Maternity Services

Lord Patel Excerpts

Thursday 25th January 2024 Lords Chamber

[Lord Patel (CB)]

My Lords, I thank the noble Baroness, Lady Taylor of Bolton, for initiating the debate today on maternity services in England—or should I say, as has already been mentioned, the woeful state of maternity services in England as evidenced by a series of recent reports on their failings. Although we are debating maternity services, what we are really talking about is the state of care the nation is willing to provide for the mothers of the nation and their babies—the future citizens who will shape our nation.

I should say at the outset that I am well aware that good quality maternity services depend on the care and expertise that the key profession—midwives—provides. The rest of us, including obstetricians like me, are there to support them. I therefore fully subscribe to all the comments made about shortages of midwives and the quality of midwife care.

Before I go any further, I need to declare my interest: I am a lifelong obstetrician. I spent 37 years of my working life being one, and every minute of it was a joy and a pleasure. I would go back to it tomorrow if they let me—but they will not. I am also a fellow of several Royal Colleges, but that is totally irrelevant.

I am pleased to take this opportunity to put on record my eternal gratitude to all the thousands of mothers who afforded me the privilege of being a part of their lives at the most important time of their lives: during their pregnancy and the birth of their baby. I learned that pregnancy and childbirth give a whole new meaning to the word “beautiful”.

I had a special interest in looking after mothers who had preexisting conditions that could affect their pregnancy and the unborn baby, or who developed complications that may have threatened their pregnancy and the life of their baby. I was privileged to be able to do so. Understandably, these mothers were anxious and hoped all would go well. I remember one occasion when I delivered the healthy baby of a first-time mother who had diabetes and had had quite a challenging time during her pregnancy, to say the least. I noticed the pleasure on her face—I have seen it a thousand times; it is quite remarkable when a mother sees her baby for the first time—and I asked her how she felt. After thinking for a minute, she said: “I know the days will be shorter and the nights longer; clothes will be shabbier, but the future will be happier. I will forget the past. The baby will make love stronger. I was a woman yesterday; I am a mother today”. I will never forget that. To witness the joy in her face was a privilege. Sadly, according to recent reports, this is not the case for hundreds, if not thousands, of mothers. It should not be so. We should be ashamed that it is so for even one mother—but it is so for thousands, according to the reports already mentioned.

I was fortunate to be part of a team of professionals—midwives, obstetricians, anaesthetists, neonatologists and others—who were all committed to providing the best possible personalised care to all mothers and their babies. We never lost a mother in three decades, and had zero tolerance to intrapartum stillbirths. Weekly perinatal meetings were mandatory for all to attend to make sure that adverse events were fully discussed, learned from and never repeated.

The Government believe, as was noted by the noble Baroness, Lady Cumberlege, that the NHS is one of the safest places in the world to give birth. Minister, it was. In the past, our maternity services were where others came to learn. Why were our maternity units regarded as the best? It was because, as now, dedicated professionals provided safe, compassionate care to mothers and their babies, and took pride in doing so; and, importantly, they were left alone to get on with it.

Multiple reports from the CQC, as has already been mentioned, and independent investigations into several maternity units in England have shown that care is not safe, resulting in unacceptably high levels of harm to mothers and their babies. We all know that there are more such reports to come. While workforce shortages, pressures of work, lack of communication, and poor governance are all cited as possible problems, and they undoubtably are and need to be addressed, I believe that the genesis of the long-standing problems is deeper and goes further back. Therefore, I support absolutely the plea made by the noble Baroness, Lady Cumberlege, for a new beginning for maternity services.

The response from the Government and organisations responsible for the delivery of maternity services to adverse reports is to produce more documents about what they will do—set up a task force, a workforce plan that may deliver in five or 10 years, safety organisations, three-year plans, long-term plans, and much more. These lack implementation plans or regular outputs to demonstrate success.

The quality of maternity services is a bellwether for the quality of services in the rest of the NHS. Levels of maternal and perinatal deaths are good indicators of the quality of maternity services, as evidenced by several of the investigations. In this respect, as has already been mentioned, the latest maternal mortality report is a cause for concern in many ways. Confidential inquiries into maternal deaths were formally established in 1954, although their predecessor existed from 1928: it is the world’s longest-running successful audit system of healthcare and is a good barometer of the performance of the maternity service.

As has been mentioned, the latest report from MBRRACE of deaths between January 2020 and December 2022 shows that the rate of maternal deaths was 13.41 deaths per 100,000 maternities. That is the highest in the last two decades and much higher than the rate of 8.79 among the 2017-2019 cohort. Even after removing deaths due to Covid-19, the rate is significantly higher than among that cohort. The UK now has one of the highest maternal mortality rates in the developed world, compared with Norway’s 2.79, Germany’s 4.0—which, by the way, has remained static for 20 years—and France’s 6.0. We are way behind.

The main causes are important. The first is thromboembolic disease. We require a clear strategy for how we are going to reduce this, because it has remained the number one cause now for decades. I urge the professionals—the Royal College of Midwives and the general practitioners, obstetricians and psychiatrists—to come together to produce clear guidelines on how these deaths will be reduced. The second is cardiac disease. These deaths are preventable. Third, importantly and very tragically, are suicide deaths. These are vulnerable women whose mental health condition is not difficult to recognise during the antenatal period. They are women who might be abused in the house; women who are further abused when they take home a baby. We should not, as a society or as professionals, fail them, but we do. These 39 suicide deaths are tragic deaths: all maternal deaths are tragic, but these are particularly so. They are preventable and we should address that.

Maternal deaths also show up gross inequalities related to ethnicity and deprivation, as has already been mentioned several times. Black mothers have four times the risk, Asian mothers have twice the risk and mothers from deprived populations have twice the risk. These are not new or surprise findings, as mentioned by the noble Baroness, Lady Taylor of Bolton: inequalities in care and outcomes have been well documented for a long time. The Government have produced plans to try to reduce these, but none has shown any results. Can the Minister say which of the plethora of initiatives to reduce harm, deaths and inequalities in maternal health have had any effect? What benefits have been derived from the work of the Maternity Inequalities Oversight Forum, the Maternity and Neonatal Care National Oversight Group, the Maternity Disparities Taskforce, or the several other initiatives, in reducing inequalities and the deaths of mothers and babies and improving maternity services?

What we do have are repeated reports of high-profile organisational failures, soaring clinical negligence claims, huge variations in outcomes and in the culture of care, workforce challenges, inequalities in care and outcomes linked to ethnicity and depravation, rising maternal and perinatal deaths, and serious safety issues, to the point that the regulator, the CQC, says that England’s maternity units currently have the poorest safety ratings of any hospital services it inspects. Does this not all add up to a service that needs radical reform? Is it not time we had a root-and-branch independent review of maternity services that brings about the changes needed to have a world-class service that is compassionate, safe and delivers world-leading outcomes for mothers and babies? Can the Minister say why we should not have such a review, as part of his answer as to what difference all the initiatives so far have made to improve the service, with real figures to demonstrate it? I know he is fond of data as evidence.