Is Wes Streeting's call for a rapid investigation into maternity units across England the right approach?

Summary

The Secretary of State for Health and Social Care, Wes Streeting MP, has called out the unacceptable state of current NHS maternity care and ordered a rapid investigation into ten maternity units across England that will take a system-wide look at maternity and neonatal care. But is another investigation the right approach to support the needed improvement? A hub member* shares their thoughts on the announcement of this investigation.

Content

Another (expensive) inquiry is unlikely to tell us any more than what we already know from previous inquiries—same themes repeatedly come up and this will likely be no different. 

It’s devastating when families have poor and unexpected outcomes and are harmed during care. We must always have absolute compassion to those grieving and wanting an honest and open communication about what happened. However, with this in mind, I think the call for another broad investigation feels more like seeking someone or something to blame than to help families and improve services for more families in the future.

Like we all know, the maternity service is a complex system with multiple interdependencies and high demand and charged emotion, so there are no simple solutions. Frontline midwives don’t need another ‘expert’ to tell them what the issues are, they are acutely aware and work with them daily trying their best in really difficult circumstances. 

The service is already swamped and sluggish with numerous action plans from previous reports and inquiries; there needs to be support to convert these into prioritised sustainable impactful improvement work. One of the stated aims of this review is that it will bring together the findings of past reviews into one clear set of national actions. While this would be welcome, surely this work could be done now, based on the existing body of evidence, rather than after another investigation?

All the midwives I know are committed to providing the best and most compassionate care they can to each birthing person and family, working with them in genuine partnership. In my experience, maternity cultures are not degraded (maternity teams can, and do, work extremely well together) but they can be under pressure and feel a bit battered. Tired midwives and teams under stress make mistakes and systems compound the issues rather than provide a safety net. 

Every shift, we have to navigate not only the provision of good care with less and less staff but also unexpected and emergency events, new technology (electronic patient records with relentless upgrades), multiple and ever-changing systems and processes, another review or inspection, new updates and lessons learnt and more training—it’s hard to get it all right and take it all in. 

Some priorities, in my opinion:

• We need enough midwives each shift to be able to provide the right care in the right way so getting the workforce issues sorted is foundational.
• We could really do with some safety system improvement experts to work with us to convert the lumbering action plans into agile actionable change. 
• We could do with some kindness for all those involved in receiving and delivering care in, at times, the most challenging circumstances—the relentless criticism is crippling us all.  

There needs to be wider thinking around organisational and leadership commitment for delivering change and improvement, with proper resourcing for clinicians to do their job well. I feel strongly that this is not a them and us issue—it’s a wider societal issue about expectations, demands, resourcing and reciprocal respect. 

Who would want to be a midwife? Well, it’s still a privilege to be part of families' significant life events and every birth is unique and awesome. And it’s a joy to work with some of the most dedicated and warm people I know—far nicer cultures than other industries. 

I think people are (still) drawn to the profession because it has such clear purpose and can (should be) the most rewarding. But its tough. Midwives are leaving because they feel very compromised, unable to give the care they want (and out on their own when they support women's choices outside the guidance), and waiting to be blamed for something, losing not only their jobs but also their registration and livelihoods.

There is a lot of despair, tiredness and frustration but still a bucket full of nurturing and passion. 

We would like to hear from frontline staff and patients and families their opinions on a national maternity investigation and on this blog. Add your comments below (you'll need to be a hub member—sign up here) or email us at [email protected].

About the Author

*The author works as a frontline midwife but wishes to remain anonymous.