Crisis in NHS maternity units revealed as 21 rated ‘substandard’ | Care Quality Commission (CQC)

Nearly half of all NHS hospital maternity services covered so far by a national inspection programme have been rated as substandard, the Observer can reveal.

The Care Quality Commission (CQC), which regulates health and care providers in England, began its maternity inspection programme last August after the Ockenden review into the Shropshire maternity scandal, which saw 300 babies left dead or brain damaged by inadequate NHS care.

An Observer analysis of the CQC inspection shows that 45 maternity services have so far been given a rating under the new inspection programme, with six declared inadequate and another 15 rated as “requires improvement”. Twenty-three have been rated as good and just one as outstanding, with four improving.

Of the services inspected under the programme, which focuses on safety and leadership, about two-thirds have been found to have insufficient staffing, including some services that were rated as good overall. Eleven services saw their rating fall from their previous inspection.

Dr Suzanne Tyler of the Royal College of Midwives said: “Report after report has made a direct connection between staffing levels and safety, yet the midwife shortage is worsening. Midwives are desperately trying to plug the gaps – in England alone we estimate that midwives work around 100,000 extra unpaid hours a week to keep maternity services safe. This is clearly unsustainable and now is the time for the chancellor to put his hand in the Treasury pocket and give maternity services the funding that is so desperately needed.”

Carolyn Jenkinson, the CQC’s deputy director of regulatory leadership, said: “Many women and people using NHS maternity services receive good, safe care during pregnancy, labour and postnatally, but sadly that’s not everyone’s experience.

“At some NHS trusts we have found that issues such as the quality of staff training, a lack of robust risk assessment and a failure to engage with, and listen to, the needs of women and their families are impacting on the safety of services. We have been clear with those hospitals where action must be taken and clear that there must be sufficient investment to ensure that services have the right numbers of staff, with the right training, to enable them to deliver consistently high quality, safe and personalised maternity care for all.

“In recent years there has been an increased national focus on maternity safety which is welcome and crucial to improvement, but the pace of change needs to be accelerated.”

Observer analysis indicates that, when the pandemic started, about a third of maternity services were rated as requiring improvement or inadequate. After the pandemic the CQC targeted inspections where it suspected there were serious risks, but the new programme will visit all NHS maternity services that have not been inspected since April 2021.

One of the struggling maternity services is Birmingham Heartlands hospital, run by University Hospitals Birmingham NHS trust. The CQC lowered its rating to inadequate after uncovering four-hour waits for the pregnancy assessment emergency room and a lack of staff.

“There was no clear system to prioritise women according to clinical need,” the report said. “This could place them and their unborn babies at risk of harm.” It added that there were about 30 midwifery vacancies for inpatient services, and a lack of medical staff cover for days at a time.

The Birmingham trust admitted the maternity service was facing “significant challenges” but said it was expanding the assessment emergency room and improving staffing.

Maternity services at Poole hospital were also downgraded to inadequate earlier this year, with the CQC identifying staff shortages in midwifery and medical roles. “Midwifery staffing levels impacted negatively on the safety of the maternity unit,” the CQC report said. The maternity unit closed four times in the past year due to “staffing challenges”. There were 170 delays to the induction of labour in six months due to a lack of staff and beds, as well as three cancelled and two delayed caesarean sections. The midwifery staffing vacancy rate was 17%.

University Hospitals Dorset NHS Foundation Trust, which runs the hospital, said it had put improvements in place and cut triage waiting times, and added that staffing issues were common across the NHS at present.

A Department of Health spokesperson said: “The NHS is already one of the safest places to give birth in the world, but there is more to do. We’ve taken steps to improve the quality of care, with £165m of extra investment a year. This includes funding to increase the number of midwifery posts available.

“NHS England has also published its three-year delivery plan for maternity and neonatal services, which will make maternity and neonatal care safer and more personalised for all women, babies and families.”