A culture of blame on maternity wards in England is holding back improvements in safety and leading to preventable infant deaths, a report from a group of MPs has found.
The research comes from the health committee, a cross-party group of MPs whose role it is to scrutinise health services and government policy in the UK.
They have been studying maternal health outcomes in England's National Health Service (NHS) compared to other high-income counties and found that England was lagging behind — finding that if services were as safe as Sweden’s, it’s possible that the deaths of 1,000 babies could be avoided each year.
Instead, despite high-profile cases of serious failings in hospitals in East Kent and Shrewsbury and Telford, improvements have been too slow, experts speaking to the panel of MPs concluded.
In fact, almost 2 in 5 (38%) of NHS maternity services in England require “improvement for safety,” Professor Ted Baker, the Care Quality Commission’s chief inspector of hospitals, told MPs.
“That is a significant number, and larger than in any other [medical] specialty. It’s a reflection of the cultural issues in maternity services nationally” he said.
“Although the majority of NHS births are totally safe, failings in maternity services can have a devastating outcome for the families involved,” the chair of the health committee and former health secretary, Jeremy Hunt, said.
“Despite a number of high-profile incidents, improvements in maternity safety are still not happening quickly enough,” he continued. “Although the NHS deserves credit for reducing baby deaths and stillbirths significantly, around 1,000 more babies would live every year if our maternity services were as safe as Sweden.”
Hunt pointed to a culture of blame in hospitals which prevents staff from admitting to mistakes and for people to learn from them.
The report provides detail on the “Swedish model”, which includes a no-blame compensation scheme for people who have experienced medical injuries at hospitals — encouraging transparency — whereas in the NHS negligence has to be proven before any compensation is awarded. It found that Sweden saw a 50% reduction in “serious avoidable birth injuries” between 2000 and 2016 as a result of this strategy.
Experts also described “persistent health inequalities” affecting outcomes during pregnancy and childbirth.
Shockingly, while the number of stillbirths and neonatal deaths have fallen since 2014, women from Black, Asian, and other minority ethnic backgrounds were still more likely to experience either outcome, the report found.
That finding is in keeping with previous reports revealing poorer maternal health outcomes for women of colour in the UK — a problem that has been highlighted by activists including Candice Brathwaite and Sandra Igwe. An ongoing inquiry into racism in the health system was launched in February after researchers found that Black women are four times more likely to die in childbirth in the UK.
Professor Dame Jane Dacre, chair of the health committee’s expert panel, said: “We’ve found persistent health inequalities experienced by women and babies from disadvantaged groups, with poorer outcomes across all of the commitments we considered.”
She added that underpinning all these issues were problems with staff training and shortages. “Maternity services must have the right number of staff, in the right place, at the right time, and with the right skills,” she said.
Overall, the report recommended that 1,900 more midwives and 500 more consultants need to be recruited to deliver a safe service, a no-blame compensation scheme should be introduced, and that the health service needs an extra £200 to £350 million per year to improve maternity services.
Speaking to the Guardian, Clea Harmer, chief executive of the stillbirth and neonatal death charity Sands, said: “Babies should not be at a higher risk of death simply because of their parents’ postcode, ethnicity, or income.”
Dr Edward Morris, the president of the Royal College of Obstetricians and Gynaecologists, which represents doctors in this field, said that they “acknowledge that stillbirth rates are still higher in the UK than in many other high income countries, with Sweden leading the way.”
“While huge amounts of progress have been made and the number of stillbirths is going down, the death of any baby is a tragedy,” he added.