Maternity Services

Baroness Merron Excerpts

Thursday 25th January 2024 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I congratulate my noble friend Lady Taylor on securing this debate and setting out the issues with her customary elegance and clarity for us to build on further. As my noble friend said, all the briefings we received in preparation for this debate referred to a very worrying situation and—I shall head this off at the pass—to the fact that Covid cannot be used as an excuse because the pressures have been building for more than 10 years, which is something that I am sure the Minister will want to address.

As we heard, despite the Government and the NHS publishing various targets, programmes, strategies and action plans over the years to improve services, and having a lot of different evidence bases to call upon, and, sadly, inquiries into circumstances where things have gone tragically wrong, it is unfortunate that we find that maternity is an example of how services have deteriorated on the Government’s watch. As my noble friend Lady Armstrong said, even with all these plans, targets and so on, without proper implementation, they do not deliver improvement.

Within all of this, we know the data is important. I noticed in his response to a Written Question from the right reverend Prelate the Bishop of St Albans last month, the Minister explained that:

“The most recently published data which measures progress against”


government targets in the national maternity safety ambition

“coincided with the COVID-19 pandemic and is out of date”.

The Minister also said in his written reply that:

“The Department is working to increase the frequency and timeliness of publications”.


I am sure the whole House would agree that that would be welcome.

Does the Minister agree that it is extremely difficult to deal with any issue, including that of maternity services, without knowing the facts of the challenge? This was raised with particular regard to inequalities by my noble friend Lady Thornton and the noble Baroness, Lady Gohir.

The House will be aware of Labour’s commitment to train 10,000 more nurses and midwives every year, along with long-term workforce planning across the NHS by reviewing training and looking at creating new types of health and care professionals, drawing on a diverse skills mix. We are also committed to setting an explicit target to end the maternal mortality gap, which sees black women in the UK four times more likely to die while pregnant, giving birth or as new mothers, compared with white women. This will come partly from the aforementioned training of more midwives and health visitors but also by the incentivising of continuity of care—something referred to by the noble Baroness, Lady Cumberlege, from her experience in chairing the work that gave rise to the Better Births report. It will also come from improving course content on the presentation of illness and pain among different groups. I hope the contributions and expertise in your Lordships’ House will continue to contribute to making those commitments a reality in terms of improvement.

As we have heard a number of times in this debate, the Care Quality Commission has reported a decline in positive maternity experiences in recent years. The noble Lord, Lord Patel, described the health of maternity services as a bellwether for the health of our NHS. As we have heard, it seems that in our maternity services we are now finding that we are well behind in the maternal mortality stakes. That was not the case, but it is now. I was touched, as were other noble Lords, when the noble Lord, Lord Patel, expressed his gratitude to the thousands of mothers who allowed him to be part of their lives. I am sure that those thousands of mothers would also wish to express their gratitude to the noble Lord.

The approximately 20,000 responses to the CQC’s Maternity Survey 2022, which my noble friend Lady Donaghy referred to, showed that fewer women were being given the help they needed when they contacted a midwifery team. They were getting less help in hospital care after birth and less help with postnatal care. It also showed less confidence and trust, and a reduction in the availability of appropriate advice and support when contacting a midwife or hospital at the start of labour or while in the care of that hospital.

I thank, as have other noble Lords, the whole of the staff team who are in the provision of maternity services. As the noble Baroness, Lady Watkins, said, many of these staff go above and beyond. That is confirmed by the CQC, and rightly so. However, it is evident that there are external pressures on them that get in the way of them doing the job they need to do, and it is on this that the Government hold the levers.

The CQC has continued to raise concerns about the quality of maternity care in England over many years. In the most recent State of Care report for 2021-22, the regulator reiterates its ongoing concerns about both the safety and the ethnic inequality of maternity services, as well as the impact of poor training, poor culture and poor risk assessments on people’s care.

By September 2023, the CQC had inspected nearly three-quarters of maternity services and described the overall picture as one of a service and staff under huge pressure, warning that many patients were still not receiving safe and high-quality care. Most recently, in November 2023, around two-thirds of maternity units in England received a CQC rating of “requires improvement” or “inadequate in safety”. That compared with 55% in the previous year, so it is going in the wrong direction. I would be interested to hear the Minister’s response on this.

We have heard much in this debate, and rightly so, about maternal mortality. The latest data shows that between 2020 and 2022 it increased to levels not seen since 2003 to 2005. It is right, as noble Lords have said, that even within this extremely concerning statistic all is not uniform: the case is far worse for women who live in the most deprived areas. They are more than twice as likely to die during pregnancy, or up to one year afterwards, than women living in the least deprived areas. Between 2019 and 2021, 12% of the women who died had severe and multiple disadvantages and, as we have heard, women from black and ethnic backgrounds are three times more likely than white women to die during or up to six weeks after pregnancy, while Asian women are twice as likely.

The noble Baroness, Lady Gohir, was right to say that this broad-brush approach to definition masks the range and depth of inequalities. The noble Baroness, Lady Bull, was also right to point to the fact that inequality extends to those with a learning disability. Can the Minister say whether work is going on to produce much closer attention to the needs of groups, and to break down the nature of people within those groups, in order that we can reflect and respond to the reality of those with differing experience?

We have heard today about the tragedy of many failures within maternity services. I recall, during the many Statements that we have dealt with in this House, the expression of how devastating it is to look at these failures and to have to discuss them. Having looked recently at the independent review of maternity services at Nottingham University Hospitals NHS Trust, which is ongoing, I would say that it is staggering that it required concerned local families, MPs and others over many years to be crying out about the quality and safety of maternity services in their area. This will be the UK’s largest ever maternity services review, with around 1,700 families’ cases reportedly being examined. Donna Ockenden, who is in the lead, has said that the review will not report until September 2025 because

“no one will thank us for doing a half-baked job”.

She added that there would also be a period of family feedback, which could last until the start of 2026. This makes absolute sense, but it is worth asking why it took so long for those investigations to begin.

We have heard so much about staffing: it is absolutely key and retention is what we need. In addition, my noble friend Lady Thornton referred to the multidisciplinary training that is absolutely vital to cement the proper working practices that we need. Yet we find that so many cannot find the time to attend this training. Can the Minister say what is being done to address this?

In conclusion, the birth of a child, as we know, is a unique event. Mothers, babies and families all deserve the best. I hope that this debate and the work that may flow from it will deliver the improvements that we all need to see.