Robert Wilson, Head of the Sands and Tommy's Joint Policy Unit, writes about the challenges facing the new government and what they must do to improve maternity and neonatal services in the UK.

The single word title of the Labour manifesto was ‘change’. There are few areas where transformative change is more needed than in maternity and neonatal services. Before the election, then-Shadow Secretary of State for Health and Social Care, Wes Streeting said that fears over the state of maternity services gave him “in the pit of my stomach, a degree of anxiety”.  

The previous government was not on track to meet its ambitions to half rates of stillbirth and neonatal death by 2025 relative to 2010 levels, or to reduce rates of preterm birth, and we still don’t know the true scale of miscarriage in the UK. 

Alongside this maternal death rates have increased to levels not seen for nearly 20 years. Progress is possible. The new government must commit to renewed ambitions. But importantly, it must recognise that achieving them requires political focus.

The Labour manifesto stated that ‘childbirth should not be something women fear or look back on with trauma’. They have committed to ensuring that Trusts failing on maternity care are robustly supported into rapid improvement, training thousands more midwives, and setting an explicit target to close the Black and Asian maternal mortality gap. Are these commitments enough to support the transformative change needed to save more babies’ lives?

While positive that their manifesto included specific reference to improving the safety of maternity services, to make progress this needs to be much broader than supporting ‘failing’ Trusts. The Sands and Tommy’s Joint Policy Unit has been very clear that issues with maternity and neonatal services are not isolated to a few ‘bad apples’. 

We raised concerns when the previous health secretary suggested that there were problems with maternity services only in some ‘darker corners’ of the NHS. Over years, reviews and investigations into maternity and neonatal services have consistently identified similar themes around poor culture, a lack of openness and transparency, and care not being delivered in line with nationally agreed standards. For too long these have been treated as isolated one-offs. 

The government must recognise that there are similar issues affecting all services. Our recent report highlighted a range of systemic issues that need to be addressed to improve care and save more babies’ lives.

Tackling health inequalities

"The Labour manifesto promises that no matter your background, you can thrive. This needs to start from pregnancy and birth."

It is welcome that a Labour government have committed to tackling inequalities in rates of maternal mortality, but tackling inequalities in maternity outcomes must also include a focus on babies. Black babies are twice as likely to be stillborn than White babies, Black and Asian babies are more likely to die in the first weeks of life, and Black women are an estimated 40% more likely to experience a miscarriage. There are also significant inequalities associated with deprivation - the rate of stillbirths in the most deprived areas of the UK is double that in the least deprived areas.

As part of their health mission, the Labour party has said it will tackle the social determinants of health. This focusses on halving the gap in healthy life expectancy between the richest and poorest regions. This is welcome, but health inequalities are more than just about years lived in good health. Addressing stark inequalities in maternal and perinatal outcomes requires specific focus. 

The new government must commit to a much more comprehensive approach in this area. One that moves away from diagnosing the problem, towards building consensus on the key changes needed to make progress, both inside and outside of the health service. The Labour manifesto promises that no matter your background, you can thrive. This must start from pregnancy and birth.

Improving standards of care

Current estimates suggest that in the UK at least 1 in 5 stillbirths and neonatal deaths could have been prevented with better care. This equates to over 800 babies a year. That is over 25 classrooms full of children whose lives could have been saved. Not by any new drugs or interventions, but simply if their care had been delivered in line with nationally agreed standards.  

The Labour manifesto committed to ‘putting patients in control of their health’ and has pledged that ‘patients will be able to see the medical guidelines for the treatment they should get, to hold health services to account and understand what their choices are’. This must include clear advice on the care women are entitled to during pregnancy, labour, and birth. Alongside evidence-based information that supports informed decision making.

The Labour manifesto promised that ‘never again will women’s health be neglected’ and that Labour will ‘prioritise women’s health as we reform the NHS’. This must include support throughout pregnancy and the neonatal period. NICE guidelines which recommend that women with early pregnancy bleeding should be seen within 24hrs of referral is consistently not being followed, and the lack of systematic counting of miscarriage conceals the full picture of pregnancy loss across the UK.

Our progress report also made clear that there is unacceptable variation in the provision of optimal neonatal care across the country, meaning that babies born preterm are not consistently receiving best-practice care.

Supporting improvements in standards of care requires a commitment to adequate funding, including investment in the workforce. Staff continue to report working in an over-stretched system. Commitments made to recruit more midwives must be properly funded, but also expanded to cover the wider maternity and neonatal workforce. 

There must also be investment in research so that we can improve standards of care and save more lives in the future. We’ve highlighted how the previous government’s commitments to increase spending on maternity and neonatal services fall far-short of the amount needed to support transformative change.

Professional standards and accountability

Labour has committed to implementing professional standards and regulation of managers in the NHS and will introduce  ‘Hillsborough Law’, which will place a legal duty of candour on public servants. 

This is a key area where progress is required to save more babies’ lives. Repeated reviews and inquiries have highlighted how the lack of openness and transparency when things go wrong is a major impediment to improving the safety of services, and how too-often those who raise concerns are ignored or worse, victimised. Currently we have a system which appears to discourage candour - where too often organisational reputation is put above patient safety. In our own work we have highlighted how Trust boards lack effective oversight of maternity and neonatal services.

Reports into maternity and neonatal services have consistently highlighted a lack of kindness and compassion among some clinical staff.  It is now getting towards two years since the report into East Kent maternity services was published by Dr Bill Kirkup. This report recommended that:

‘Relevant bodies, including Royal Colleges, professional regulators and employers, be commissioned to report on how the oversight and direction of clinicians can be improved, with nationally agreed standards of professional behaviour and appropriate sanctions for non-compliance’.

To date, it is not clear what actions Royal Colleges of professional regulators have taken to progress this recommendation. The new government must ensure proper oversight of implementing such recommendations, including of those organisations tasked with taking them forward. 

A recent review carried out by the Thirlwall inquiry has highlighted the number of recommendations from inquiries that are still to be implemented. Without a focus on implementation, recommendations will keep being forgotten, until the next scandal occurs.

Find out more about the work of the Sands and Tommy's Joint Policy Unit.


Exit Site