Shocking betrayal of mothers and babies: NHS failure to learn from previous tragedies led to hundreds of excess maternity unit deaths, damning report finds
- A report has found there are hundreds of avoidable maternity deaths each year
- MPs said there had been ‘no significant progress’ in reducing high death rates
- Report found a ‘culture of blame’ stopped the NHS from learning from tragedies
- The blunders on maternity wards cost the NHS £2.3billion in payouts each year
Maternity services are still failing mothers and babies – leading to hundreds of avoidable deaths each year, a damning report has found.
MPs said units were understaffed, teams were dysfunctional and there had been ‘no significant progress’ in reducing high death rates.
Some women are made to ‘feel like a failure’ for having a caesarean section, while others are left for hours without pain relief.
The report by the health and social care select committee found that a ‘debilitating culture of blame’ had prevented the NHS from learning lessons from previous tragedies.
It follows a series of high-profile scandals in which dozens of mothers and babies have died or been left with severe disabilities due to poor care.
The report said Sweden’s ‘no-blame’ compensation scheme provided a model for how to reduce maternity deaths.
Maternity services are failing mothers and babies – leading to hundreds of avoidable deaths each year, a report by the health and social care select committee has found (stock image)
It looked at infant mortality rates in the UK, calculating that ‘if we had the same rate as Sweden, approximately 1,000 more babies would survive each year’.
The committee commissioned an expert panel to look at maternity services in England. They found ‘little evidence’ the Government will meet its targets of halving the 2010 rates of stillbirths, neonatal deaths, maternal deaths and brain injuries by 2025.
The experts said efforts to reduce maternal deaths were ‘inadequate’, although there had been ‘significant progress’ in reducing stillbirths and neonatal deaths.
Blunders on maternity wards are costing the NHS £2.3billion in payouts each year, the report revealed. Nearly four in ten maternity services are failing to meet safety standards.
Medical scholar Professor Dame Jane Dacre, who led the expert panel, said: ‘Three commitments have been rated as ‘requires improvement’ – maternity safety, continuity of care, and safe staffing – while a rating of ‘inadequate’ has been given to the commitment to provide all women with a personalised care and support plan.
‘Maternity services must have the right number of staff, in the right place, at the right time and with the right skills – without that, progress will stall.’
Professor Ted Baker, chief inspector at the Care Quality Commission (CQC), told MPs this was ‘a reflection of the cultural issues in maternity services nationally’.
This includes a ‘defensive culture, dysfunctional teams and safety lessons not learned’.
An expert panel found ‘little evidence’ the Government will meet its targets of halving the 2010 rates of stillbirths, neonatal deaths and maternal deaths by 2025 (stock image)
Experts said there were not enough maternity staff, and as a minimum, the NHS needed 1,932 more midwives and 496 more doctors.
The report highlighted ‘unacceptable’ inequalities which mean poorer and ethnic minority women receive worse care.
It said pressure for ‘natural’ births put women at risk, adding: ‘It is deeply concerning that maternity units appear to have been penalised for high caesarean section rates.’
The report said when things do go wrong on maternity wards, staff often fail to admit their errors due to a ‘culture of blame instead of learning’.
Committee chairman Jeremy Hunt, a former health secretary, said the report must send a ‘strong message that the Government and the NHS need to redouble their efforts’.
Inquiries are under way into maternity scandals at Shrewsbury and Telford NHS Hospitals Trust, and East Kent Hospitals University Trust, and last week it emerged that between 2010 and 2020, at least 46 infants suffered severe brain damage and 19 were stillborn at Nottingham University Hospitals.
Yesterday the Department of Health announced a £2.5 million fund to review safety of maternity services across the NHS.
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