Emily Barley is co-founder of the Maternity Safety Alliance. Before her daughter Beatrice died, Emily was leader of the Rotherham Council Conservative Group, and in 2019 was the Conservative Party candidate for Wentworth and Dearne.
Mums rely on inspections and ratings of maternity services by the Care Quality Commission (CQC) when they choose where to have their babies – but can they be trusted?
In 2021, when I learned I was pregnant, I was aware of some of the problems in maternity care around the country and thought I was being responsible by choosing to Barnsley, a hospital where maternity services were rated ‘good’ by the CQC. It is a decision I regret daily, as my daughter Beatrice died during labour in May 2022 because of medical negligence.
As the regulator of health and social care in England, the CQC is responsible for inspecting maternity services and ensuring they are safe. But over the last ten years a pattern has emerged of failure to recognise and act when maternity services are not safe – with investigations finding regulatory failure going back to the CQC’s inception in 2009.
The CQC has been implicated in numerous local maternity scandal so far investigated. In Morecambe Bay, the investigation described ‘organisational failure’ at the CQC; in Shrewsbury & Telford, they rated maternity services ‘good’ when an investigation found over 200 babies had died avoidably; and in East Kent despite identifying problems in 2014 the CQC did not act and babies continued to die. A similar story is expected when Ockenden’s investigation into maternity services in Nottingham concludes next year.
In response to these criticisms and national concern about the state of maternity care, in 2022 the CQC launched a new ‘maternity inspection programme’, with plans to inspect every maternity unit in England. So far, these focused inspections have painted a dire picture, finding that over two-thirds of maternity units are not meeting basic standards for safety and showing a massive decline in ratings.
As the CQC gets better at identifying failure the Government would like us to believe that they have learned from the past, sorted themselves out, and the ratings coming out of the new programme can be relied upon. But the truth is that the CQC’s idea of what ‘good’ and ‘outstanding’ look like is far removed from mine and anyone else who wants to bring their baby home safely.
For example, Leeds maternity services were rated ‘good’ last year despite repeated failures in care causing serious harm. A coroner concluded that a baby died there following “a number of gross failures of the most basic nature”, and I am in touch with several families whose babies also died at Leeds during labour or soon after birth over the last couple of years.
In February, the CQC maintained Royal Surrey maternity’s ‘outstanding’ rating, the best possible grade, which the hospital has held since 2018. The news was welcomed uncritically by many including Kate Brintworth, the chief midwife at NHS England, but a closer look suggests care may not match the public’s expectations of what ‘outstanding’ means.
A Freedom of Information (FOI) request I made shows that throughout the period Royal Surrey maternity has been rated ‘outstanding’ babies have been brain injured and killed by problems in care at the hospital. The FOI response reveals that babies have been harmed after a variety of basic failings, including not monitoring their heart rates properly, not escalating to senior staff when a baby needs help, delays to delivery, staff not doing proper handovers, and serious infections not being diagnosed and treated properly.
These findings demonstrate the issue at the heart of the crisis in maternity care today: complacency. At every level of the NHS and into government there is a sense of shoulders being shrugged as healthy babies die because of negligent care. Avoidable death and avoidable serious harm have become sufficiently normalised that it even happens at hospitals that are lauded as our best.
The approach the CQC takes to its maternity inspections includes this acceptance of failure, and all too often avoidable deaths are dismissed as ‘isolated incidents’, even when there are several. Hospitals are almost always given notice of an impending inspection, usually just a couple of days but that’s plenty of time to clean up.
To make things even worse, CQC inspectors are supported by specialist advisors, some of whom are responsible for dangerous maternity services elsewhere and have no idea what ‘good’ really looks like. On-site for just 2-3 days, they’re heavily reliant on what they are told by hospital leaders, with limited time to interrogate the evidence. Often, they will speak to just a handful of patients and usually refuse to engage with people like me, whose babies have died.
There have now been 15 years of regulatory failure by the CQC, with no sign that anyone in a position of power or influence has recognised the full extent of the problem and the wider impact that has on the quality and safety of maternity services. This is just one of the reasons I and a group of families affected by failings in maternity care joined together to form the Maternity Safety Alliance and campaign for a statutory public inquiry on maternity safety in England.
We want to get into the details of why, despite a raft investigations and schemes intended to ‘improve’ the situation, the NHS continues to kill and maim mums and babies through negligent care. We want a national public inquiry to look at every element of what is going wrong and how we can fix it, with high priority given to the CQC’s failure to uphold its responsibilities.
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Author: Emily Barley
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