National Review of Maternity Services in England 2022-2024: Key Findings and Implications

The Care Quality Commission (CQC) has recently published its comprehensive review of maternity services across England, covering the period from 2022 to 2024. This report sheds light on the current state of maternity care, highlighting significant concerns that need urgent attention.

Overview of the Report

The CQC’s national maternity inspection programme involved 131 inspections of hospital maternity locations that had not been inspected since before March 2021. The findings reveal a mixed picture of maternity services across the country:

• Ratings Distribution: Of the inspected locations, 48% were rated as good, 36% as requires improvement, 12% as inadequate, and only 4% as outstanding
• Safety Concerns: Safety remains a critical issue, with no services rated as outstanding for safety. Almost half (47%) were rated as requires improvement, 35% as good, and 18% as inadequate.
• Leadership and Management: At 12 locations, the ratings for being well-led dropped by two levels, and at 11 locations, the ratings for safety also dropped by two levels.

Key Issues Identified

The report highlights several systemic issues that are impacting the quality and safety of maternity services:

1: Inconsistent Quality of Care

Too many women and babies are not receiving the high-quality care they deserve. The CQC found that nearly half of the inspected maternity units were rated as “requires improvement” or "inadequate". This inconsistency is attributed to several factors:

• Staffing Shortages: Many units are struggling with a shortage of midwives and other essential staff, which impacts the level of care provided.
• Training and Development: There are significant disparities in the training and professional development opportunities available to maternity staff across different trusts.
• Resource Allocation: Variations in funding and resource allocation lead to differences in the quality of facilities and equipment available to maternity units.

Cultural Issues: In some units, there is a culture of normalising poor care and serious harm, which undermines efforts to improve safety and quality.

2: Safety Incidents

There is a concerning trend towards the normalisation of serious harm in maternity services. The report calls for improved reporting, learning, and communication following patient safety incidents.

It was found that incidents of serious harm were not consistently reported or graded, leading to missed opportunities for investigation and learning. Some services tended to accept maternity incidents as inevitable or failed to report them due to time constraints caused by staffing pressures. This lack of consistent reporting and learning from incidents can have significant and long-lasting impacts on the mental health of women using these services.

3: Leadership Challenges

 Effective leadership is crucial for driving improvements in maternity services. The CQC report highlights that at several locations, the ratings for being well-led dropped significantly. Leadership challenges include:

• Inadequate Oversight: Some trusts lack robust oversight mechanisms to identify and address issues early.
• Leadership Development: There is a need for more comprehensive leadership development programmes to equip leaders with the skills necessary to foster a culture of safety and continuous improvement.
• Staff Support: Ensuring that maternity staff feel supported and valued is essential for maintaining morale and improving care quality.

Recommendations and Resources

To address these issues, the CQC has made several recommendations and developed additional resources aimed at supporting maternity staff at all levels. Trusts are encouraged to adopt a culture of continuous improvement and learning from one another. Specific initiatives include:

• Enhanced Reporting Systems: Implementing robust systems for reporting and learning from patient safety incidents to prevent the normalisation of harm.
• Leadership Development: Offering development programmes to all maternity and neonatal leadership teams to promote positive culture and leadership.
• Resource Allocation: Ensuring adequate funding and resources are allocated to maternity services to improve facilities and equipment.
• Training and Support: Providing comprehensive training and support for maternity staff to enhance their skills and capacity to deliver high-quality care.

The CQC’s national review of maternity services in England serves as a crucial wake-up call. The widespread issues identified require immediate and sustained action to ensure that all women and babies receive the safe, high-quality care they deserve. By addressing these challenges head-on and fostering a culture of improvement, we can work towards a future where maternity services in England are exemplary across the board.

For more detailed information, you can access the full report here.