The CQC’s State of Health Care and Adult Social Care in England (2022/23) report highlights inadequacies in maternity services across England

On 20 October 2023, the CQC published their State of Health Care and Adult Social Care in England for 2022/23. The report stressed that the CQC continue to have concerns around the quality of maternity services in England.

In the CQC’s analysis of the ratings given to maternity services up and down England this year, 10% of maternity services were rated as ‘inadequate’ overall, 39% were rated as ‘requires improvement’. The main themes outlined by the CQC in what was causing inadequacies in maternity services were:

• Leadership
• Staffing issues
• Communication
• Impact of inequalities on maternity care

Leadership

In the CQC’s May 2022 report titled ‘Safety, Equity and Engagement in Maternity Services’, they suggested that Trusts needed a strong maternity leadership team, where the service level manager, midwifery, and obstetric leaders worked in tandem to provide sufficient maternity care. However, the CQC have continued to find concerns with ‘problematic’ working relationships between service level managers, neonatal, midwifery and obstetric leaders. The CQC also continued to see issues with governance and service delivery level packages.

Staffing issues

The CQC have reported significant staffing issues in many of the trusts that they have visited. They found staffing levels fell below the recommended workforce numbers for full time equivalent midwives. The staffing issues in some instances led to the closure of birthing suites and people being sent to other hospitals to give birth. The CQC have even noted specific concerns surrounding obstetric consultant cover for maternity units. The CQC warned about how the staffing issues in the maternity services can ultimately lead to delays in care and a lack of one-to-one care during labour.

Communication

In the CQC’s initial findings, they highlighted that poor communication is impacting the quality of care that is provided in the maternity services. They cited their 2022 maternity survey which found that only 59% of people using maternity services said that they were always provided with the information and explanations that they required during their care in hospital. In many accounts from the survey, it was suggested that patients were not being listened to, and their agency was being limited due to poor communication and information.

Impact of inequalities on maternity care

The CQC have reported on ongoing ethnic inequalities across a number of areas including maternal and neonatal healthcare. Midwives from ethnic minority groups were interviewed by the CQC to understand what issues ethnic minority group patients were having. There was a strong consensus from those interviewed that patients with poor or no English were more likely to not be listened to. Another issue that was noted was the racial stereotyping and lack of cultural awareness among staff, which led to misconceptions, a lack of knowledge into certain conditions, and failures to notice symptoms that look different on different skin colours.

Parallels to University Hospitals of Derby and Burton NHS Foundation Trust Independent Maternity Learning Review

The CQC’s findings hold some key similarities to HSIB’s Independent Maternity Learning Review for University Hospitals of Derby and Burton NHS Foundation Trust that was published in February 2023. In both reports the need to improve working relationships between disciplines was highlighted as a concern. Both reports cited challenges with ensuring staffing levels were optimised. In addition, there was an indication in both reports that communication issues led to non-engagement and an unwillingness to involve the patients and their families in decisions about their care.The CQC report is a huge concern for families using maternity services in England. The worrying inadequacies that continue to be highlighted by the CQC suggest that urgent attention is required to improve maternity services standards and to ensure the safety of patients and newborns during pregnancy.

You can access the CQC State of Care report and the HSIB UHDB Independent Maternity Learning Review report below:

State of Care 2022/23 - Care Quality Commission (cqc.org.uk)Maternity learning review: December 2022 | University Hospitals of Derby and Burton NHS (uhdb.nhs.uk)

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Our Clinical Negligence team has a wealth of experience in dealing with a variety of maternity negligence claims. If you think that you, or a loved one, may have been affected by negligent medical care,  please contact Karen Reynolds, Siobhan Genever or another member of our team to discuss how we can help and support you.