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The National Maternity and Neonatal Investigation was established last summer by then-health secretary Wes Streeting with the goal of producing a report aimed at fostering improvements across England’s maternity services. This initiative came in response to a series of maternity scandals that had severely eroded trust in the NHS among many families. Baroness Amos, leading the investigation, engaged directly with over 450 families and conducted visits to 12 NHS trusts to gather insights on necessary changes within the system.
A central issue identified by Baroness Amos and her team was the persistent failure to listen to women and their families, which contributed to poor outcomes. The report highlights significant inconsistencies in the quality of care delivered, with wide variations evident throughout the healthcare system. Describing the current state, Baroness Amos stated that the system is “fragmented, overly complex and too slow to learn and improve.” One of the key recommendations urges maternity units to revamp their triage services, which have increasingly taken on the role of an accident and emergency (A&E) department for maternity cases. The report emphasizes that midwives should be available to respond promptly to calls and provide advice, while face-to-face appointments must be offered when concerns persist, stating that such changes have the potential to save lives and reduce harm. Additionally, racism and discrimination are identified as critical safety issues demanding urgent attention, including the collection of detailed data on unequal outcomes, which should be raised to board level when patterns are detected.
The inquiry also considered calls for a statutory public inquiry that would compel senior officials from troubled hospital trusts to provide evidence. However, Baroness Amos expressed hesitation about this approach, telling the BBC, “Statutory public inquiries take a very, very long time.” She added, “From the work that I have done and from the conversations that I have had with families, I don’t at the moment see that there is a need for a statutory public inquiry, but that’s not a decision for me to take.”
Reactions to the report have been mixed. Bereaved parent Rhiannon Davies, who campaigned for a review following the avoidable death of her daughter Kate in 2009, generally welcomed the findings. She praised the reframing of listening to women as a patient safety issue, not merely a matter of patient experience, and acknowledged the significant focus placed on maternity triage, noting its great potential “but only if we get it right.” In contrast, Dr Kim Thomas of the Birth Trauma Association criticized the report as a “huge missed opportunity.” She argued it failed to adequately reflect families’ experiences and expressed disappointment that injuries caused by forceps deliveries and the psychological impact of post-traumatic stress on women and their partners were absent from the report. Thomas also felt that the report placed too much emphasis on staff experiences rather than those of patients.
Helen Gittos, chair of the Family Expert Reference Group for the National Maternity & Neonatal Taskforce and mother to a baby who lived for a week after a brain injury under the care of East Kent NHS Trust, had mixed feelings about the report. She believes many recommendations could be effective if implemented decisively and without dilution. However, she expressed concern that the report’s portrayal of East Kent NHS Trust was “overly positive.” Gittos warned that if improvements cannot be sustained despite significant support from national teams, this signals that the assistance provided is ineffective. Meanwhile, the Maternity Safety Alliance, a group campaigning for a public inquiry, described the report as failing “to address core issues at the centre of maternity failings.” They also criticized the proposal for a maternity commissioner, calling it “fundamentally dangerous” due to an excessive concentration of power and questioned the independence and potential for meaningful change from this role.
In response, the Department of Health and Social Care committed to taking “urgent steps” based on the investigation’s findings. This includes empowering the Maternity and Neonatal Commissioner to independently oversee the system, drive improvements, and restore public trust. The department also pledged a national action plan to revamp services, expected in December, alongside a £41 million investment aimed at enhancing safety in maternity and neonatal care
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