Maternity services across England are failing “too many” women, babies and families, according to an interim report from an independent review examining the state of care in the National Health Service (NHS). The investigation, led by Valerie Amos, has identified deep-rooted structural problems ranging from racism and staffing issues to poor accountability and crumbling infrastructure.
Commissioned by the UK government, the review has already received more than 8,000 submissions from patients, families and healthcare professionals. The final report is expected to be published in June, with the UK Health Secretary Wes Streeting pledging that the government will act on its recommendations.
The interim findings paint a troubling picture of a system under strain, where problems occur “at every stage” of the maternity journey, from antenatal care to delivery and postnatal support.
One of the most concerning findings of the review is the presence of racism and discrimination within maternity and neonatal care. According to the report, families from ethnic minority backgrounds frequently encounter stereotypes and bias during treatment.
Baroness Amos identified six key areas where problems persist across England’s maternity services: severe capacity pressures, poor relationships within maternity teams, structural inequalities within healthcare systems, lack of compassion and transparency, infrastructure and lack of personnel to deliver safe care.
Restoring trust in maternity services
The crisis has also raised concerns about trust between families and the NHS. Allegations in recent years that some hospitals altered medical records or attempted to cover up errors have damaged public confidence.
Speaking to Asian Voice, NHS consultant obstetrician and fetal medicine specialist Lorin Lakasing said such practices could have a devastating impact on trust.
“Very,” she said when asked how damaging altered records or cover-ups are to public confidence. “Women and families are right to be concerned but they should probe deeper.”
Dr Lakasing argues that the problem is partly driven by financial incentive systems within the NHS. Hospitals can receive favourable ratings or funding when they meet certain targets, which may discourage staff from revealing shortcomings in care.
“These behaviours are the result of financially driven incentive schemes which reward units for meeting targets and returning favourable compliance data irrespective of patient outcomes,” she said. “Revealing deficiencies risks poor ratings and withdrawal of funds.”
The staffing paradox
Although staffing shortages are frequently cited as a cause of maternity care problems, Dr Lakasing believes the issue is more complex. “Numerically, we have more maternity staff than ever before and the birthrate is falling,” she explained. “Staff-to-patient ratios are favourable by international comparisons.”
Yet more than 30% of midwifery graduates in the UK are unable to find jobs despite these reported shortages. According to Dr Lakasing, the real issue lies in how staff are deployed. Many clinically trained professionals are working in administrative or non-clinical roles, meaning fewer staff are available on the frontline.
“The frontline staff-to-patient ratio suffers,” she said, adding that tensions can also arise between frontline clinicians and staff working in non-clinical positions with different priorities.
The challenge of political reform
Health and Social Care Secretary Wes Streeting addressed the findings stating, “I will shortly launch and chair a new National Maternity and Neonatal Taskforce to develop a new national action plan, which will draw on Baroness Amos’s interim findings and will be further informed by the recommendations of her final report due in the Spring.
“Action on maternity and neonatal care cannot wait, however, which is why this government has recruited over 800 more midwives, is investing over £140 million to address critical safety risks on the maternity estate, and is rolling out guidance to tackle the leading causes of maternal death.”
However, Dr Lakasing believes that decades of political reform have also complicated efforts to improve NHS services.
“In the UK, healthcare is highly politicised,” she said. Successive governments have attempted to demonstrate their commitment to the NHS through reforms aimed at proving value for taxpayers and ensuring safety through regulation.
While these goals are reasonable in principle, the cumulative effect has been a system layered with bureaucracy. “The result is a bureaucratic mess which absorbs huge amounts of resources, leaving diminished amounts for frontline services,” she said.
Short electoral cycles, she added, also discourage long-term reforms.
Practical steps for improvement
Despite the challenges, Dr Lakasing believes meaningful improvements are possible.
She suggests several urgent changes that could improve safety in maternity wards, including building strong multidisciplinary teams led by experienced clinicians and offering better pay for clinical work, particularly during unsocial hours.
She also calls for more realistic public messaging around pregnancy and childbirth, grounded in NHS outcome data, and for the overhaul of safety strategies that consume resources without improving outcomes.
