Almost two-thirds of maternity units provide dangerously substandard care that puts women and babies at risk, the NHS watchdog has said in a damning report.
The Care Quality Commission (CQC) has rated 65% of maternity services in England as either “inadequate” or “requires improvement” for the safety of care – up from 54% last year.
Services are beset by a host of problems, including serious staff shortages and internal tensions, which mean that too many mothers and their babies receive care that is not good enough, it said.
Women too often face delays in accessing care, do not receive the one-to-one care from a midwife to which they are entitled or experience communication problems with staff looking after them, including being shouted at by midwives.
The CQC judged overall quality of care to be inadequate or require improvement at 85 maternity units, almost as many at which it rated it to be either good or outstanding – 87. The number of units offering substandard care has soared by 30 in the last year, from 55 to 85.
It said that, having inspected 73% of all maternity units, “the overarching picture is one of a service and staff under huge pressure. People have described staff going above and beyond for women and other people using maternity services and their families in the face of this pressure.
“However, many are still not receiving the safe, high-quality care that they deserve.”
The CQC believes that, as judged by its five domains of care, 49% of maternity units are inadequate overall (10%) or require improvement (39%) – up from 39% last year. There is a “deteriorating picture in maternity services”, said Kate Terroni, its interim deputy chief executive.
It voiced particular concern about the poor experience of women from ethnic minorities who are giving birth. Interviews with midwives from such groups told the CQC that “care for people using maternity services is affected by racial stereotypes and a lack of cultural awareness among staff.”
Louise Ansari, the chief executive of the NHS patient champion Healthwatch England, said the CQC’s findings were “deeply concerning”. Its own research into maternity care showed “many women feel they lack agency or information from staff about their care during pregnancy and birth”, she said.
The care provided by ambulance services was also getting worse, the CQC added.
The safety of care at 60% of services was rated as either inadequate or requiring improvement – double the 30% that received those ratings last year. While 999 response times have improved since last winter, too many ambulances are taking longer than seven minutes to respond to life-threatening emergencies and more than 18 minutes to heart attacks, strokes and cases of sepsis.
The CQC’s grim verdict on the state of NHS care and social care came in its annual State of Care report. Sally Warren, the director of policy at the King’s Fund thinktank, said that the document “reveals the sad reality that the quality of care that patients need and deserve is not being met in many parts of the NHS and social care”.
Long waits for NHS care were driving more patients to pay for private healthcare and risk creating a “two-tier” healthcare system, the CQC said.
It cited the case of a patient on benefits who, unable to access NHS dental care, pulled out one of their own teeth and then spent £1,200 on private care. They paid the bill using a credit card, “doing without household essentials until the debt was paid”, the report said.
Sally Gainsbury, a senior policy analyst at the Nuffield Trust thinktank, said the report “illustrates the consequences of a health and care system fighting ever-multiplying fires.
“There are troubling signs that fairness and access for all is being put in peril. With more people now choosing or forced to pay for private healthcare if they can, there is a very real risk of entrenching a two-tier health system for those who can afford to go private.”
Prof Sir Stephen Powis, NHS England’s national medical director, said: “While the NHS has made improvements to maternity services over the last decade, with fewer stillbirths and neonatal deaths, the NHS is also increasing investment to £186m annually to grow our maternity workforce, strengthen leadership and improve culture, and working closely with select hospitals to ensure they make the necessary changes following recent maternity reviews, to ensure safer, more personalised and more equitable maternity care.”
