Half of England’s maternity services need improvement, report shows

The State of Care report, published on Friday 20 October, covers almost three quarters of maternity units inspected by CQC so far. It highlights staff shortages and conflict within units, and the impact this is having on the care received by mothers and their babies.

In an increase of 10% from last year, 49% of maternity units now have an overall quality rating of ‘inadequate’ (10%) or ‘require improvement’ (39%) from CQC. This is a total of 85 units across England.  

47% are rated ‘good’ compared to 56% last year, and only 3% are ‘outstanding’.

The CQC reviews found high vacancy rates, and leadership gaps. Their latest report explains that while many staff working in maternity care go “above and beyond”, the pressure from understaffing is impacting on their ability to provide good care.

CQC also continues to raise concerns about women and birthing people not being listened to, experiencing delays in receiving care, poor communication, and a lack of one-to-one care from a named midwife.  

Alongside staffing levels, culture and leadership has again been raised by the CQC as an important issue. It is clear that there is a need to move beyond diagnosing culture and teamwork to introducing effective interventions to address the problems.    

The CQC’s assessment comes just a week after another report analysing data from neonatal intensive care units (NICUs), which also showed a staffing crisis: on average, a third of shifts were understaffed in NICUs, and there was a wide variety of outcomes for babies between units.

10 months ago, the CQC’s survey of around 10,000 women and people who gave birth in 2022 also found a continued decline in experiences of maternity services over the past 5 years.  

And the most recent UK data from 2021 shows a rise in stillbirths and maternal deaths in many parts of the UK and continued inequity for women and birthing people and their babies from areas of deprivation and for minoritised ethnic communities.

Kath Abrahams, Tommy’s Chief Executive says:  

“Earlier this year we welcomed the Government’s long-term commitment to improving staffing by increasing the number of midwife and nurse training places available.  

“But as report after report has shown: maternity services in the UK are in rapid decline and the impact it is having on the safety of pregnancy and birth is devastating.  

“The worrying decline in the safety and quality rating of maternity units is happening despite initiatives that have been introduced to improve safety. There is an urgent need to evaluate the impact that these approaches are having as well as to identify barriers to delivery.      

“Change must come more quickly, or more babies’ lives will be put at risk. The Government must put in place the funding, workforce and systems to ensure safe care, for everyone, wherever they live and do so with urgency.”

In 2021 the Sands and Tommy’s Joint Policy Unit was set up to identify the key changes needed to save babies' lives, reduce inequalities and improve outcomes for families, and ensure that decision makers are informed and accountable for improving maternity care.

In May this year we published the JPU’s first Saving Babies’ Lives progress report which showed how the pressure that staff are under is impacting on the NHS's ability to deliver safe, personalised, care for everyone.