

The Government committed immediately to implementing the Ockenden recommendations but has yet to commit to the ones from Dr Kirkup. It said it is considering the report and expects to respond soon.

A Department of Health and Social Care spokesman said: “The Care Quality Commission’s report identifies the same priorities for improvement set out by the Health and Social Care Secretary in Our Plan for Patients.

“The plan – ABCD – is designed to address ambulance pressures, bust the backlog, support care and discharge from hospital and improve access to doctors and dentists.”

On maternity, he added: “It is vital NHS trusts focus on safe, personalised care across maternity services. We want NHS staff of all professions and disciplines to work together with women and families to deliver co-produced personalised and safe care.

“The NHS is investing £127 million in maternity services in the next year to help increase the maternity NHS workforce and improve neonatal care. This is on top of £95 million invested into the establishment of 1,200 midwives and 100 consultant obstetricians.

“The Care Quality Commission has begun a new maternity inspection programme to help services improve, both at a local and national level.”

An NHS spokesman said: “Despite improvements to maternity services over the last decade – with significantly fewer still births and neonatal deaths – we know that further action is needed to ensure safe care for all women, babies and their families.”

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