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This research briefing sets out the current policies addressing the quality and safety of health services in England and discusses recent concerns regarding disparities in maternal health between ethnic groups.

Health services are a devolved policy responsibility. This briefing refers to the position in England.

Concerns about the quality and safety of maternity services

The quality and safety of maternity services has been a focus of national policy in recent years following several independent investigations into maternity and neonatal services at specific NHS Trusts, including The Report of the Morecambe Bay Investigation (2015; PDF), the Independent Maternity Review of maternity services at the Shrewsbury and Telford Hospital NHS Trust (March 2022) and the report into Maternity and neonatal services in East Kent (October 2022).

An independent review into the quality and safety of care at Nottingham University Hospitals maternity services is currently underway; a separate police investigation is being launched and will take place alongside the independent review.  

Concerns about safety within maternity services have also been raised in Care Quality Commission (CQC) ratings; in 2021, 38% of maternity services were rated as requiring improvement for safety.

Independent investigations also raised concerns about staffing levels and their impact on patient safety. The Royal College of Midwives notes the midwifery workforce has not kept up with higher demands due to an increasing proportion of pregnancies and births for women who have medical and social needs combined with Government policies to provide women with more personalised care and greater continuity of care.

Policies to improve quality and safety

The most recent policy for maternity care is set out in NHS England’s three year delivery plan for maternity and neonatal services, published in March 2023. The plan is centred around four key themes:

  • Listening to women and families with compassion
  • Supporting our workforce
  • Developing and sustaining a culture of safety
  • Meeting and improving standards and structures.

This three-year plan builds on maternity safety measures in the NHS Long Term Plan (January 2019) and on the work of the Maternity Transformation Programme.

The National Maternity Safety Ambition, launched in 2015, aims to halve the 2010 rates of stillbirths, neonatal and maternal deaths and brain injuries occurring during or soon after birth by 2025. The latest statistics show that neonatal and maternal death rates appear unlikely to halve by 2025. Although the stillbirth rate fell by more than 20% between 2010 and 2020, more recent figures for 2022 show that the rate has since increased and a 50% reduction by 2025 may not be met.

Response to concerns

In July 2023, the Government published its full response to an independent review into maternity failings at East Kent Hospitals NHS Trust.

At a national level, this committed the Minister for Mental Health and Women’s Health Strategy to chair a newly created maternity and neonatal care national oversight group. This will bring together the stakeholders from the NHS and other organisations to look at maternity and neonatal improvement programmes and the implementation of recommendations.

Following concerns about failures by maternity services to investigate and learn from patient safety incidents, in 2018 the Healthcare Safety Investigation Branch became responsible for conducting independent maternity investigations for all cases of early neonatal deaths, term intrapartum stillbirths and cases of severe brain injury in babies and maternal deaths. Responsibility for maternity investigations transferred to CQC on 1 October 2023.

To address staffing concerns, NHS England has provided recent funding aimed at expanding the workforce, including £127 million in March 2022 to boost the workforce and help improve the culture in maternity units.

Disparities in maternal health between ethnic groups

There has been notable press coverage of concerns about disparities in maternal health between ethnic groups, with Black women having particularly poor outcomes. For example, the 2022 MBRRACE-UK report (PDF) has demonstrated that Black women were at almost four times greater risk of maternal mortality than White women.

The reasons for these disparities are not fully understood, but differences in the incidence of deprivation, co-morbidities and pre-existing conditions between ethnic groups and barriers to engagement with health services for some groups (PDF) are thought to contribute.

Other factors relate to the experience and treatment of Black and minority ethnic women within maternity services. Respondents to the Black Maternity Experiences Survey (2022) reported concerns about the standard of care they received during labour, and how their concerns were addressed by professionals.

There are concerns that Black and minority ethnic women’s experience of maternity services may be negatively affected by implicit or explicit racism and negative perceptions of religious and cultural practices within maternity services.

Measures to address health disparities

The Government’s Women’s Health Strategy for England (2022) set out plans to address health disparities, including through the Maternity Disparities Taskforce, which was to explore disparities in maternity care and address poor outcomes among women from minority ethnic backgrounds and those living in deprived areas.

In June 2023, the Women and Equalities Committee published its report, Black maternal health, expressing concern about Black women’s experience of maternity services and concern that “Government and NHS leadership have underestimated the extent to which racism plays a role”.

Responding in June 2023 (PDF), the Government welcomed the Committee’s report and said it remained committed to tackling maternal inequalities and improving equity for mothers and babies. The Government did not commit to producing a cross-Government target and strategy for eliminating maternal health disparities, as recommended by the Committee.

Another Committee recommendation was that a review be carried out into education and continuing professional development for maternity staff in relation to maternal disparities. The Government said that NHS England would carry out a scoping exercise to inform the review.

A seperate Library briefing on Infant mortality and health inequalities examines the progress to date in reducing deaths during both the neonatal (first 28 days) and post-neonatal (28 days to 1 year) periods, collectively referred to as ‘infant mortality’. It particularly focuses on persistent inequalities in infant mortality rates by geographical area, ethnicity and socio-economic group.

This briefing does not cover the recently announced independent inquiry into events at the Countess of Chester Hospital following the trial of former neonatal nurse, Lucy Letby. The inquiry will focus on the case’s wider circumstances, including the trust’s response to clinicians who raised the alarm, and the conduct of the wider NHS and its regulators.

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