The announcement of a new inquiry into maternity care failures in England, including the shockingly higher risk of mortality faced by black and Asian mothers, indicates an overdue recognition that improvements are needed. From the devastating 2015 review of a decade of failure at Morecambe Bay, to last year’s birth trauma report from MPs, there is no shortage of evidence that women face unacceptable risks when giving birth on the NHS. The question is whether a review chaired by Wes Streeting himself can achieve what previous ones have not.
His role as chair is not the only novel aspect of this inquiry. A panel including bereaved parents will share their experiences and knowledge, alongside expert evidence. This format should focus minds on the human consequences of systemic failures, including mother and baby deaths, and on the need for accountability when things go wrong.
But while the ultimate goal is a “national set of actions”, there is no getting away from local variations. Part of the impetus behind this review comes from campaigners in Sussex and other areas where maternity services are currently causing serious concerns. Ten of these will now be scrutinised in the inquiry’s first stage.
Past inquiries have generally pointed to a combination of resource and cultural factors, including poor leadership, in seeking to explain why and how things have gone wrong. Such findings have not been limited to the hospitals themselves, and have included regulators.
But the reality is always complex and not reducible to soundbites. For example, poor relationships and communication between nurses and doctors are known to cause problems in maternity settings. Where such conflicts have been uncovered, they have generally had an ideological aspect, relating to differing attitudes to vaginal versus caesarean deliveries. But they can also be connected to wider questions about the level of skill and investment in the workforce.
In his seminal review of care failures in Mid Staffordshire, Sir Robert Francis asked the National Institute for Health and Care Excellence to examine the evidence about staffing ratios and patient safety, and to make recommendations. But in 2015, as Prof Anne Marie Rafferty and Prof Alison Leary noted in an article on that report’s legacy, this work was suspended. They believe this decision was motivated by the Conservative government’s anxiety about potential cost implications.
Mr Streeting says he is horrified by what he has heard about maternity care failures, particularly the lack of compassion shown to families after life-changing losses. Hence his decision to make this issue a “litmus test” for the government. But raising standards in the context of tight funding settlements, high levels of unmet need and ongoing staffing difficulties will be an enormous challenge.
Judge-led public inquiries should not be the only means for people who have been failed by the state to seek redress. Mr Streeting’s maternity review looks like a worthwhile attempt at developing an alternative – and he deserves praise for explaining this. With a pledge to present findings at the end of the year, he hopes to avoid one of the flaws with inquiries – that they take too long. The problem of how to deliver the accountability that affected people want is more intractable. Hardest of all, judging from past experience, is turning the findings of such inquiries into viable plans for real service improvements.