NHS maternity services in England are continuing to fail women and babies, according to an interim report from the Independent National Maternity and Neonatal Investigation.

The government-commissioned investigation, led by Baroness Valerie Amos, found pervasive discrimination, a lack of kindness and compassion, and a reluctance among trusts and professionals to admit mistakes.

Families had been disregarded and not listened to during pregnancy, and labour and maternity care was being delivered in “wholly inadequate” estate facilities. The system, which looked like a “fragmented service,” Amos said, was “not working for women, babies and families, or for staff.”

In her 'Reflections and Initial Impressions’ report last December, Amos said, “nothing prepared me for the scale of unacceptable care that women and families have received, and continue to receive” across England’s maternity and neonatal services.

In her latest report, she reiterated that areas identified in previous reviews and investigations as requiring action did not seem to have been addressed or had only been partially addressed. 

“Time and time again,” families and staff saw the same issues repeated and numerous reviews making recommendations. “This cycle must stop,” Amos said.

Racism, Shortages, and Unaccountability

Amos identified six contributory factors placing pressure on maternity and neonatal services. These included workforce shortages, capacity constraints, culture and leadership, racism and discrimination, lack of accountability when care failed, and the poor condition of NHS hospitals and buildings.

Capacity pressures meant antenatal appointments were often too short for meaningful discussion. Women and families waited hours for medical assessment or clinical review. There were delays in admissions, induction of labour, and planned caesarean sections.

The report highlighted “persistent inequalities” in outcomes. Women from Black and Asian backgrounds and those in more deprived areas continued to experience poorer outcomes.

Racism and discrimination were reported across the system. This included behaviour by staff towards women and families, between colleagues, and from women and families towards staff.

There was often a lack of transparency, clear communication, and learning when incidents occurred.

“We have seen maternity and neonatal services trying to respond in difficult circumstances and dealing with competing pressures, but too often failing to deliver the safe care that women, families, and babies expect and deserve, at times with devastating consequences,” Amos said.

Calls for System-Level Reform 

Amos also noted examples of exemplary practice, which she said would inform her final recommendations.

Layla Moran, chair of the Commons Health and Social Care Committee, said it was “heartbreaking to yet again hear the stories of families tragically failed by the system, but also of healthcare professionals who have faced vitriol for doing their jobs in difficult circumstances”. 

She described the findings as “sadly all too familiar” and urged the government to act at a national and systemic level, rather than waiting to begin reforms.

Baroness Amos’s final recommendations to ministers are due to be published in the spring.

Rob Hicks is a retired National Health Service doctor. A well-known TV and radio broadcaster, he has written several books and has regularly contributed to national newspapers, magazines, and online publications. He is based in the United Kingdom.