Ministers must invest £350m to make maternity units safe, MPs say

Some women were made to feel ‘like a failure’ for having a caesarean section finds select committee report

(Getty Images)

NHS maternity units need an immediate investment of £350m to prevent women and babies dying from avoidable harm, a landmark report by MPs has said.

Following an investigation into maternity safety across the NHS, the Commons Health Committee said millions in extra spending was needed to fill staffing gaps, with the NHS short of almost 2,000 midwives and 500 doctors.

The report said there was still “worrying variation” in the quality of maternity care with elements of past scandals still being found in other units today. This included a defensive culture, dysfunctional teams, and poor quality investigations after incidents.

Health Education England calculated the NHS was short of 1,932 midwives. Separate estimates for doctors suggest the NHS needs at least 496 obstetricians.

The report said: “With eight out of 10 midwives reporting that they did not have enough staff on their shift to provide a safe service, it is clear that urgent action is needed to address staffing shortfalls in maternity services.

“We recommend the budget for maternity services be increased by £200–350m per annum with immediate effect.”

NHS England has invested £96m this year to increase midwife numbers by 1,000 and to provide dedicated safety training for staff.

The select committee, chaired by former health secretary Jeremy Hunt, also called for sweeping reforms to the compensation system for harmed families, to end what it called a blame culture in maternity services.

The changes would mean parents no longer having to fight for years to prove negligence and would instead receive compensation sooner if what happened was classed only as avoidable. The committee said the focus on negligence was feeding into a defensive culture within the NHS.

A similar model is used in Sweden where rates of serious birth injuries fell 50 per cent between 2000 and 2016.

MPs also called for the dangerous “normal birth” ideology found in some scandal trusts must be eradicated and said data on caesarean section rates in hospitals must no longer be used as a performance metric for the NHS.

Speaking to The Independent, committee chair Jeremy Hunt said: “The £350m is a drop in the ocean compared to the £1.4bn that we spend on maternity lawsuits, so we would save many times over the cost of additional staff if we can bring down the number of adverse incidents and in doing so, we can save countless families from the most appalling tragedies.”

He said while there had been improvements in maternity care with a 30 per cent reduction in neonatal deaths and 25 per cent cut in stillbirths over the last decade, there was still more to do, with 1,000 more babies surviving every year if the UK matched the performance of Sweden.

The MPs’ report comes amid inquiries investigating hundreds of cases of deaths and babies being left brain damaged at Shrewsbury and Telford Hospital Trust and the East Kent Hospitals University Trust. The Care Quality Commission has said 41 per cent of maternity units need to improve their safety.

Last week The Independent revealed similar concerns at Nottingham University Hospitals Trust, one of England’s largest NHS trusts.

Mr Hunt, who served as health secretary for six years, and commissioned the inquiry into Shrewsbury, said the reforms to staffing levels and training would take time.

“The single most depressing thing from my time as health secretary was the realisation that you could have a tragedy in the northeast of the country one month, and exactly the same tragedy in the southwest of the country the next, and nothing had happened to spread the learning around the NHS after the first case.

“That is because when something goes wrong, instead of the first priority being to learn from the mistake and spread the learning, it is self-protection. People are worried about being fired, worried about being struck off, worried about the reputation of their unit and that's why, in this report we've gone where no one has gone before on maternity safety and said we've got to change the law around litigation.”

He added: “I increased the number of doctors we train overall, and the number of midwives we train, by a quarter, but not a single extra doctor has yet joined as a result of those reforms because it takes seven years to train. These reforms will take time to bear fruit and we need to go further than I went.”

The committee said only 8 per cent of units were meeting the highest standards of training for staff and it urged independent investigations carried out by the Healthcare Safety Investigation Branch to continue, with the outcomes more widely shared.

It also called for doctors to be trained in “accepting a degree of fallibility” and how to react appropriately when they make mistakes.

On the pressure for women to have a “normal birth” the committee said there was still evidence this was happening despite denials from senior leaders.

The committee said some women were made to feel “like a failure” for having a caesarean section, adding that NHS organisation, leaders and experts “need to work hard to stamp out the damaging ideological focus on ‘normality at any costs’, which caused such huge loss and suffering at Morecambe Bay and Shrewsbury and Telford – and may exist in other trusts today”.

It recommended an immediate end to the use of data on caesarean sections as a performance metric and said NHS England should notify all units this was the case.

Mr Hunt said: “There is a change happening in the NHS, where safety is becoming a bigger priority, but it is a work in progress and we are not there yet. That's what we uncovered in this report. There is a difference between the reassurance you get from NHS leaders and royal college leaders and what is happening on the ground.

“What we're saying in this report is that choice is a good thing, but only well informed choice, where a mother is given the correct safety information about the choices she has.”

Responding to the report maternity safety minister Nadine Dorries said: “No parent or baby should have to suffer from avoidable harm during childbirth.

“Maternity safety is an absolute priority for this government and I’m pleased to say we are on track to surpass our ambition for a 20 per cent reduction in the stillbirth rate and the neonatal mortality rate.

“We know there is more to do be done, and the government is backing NHS maternity leaders with investment to help improve workplace culture, while also funding a plan to reduce birth-related brain injuries and better match maternity staffing to local needs.

“A strong workplace culture only makes a difference when the NHS has the staff it needs, which is why we are growing the maternity workforce with a £96 million recruitment drive.”