Maternity Services

Baroness Cumberlege Excerpts

Thursday 25th January 2024 Lords Chamber

[Baroness Cumberlege (Con)]

My Lords, it gives me great pleasure to follow the noble Baroness, Lady Taylor of Bolton, and thank her for a very interesting and incisive speech. I see that congratulations are being offered to her right now and she deserves them.

One thing that struck me as the noble Baroness was speaking was how important it is that we concentrate on relationships. We must consider all the relationships involved—the parents, the rest of the family and grandparents perhaps—but the most important is the relationship of the staff with the women and their babies. We know that there is huge pressure on midwives at the moment—the noble Baroness raised that issue.

This is a very important debate, and I am extremely pleased that the noble Baroness has taken to the opportunity to raise it. She and many other Members of the House of Lords feel strongly about maternity services and the beginning of new life. The way in which women and their babies are looked after is critical to the well-being of this country. It is a very interesting debate to have raised and I thank her warmly for it.

Maternal mortality rates are at their highest for 20 years. That is quite shocking and really must be addressed. I hope that through this debate we will raise the issues that are important.

I want to say something about when I chaired the National Maternity Review. I was asked to do it by the chief executive of NHS England, who was then Sir Simon Stevens—now the noble Lord, Lord Stevens—and I was given the task of completing the review in nine months, which seemed a very appropriate time. We published our report in 2016 and called it Better Births. It set out five years in which to plan and work towards improving maternity services in England. I was fortunate to have a wonderful, expert group of people on the review team, which was hugely helpful. The important thing we did was to go out and listen to the women of England, their partners and their families, and to the staff who provided maternity services. We listened and we learned from them, not just women who were already mothers but women hoping to become mums in the near future. We heard uplifting, inspiring stories of good maternity care and good outcomes, but we also heard some truly sad stories where care had not been good or outcomes had been devastatingly bad.

What we heard guided us, and the five-year plan we set out was based on what women told us they particularly wanted. At the core were two things that we believed would raise the quality of care and improve safety, leading to better births. The first was that women wanted, and felt they needed, the same midwife, or small team of midwives, throughout the maternity journey. They wanted a relationship based on trust and mutual respect. They wanted a midwife, or midwives, who knew them, understood them, and respected their birth plans and the choices they were making. We call that continuity of carer.

The noble Baroness, Lady Taylor, has raised this afternoon the issue of continuity. We know that continuity leads to safer care and better outcomes for the mum and the baby. Yes, continuity may be challenging in the face of workforce pressures, but we need to be much clearer that continuity is the model of care that we want to see. I think that that is what the noble Baroness was stressing, and I support that.

Secondly, women and their partners want to feel and know that their continuity of care is shared, around them and by them. We call that “personalised care”. It is centred on the woman and her baby, based around their needs and decisions, and where they have genuine choice—informed choice, but with unbiased information. Too often care is done to women and babies, rather than chosen and shaped with and by them. I know that, when staff are under huge pressure, taking the time to understand a woman’s choices and build care around her may be really very difficult, but that is what we should strive for, for all women.

Continuity and personalised care were at the heart of the five-year strategy. They stand at the heart of turning the phrase “better births” into reality. Today’s reality falls short on both continuity and personalised care. Our country is still one of the safest in which to give birth—I want to stress that—and we have met some of those wonderful staff who run our maternity services. But the evidence tells us that we are not achieving the progress that we could and should.

The most recent MBRRACE report on maternal mortality tells us that 293 women died in pregnancy or within 42 days of the end of pregnancy in the three years between 2020 and 2022. That is a significant increase over the previous years, and it excludes Covid-related deaths.

The CQC Maternity Survey 2022 tells us that 10% of maternity services are inadequate and that 39% require improvement. I was delighted that the noble Baroness, Lady Taylor, mentioned the work of the CQC, which is so important, but the figure of 10% of maternity services that are inadequate and 39% that require improvement accounts for nearly half of all services. The CQC says that safety and leadership are particular areas of concern, and they need to be addressed. We are all sadly familiar with the series of local failings in maternity care and the inquiries that have followed. I am thinking of Morecambe Bay, Shrewsbury and Telford, East Kent and Nottingham; those are just examples. Parents who have been involved in those inquiries are now calling for a full national inquiry, and I think they are right.

My Better Births report was published in 2016 and had a five-year plan, but those years have now passed. I believe that we need a fresh strategic national inquiry and a new coherent and practical plan for the whole maternity system. We need to tackle the issues of poor quality and poor outcomes. We need to listen to women and their families, and the staff who are there to care for them, and we need to be guided by what the evidence tells us will lead to better births, to make them safer and as a good an experience as is possible.

Finally, I would like to repeat something from the letter I wrote to the women of England at the start of the Better Births report in 2016:

“The birth of a child should be a wonderful, life-changing time for a mother and her whole family. It is a time of new beginnings, of fresh hopes and new dreams, of change and opportunity. It is a time when the experiences we have can shape our lives and those of our babies and families forever. These moments are so precious, and so important. It is the privilege of the NHS and healthcare professionals to care for women, babies and their families at these formative times”.


I hope those words might play a part in setting the tone and direction for what I believe is now needed: a fresh plan for maternity care.