A devastating, damning picture of NHS maternity care failings is emerging

Although local authorities, police and crime commissioners, and directly elected mayors have little to do with the National Health Service in their respective localities, many voters will still have used the opportunity provided by the local elections to register a protest about the state of the NHS as well as the cost of living and other pressing concerns.

As has been well documented, satisfaction with the service is running at a multi-decade low – far below where it was before the change of government in 2010.

Some of that disillusion, to be fair to the Conservatives, is down to the grim legacy of the Covid pandemic – longer waiting lists and the burden of dealing with long Covid. The NHS has also suffered from inflation, post-Brexit shortages of staff, and unfavourable and inexorable demographic trends.

Yet, as some of the most distinguished experts in the field of maternity care warn, there are other, systemic and cultural issues in the system that have given rise to some appalling scandals. Perinatal care, along with its associated services, is not the only area in which preventable and tragic scandals have arisen, but it is surely one of the most distressing, because it is too often a matter of life and death.

Again and again, a “cover-up” culture has been uncovered too late. The latest intelligence from leaders in the maternity sector suggests that the problem is not confined to a few examples of extraordinary neglect of mothers and babies, but is a worryingly widespread, if not endemic, phenomenon.

The alarm about maternity units is being sounded by Donna Ockenden, who conducted a devastating inquiry into failings at the Shrewsbury and Telford Hospital NHS Trust, and Dr Bill Kirkup, who led the investigation into maternity care in East Kent.

They say there could be “tragic consequences” because of cuts to “threadbare” NHS mental health and community services.

Adding to the picture, the Royal College of Psychiatrists has revealed that up to 1,200 women a year suffer from postpartum psychosis – a condition that leads to a catastrophic collapse in mental health, and has, appallingly, been ignored for too long. Suicide is the leading cause of death among women in the 12 months after birth.

The broader picture? Equally damning.

The NHS has failed to hit targets to roll out “maternal mental health hubs” as promised. The waiting time for access to community mental health services for expectant and new mothers was an average of eight weeks for a first appointment in 2022-23, and some NHS trusts have waiting times of between 15 and 30 weeks for a mother to be seen. Even then, the wait for treatment can be almost a year.

By no means are all of the problems caused by a lack of resources, but Ms Ockenden’s judgement that community health visitor services for women who have recently given birth have “vaporised” must be taken seriously: “I hear this from new mothers, midwives on the ground, and health-visiting colleagues. We’ve cut services, and therefore reduced the ability of midwives and the perinatal team to give the care that they want to give.”

If it is the case, as a matter of political reality driven by the public finances, that more money is difficult to find, then much could perhaps still be done by reforming the way in which such services are provided.

It is also always going to be the case that no amount of cash can counter the lethal culture of carelessness and secrecy that so characterised the worst of the scandals that have come to light in recent years.

The hope is that the problems in maternity care are at least now being recognised and talked about, as is the extent of these issues – and that parents are now better informed about what to watch for, and should be emboldened about acting on manifest weaknesses in service provision.

Patient pressure has the capacity to combine with political pressure to make sure that all concerned deliver what parents and infants deserve.

There are things that NHS hospitals and health visitors do that have to be regarded as imperative, when lives are imperilled. But in maternity services – as elsewhere in the NHS – tough choices about finance, taxes and reform can’t be dodged.