NHS maternity services are in crisis: everyone knows that. In fact, everyone has known a lot more than that for at least a decade. There have been so many reports highlighting the precise nature of this crisis that the health service and government now have 748 recommendations that they could implement to improve care. Instead of implementing them, though ministers are commissioning more reports, just in case the next one uncovers the thing that everyone else has missed.
Baroness Amos’s latest interim report from her own investigation has not managed to uncover that one big thing that would solve the NHS maternity crisis, though it does come close to pointing out the underlying problem that allows all the others to continue. It asks in its opening paragraphs why, ten years after the government plan for maternity services called ‘Better Births’ was published, the system is still struggling. Unfortunately Amos does not answer this question, nor does she really manage to address the accusation levelled by some bereaved campaigners like James Titcombe that her report could just be part of ‘another cycle of diagnosis without delivery’. Titcombe, of course, knows that cycle painfully well, given there was a report into the death of his son Joshua, as well as ten other babies and one mother at Furness General Hospital. That report was published more than a decade ago, in March 2015, and its findings have been replicated in multiple investigations into different NHS trusts around England in the years since.
It’s not even entirely clear whether Amos is offering much of a diagnosis in today’s report, though. Like all the other authors of all the other reports, she finds factors that are contributing to the nationwide problems in maternity. They are: capacity pressures; culture and leadership; racism and discrimination; poor responses and lack of accountability when things go wrong; the quality of estates; and workforce.
There is nothing original about these findings, which isn’t a criticism, given they clearly need to be pointed out again and again in the hope the lessons finally percolate. But the question now is surely not what the lessons are, but why are they not being learned? Why was the latest report greeted by the usual barrage of press releases from organisations around the structures of the NHS and maternity services, all offering the same platitudes about the necessity of ensuring that things change, but not one of them giving any sense of how that change might occur, or of their own responsibility in ensuring that change.
Take this comment from the NSH Confederation’s Rory Deighton, who said health leaders were reviewing these findings ‘in detail’ and working with Amos to draw up her final conclusions: ‘Our members are keen for this review, and the national recommendations in the spring, to be a turning point for women, babies and their families so that everyone gets the high quality and safe maternity and neonatal care they deserve.’ Once again, there is nothing wrong with what Deighton or his organisation’s members are saying, it’s just that they’ve all been saying it for so long for it to seem rather unlikely that they are really going to be able to see this ‘turning point’ through.
Similarly, politicians have been vowing to ensure lessons have been learned for well over a decade, but have not stepped back and wondered what it is that is preventing the system from being able to learn. So often in NHS scandals, it is easy enough for everyone to find another organisation or group that needs to be making changes, all the while ignoring the difficult or painful lessons they need to be learning and implementing. Until a report comes out that asks why the system can’t or won’t change, we will be stuck in this cycle for a lot longer than the gap between Amos’s latest interim report and her final recommendations.
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