Maternity Services

Baroness Warwick of Undercliffe Excerpts

Thursday 25th January 2024 Lords Chamber

[Baroness Warwick of Undercliffe (Lab)]

My Lords, I thank my noble friend Lady Taylor, for introducing this timely debate. It is an honour to follow the noble Baroness, Lady Cumberlege, with her long and distinguished engagement with many health issues.

I want to highlight some numbers. The Royal College of Midwives estimates that there is a current shortage of midwives across England equivalent to 2,500 full-time staff. While the NHS workforce in England rose by 14.1% between December 2019 and March 2023—that is almost 160,000 full-time equivalent members of staff—the number of midwives over that same period rose by 1.1%, or just 247 additional midwives. The impact of this shortfall, to quote the RCM, is “stark and sobering”.

Staff shortages mean women and their babies are not receiving the high-quality care midwives want to deliver. But it is not just that staffing levels simply have not kept pace with demand. At the same time, a rise in more complex pregnancies—whether due to increasing maternal age, increasing obesity in pregnancy or pre-existing medical conditions, all of which may place women at high risk of complications—has resulted in pregnant women often requiring more care and more time with midwives so that these issues can be picked up.

The last few years have also seen a significant year-on-year drop in students studying nursing, with an inevitable impact on the numbers who go on to midwifery. This is critical because, while steps are now being taken to increase the number of student midwives, the potential positive impact of this is undermined, as my noble friend has said, by too many experienced midwives leaving. Why? It is because they are burned out, insufficiently valued or rewarded, and because they cannot deliver the quality of care they want. In addition, senior midwives are needed to provide oversight and leadership, but this essential career route means losing experienced midwives, which is having an impact on the ability to train student midwives on their NHS placements. Staffing ratios need to reflect the combination of experience and skills needed to deliver care successfully. Within the workforce planning now under way, what review of national staffing ratios is taking place to ensure that we have sufficient staffing and funding for the population that NHS England serves?

The “stark and sobering” truth is that, in recent years, our maternity services have got worse, not better. The Care Quality Commission’s latest maternity survey shows the decline in positive maternity experiences. Confidence and trust in staff delivering care, whether antenatal, in-hospital or postnatal, has fallen over the past five years. Staff availability, and communications and interactions with staff, require improvement. My noble friend highlighted the BBC report from last November, which analysed CQC data and found that 67% of England’s maternity units—more than two thirds—had been rated by the CQC as inadequate or requiring improvement, up from 55% in the previous year. The CQC describes the overall picture as

“one of a service and staff under huge pressure”.

That is a thunderclap of a warning from the regulator.

More recently, we have data showing that the maternal mortality rate in the UK has risen to levels not seen for a decade, and shocking inequalities are contained within these figures. An investigation led by Oxford Population Health found that the maternal death rate was three times higher for black women than for white women, and two times higher for women from Asian ethnic backgrounds. Women living in the most deprived areas had a maternal mortality rate more than twice as high as those living in the least deprived areas.

Alongside the disturbing national data, we have seen catastrophic failings by specific NHS maternity units across England. The independent review of maternity services at the Nottingham University Hospitals NHS Trust is ongoing, while the investigations into maternity care at University Hospitals of Morecambe Bay NHS Foundation Trust, the Shrewsbury and Telford Hospital NHS Trust and the East Kent Hospitals University NHS Foundation Trust all produced recommendations for action, all prompting new oversight groups, strategies and targets.

We now have a national maternity safety ambition to halve the 2010 rates of stillbirths and neonatal and maternal deaths by 2025, which I understand we are not on target to achieve. Can the Minister confirm that? We have a women’s health strategy and the NHS long-term plan—and we finally have a Three Year Delivery Plan for Maternity and Neonatal Services, published in March last year. It sets out how the NHS will make maternity and neonatal care

“safer, more personalised, and more equitable”

for women, babies and families. This is a great ambition—an essential ambition—but where are the building blocks that are needed to achieve it and overcome the stark data I quoted earlier? It seems to me that we have some way to go for this ambition to become a reality.

Midwives who shared their experiences ahead of this debate tell me that they have lost patience with reports and reviews. They say it really is about the numbers: more midwives in the wards means better care for mothers and babies, fewer mistakes, a more positive and supportive culture for midwives to work in and more reasons to stay in the profession. “Invest in more staff as quickly as possible” is the message I received. As we have seen from some of the terrible failings in recent years, ensuring a culture that fosters openness and learning really matters. I was dismayed to find that a number of midwives were not prepared to talk to me because of the negative repercussions for colleagues who had previously spoken out. Donna Ockenden’s review of Shrewsbury and Telford Hospital NHS Trust maternity services, published in March 2022, puts it succinctly:

“Only with a robustly funded, well-staffed and trained workforce will we be able to ensure delivery of safe, and compassionate, maternity care locally and across England”.


I therefore ask the Minister: can he give us any new update on progress on the actions and recommendations in the NHS England Three Year Delivery Plan for Maternity and Neonatal Services? How are they ensuring that recommendations for action will be widely implemented in all maternity services across England? We need to know that we are moving forward. We must do better, and we must do so quickly.