Less than a week after meeting with families failed by English maternity services, Wes Streeting has announced a rapid national investigation into the care received by women and their babies across the country. Starting this summer, the investigation will urgently look at up to ten of the worst-performing hospital trusts in the country, as well as examining the maternity system at large, and bringing together the findings of past reviews into one clear national action plan. It will be modelled on the Darzi investigation into the state of the NHS, which reported back its findings two months after being commissioned.
Making the announcement at the Royal College of Obstetricians and Gynaecologists’ (RCOG) World Congress, the Health and Social Care Secretary made it clear how much the experiences of families has influenced his decision. “What they have experienced is devastating – deeply painful stories of trauma, loss and a lack of basic compassion – caused by failures in NHS maternity care that should never have happened. Their bravery in speaking out has made it clear: we must act – and we must act now.” Too many children have been dying, he said. And he wanted to say sorry. “These families are owed more than apology; they’re owed change, accountability; they’re owed the truth.”
Streeting said that he sat in meetings with families in a “state of disbelief… What you hear is so shocking, you think this can’t possibly be true. And then you look at the evidence, and you see that is exactly what they have been through.” We are, he said, “talking about the deaths of children. We’re talking about harm and disablement of children. We’re talking about mothers who’ve had severe birth injuries… The sorts of things they have to tell me, a total stranger, a man, someone in a suit from government, describing their inability to have sex with their partners and husbands any longer because of the birthing injuries they’ve suffered, or presenting me with the ashes of their children… It really does bring home to you just exactly what these women and their partners have been through.”
Addressing the roomful of doctors at the RCOG conference, Streeting said that the risk of giving birth was “considerably higher than it should be because of the state of the crisis in our maternity and neonatal services”. He referenced the “appalling scandals” in maternity care at Morecambe Bay, Shrewsbury and Telford, East Kent and Nottingham, but said that the problem was “not just a few bad units up and down the country” – it’s systemic. Poor maternity care was at the top of the list of things that kept him awake at night.
What the Health Secretary did not announce was a full, public statutory inquiry. Families whose babies have died or been harmed, and women who have been left badly injured as a result of mistakes made during birth, do not speak with one voice. However, some don’t feel today’s announcement goes far enough. Jack Hawkins, whose daughter Harriet was stillborn at Nottingham City Hospital in April 2016 after a catalogue of errors, said that everything being suggested had been “tried in some shape or form before and has not led to lasting change”. He said that he and other Nottingham families believe a full national statutory public inquiry is “the only way to hold a number of powerful people and organisations to account for their failures that have led to state infanticide at a level not seen since the Second World War”.
Fiona Winser-Ramm, whose baby Aliona Grace died as a result of a “number of gross failures” in care at Leeds General Infirmary said that while today’s announcement was a “small step” it did not go far enough. While welcoming the Secretary of State’s speech, a number of families affected by poor maternity care in Leeds said in a statement that a full independent inquiry, led by former midwife Donna Ockenden was “essential to get to the full scale of cultural and leadership failings, raised parents and whistleblowers, over many years, and in last week’s CQC report”.
Speaking to journalists after the announcement, the Health Secretary stressed that he did not rule out a full public inquiry and was keeping the option open. But there was also a need to change things now. “My priority is making sure that we drive improvements in maternity safety as rapidly as possible.” Any recommendation on a statutory public inquiry would be “in no small part determined by the findings of the rapid investigation”. Nor did the Health Secretary rule out a more detailed investigation into Leeds’s maternity services. “I’m talking to Leeds families at the moment about what we do specifically at Leeds,” Streeting responded to a question from the New Statesman. “There are major concerns. We’ve obviously seen a combination of very brave family campaigners, great journalism, and now a damning CQC [Care Quality Commission, the regulator] report. So, I think, given the size of that Trust, you can understand my level of concern.”
Streeting insisted that even within the short time frame of the rapid investigation, questions of how maternity services got into their current state – and, more importantly, why – would not be overlooked. For example, the NHS’s push for “natural births” was found to have played a role in previous maternity investigations. The Health Secretary stressed he was mindful that those let down by poor care wanted people held accountable. “I think the proof of the pudding will be in the eating,” he said. “Government more generally is struggling with quite a big question for our country, which is, ‘How do you acknowledge state failure and how do you put it right without always having to reach for the public inquiry route?’ But the challenge that we have as politicians – and victims have is – well, what are the alternatives? And that’s something we’re working through with families.”
The Health Secretary spoke forcefully about the lack of accountability hitherto, and the failure of the health watchdogs who should have been keeping maternity services safe. “It really is a national scandal,” he acknowledged. “I think it’s just utterly shameful that on top of the grief and trauma [families have] experienced, that they have to go into battle for an accurate and honest account of what happened and why.” The culture of the NHS had to change. “What’s the priority here? Is it really patients, or is it reputations?” Streeting posed. “My priority is patients.”
The Care Quality Commission, whose job it is to inspect maternity services and respond to safety concerns, needed to be “rebuilt” as “an effective regulator and guarantor of patient safety”, the Health Secretary argued. “One of the many things that’s gone wrong in this space… is that the regulators are failing to discharge their duties effectively on behalf of the public.” Not only did this fail the public, it also left the government exposed. “I’m supposed to be able to ask regulators to keep patients safe and to hold institutions to account,” Streeting explained. And yet ministers were increasingly having to take direct responsibility for these, “because of a lack of capability and confidence in the regulators”. Ministers, he said, had been “underwhelmed by the proposals that have that have come to us from the system itself for improvements in maternity services and care and safety”.
The full terms of reference for the investigation will be agreed by the end of July, as will membership of a new National Maternity and Neonatal Taskforce, which will be chaired by the Health Secretary. This will include experts and bereaved families. A final report will be completed by Christmas. But there are still many details of the urgent review to be confirmed. It’s not known yet who will lead it, but Streeting confirmed that a shortlist was being put together that would be shared with families for their feedback. Ockenden, the former midwife who led the investigation into maternity services at Shrewsbury and Telford and is currently investigating Nottingham’s maternity care, would “definitely be involved”.
It’s also not confirmed which hospital trusts will be the focus of the urgent review, either, but Mid and South Essex NHS Foundation Trust, Gloucestershire Hospitals NHS Foundation Trust, University Hospitals Sussex NHS Foundation Trust, and Leeds Teaching Hospitals NHS Trust were all mentioned by the Secretary of State in his speech today. Leeds’s maternity services were rated “inadequate” by the CQC on Friday after families had raised concerns about poor care for years. Within the next month Jim Mackey, head of NHS England, and Duncan Barton, the chief nursing officer, will meet representatives of the trusts “of greatest concern”.
The final list of trusts will be chosen according to various data sets held by the NHS, Streeting said. It wouldn’t be just the voices that shouted the loudest who would be heard, especially given the inequalities that exists in maternity outcomes, where black women are between two and three times more likely to die in childbirth than white women. “I want to make sure that we are going out and finding people and talking to people who otherwise would not come forward and wouldn’t feel that their voices would be heard,” Streeting said. “And those are disproportionately working class, disproportionately black, disproportionately Asian.” There was a problem in maternity services “right across the country”, Streeting said bluntly. “I think this is systemic and endemic.”
In her address to doctors, Ranee Thakar, the president of RCOG, insisted that women’s health needs had been ignored for too long. It was time to make them a national priority. “When we get it right for women, we get it right for everyone,” she argued. In Wes Streeting, it seems there is a health secretary who fully appreciates that. One who is truly beginning to comprehend the scale of scandal that is maternity care in England and who is honest about the mistakes made, not just by others, but by him and his own government. Women, their babies and their partners have had to wait too long for this. But Streeting is surely right that this is “the conversation we need”. A conversation that must lead to answers, change and accountability.
[See also: The trauma ward]
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