The worrying state of maternity care in England’s hospitals is today revealed by the Mail’s analysis of NHS figures.
Use our definitive interactive guide below to find out how your local maternity unit is ranked by the Care Quality Commission (CQC), which has found that more than half of NHS services are ‘failing’. That means they are unsafe for both mothers and babies.
The guide is split into an interactive map showing CQC rankings and a searchable table that gives an unrivalled insight into everything from C-section rates to how many babies are delivered by a midwife, allowing you to see the state of play at your local hospital.
Regulators blame a shortage of midwives for the crisis, with giving birth described as being like ‘Russian roulette’ by experts.
The CQC, which assesses each maternity unit in the country, says safety is still ‘so far from where it needs to be’, despite signs of a slight improvement in the wake of a string of damning scandals, according to the annual maternity survey.
CQC RANKINGS
Nationwide, most maternity services are failing. That’s according to CQC rankings which score them as being either ‘outstanding’, ‘good’, ‘requires improvement’ or ‘inadequate’.
Ratings are based on how they perform against markers such as safety, efficiency, care and leadership.
In the CQC’s latest annual report, dated September, 3 per cent of hospital maternity services were given the top mark.
The majority were deemed good or outstanding (50 per cent) or requires improvement (39 per cent).
However, Mail+ analysis of February’s CQC ratings — the most recently published — show the the overall picture has worsened slightly. Since that annual report was published, 47 per cent of maternity services are now ranked as either outstanding or good.
Although the majority of CQC ratings remained the same as their previous inspection, about 24 per cent of ratings went down and just over 12 per cent went up.
Services slapped with an ‘inadequate’ rating means there is a high risk of avoidable harm for mothers and babies, under the CQC’s criteria.
Liberal Democrat health spokesman Daisy Cooper MP said: ‘It is absolutely appalling that over half of all maternity units and services are currently rated so low.’
Abena Oppong-Asare, Labour spokesman for mental health and MP for Erith and Thamesmead, said it’s ‘terrifying’ expectant mothers will be treated in ‘unsafe’ maternity units.
‘Women continue to be failed by this Government, with too many patients still not receiving the safe, high-quality care they need and deserve,’ she added.
Poole Hospital saw its rating drop to ‘inadequate’ after regulators last March found staffing levels on the ward were so low it was impacting the safety of women and children.
Royal Sussex County Hospital was also marked down because inspectors noted there were ‘not enough midwifery staff to keep women and babies safe’.
Comments CQC inspectors recorded from the workforce included ‘staff are exhausted and on their knees’, ‘I feel it is only a matter of time before something bad happens’, ‘staff are reduced to tears every day because it is so short staffed’ and ‘I have a constant sense of dread that something awful will happen’.
Some locations in the Mail+ analysis don’t have previous ratings available to compare.
The Royal College of Midwives suggests staff shortages and lack of funding is making it harder for midwives to deliver better-quality services.
The RCM’s latest calculation is that England is short of 2,500 midwives.
WHAT MOTHERS REALLY THINK
The CQC’s annual maternity survey, published in February, revealed women’s experiences of care have deteriorated in the past five years, with staff shortages being a key area for the downfall.
A quarter of those surveyed said they were left alone at some point during their birth, or shortly after, at a time when it ‘worried’ them — a higher proportion than those who said this in 2018 (23 per cent).
There has also been a downward trend in women saying they saw or spoke to a midwife as much as they wanted after giving birth, from 73 per cent in 2018 to 63 per cent in 2023.
Katie Wilkins, 26, had a still born baby girl, Maddison, in February 2013 at Royal Shrewsbury Hospital
Richard Stanton and Rhiannon Davies at their home in Hereford. Rhiannon is holding a teddy bear – a gift for their daughter Kate who passed away at just six hours of age. Her death was later found to have been avoidable
Rhiannon Davies with her daughter Kate moments after her birth on Sunday, March 1, 2009
In addition, 10 per cent said they were not able to get help at all from any member of staff.
However, the survey, which quizzed 25,000 women and their families, did show some improvements.
For example, 85 per cent of women said they were given appropriate advice and support when they contacted a midwife or the hospital early labour, slightly up on the 82 per cent in 2022.
There was also a 3 percentage point increase in the number of women who said midwives ‘always’ listened to them (83 per cent).
RCM chief executive Gill Walton said she was ‘pleased to see things moving in the right direction’, but admitted there are ‘areas that need accelerated improvement’.
Frontline midwives have previously warned working in the NHS is like playing a ‘warped game of Russian Roulette’, as there was a risk of harm or death at any time, partly due to ‘dangerously’ low staffing levels.
‘Receiving safe maternity services should not be a Russian roulette,’ said Ms Cooper.
The MP added women ‘deserve’ the ‘highest quality care’ and blames the Government’s ‘mismanagement’ for leaving maternity units under-resourced with not enough staff or equipment to provide excellent care.
The Department of Health and Social Care (DHSC) claims it is investing extra cash to help boost the maternity workforce in hopes of fixing the low numbers of maternity staff in services across the country.
A DHSC spokesman said: ‘Every parent deserves to feel confident in the care they and their baby receive, and that’s why the Secretary of State has made improving care before, during and after pregnancy one of our top priorities for the women’s health strategy in 2024.
‘Since 2021, we have invested an additional £165 million a year, which will rise to an extra £186million a year from 2024/25, to grow and support the maternity workforce and improve maternity and neonatal care.
‘The Care Quality Commission will continue monitoring those trusts that are not providing care to an adequate standard, to ensure improvements are made.’
Kate Terroni, CQC’s deputy chief executive, said: ‘We know that many women receive good, safe maternity care, but sadly that’s not everyone’s experience.
‘Safe, high-quality maternity care for all is not an ambitious or unrealistic goal. It should be the minimum expectation for women and babies – and is what staff working in maternity services across the country want to provide.
‘It’s not acceptable that maternity safety is still so far from where it needs to be. As a healthcare system, we need to do better for women and for babies.’
NUMBER OF C-SECTIONS
In 2022-23, just shy of 40 per cent of births in England were via C-sections.
For comparison, the figure stood below 30 per cent in 2017-18, Mail+ found.
And when broken down trust-by-trust, we can reveal that every single provider has seen an increase in caesarean rates over the same timeframe.
The Royal Cornwall Hospitals NHS Trust doubled its C-section rates, according to NHS data, from just 15 per cent in 2020-21 to 30.5 per cent in 2022-23.
However, the trust has disputed this figure and said the true rate is closer to 25 per cent.
It said that an incorrect number of births and C-sections were listed in the NHS data.
The uptick comes in the wake of the horrifying revelations of the Shrewsbury maternity scandal, considered the worst in British history.
Some 201 babies and nine mothers died needlessly during a two-decade spell at Shrewsbury and Telford Hospital NHS Trust.
In a landmark 250-page report, investigators who probed the devastating failures ruled an obsession with ‘normal births’ contributed. Women were encouraged to have vaginal deliveries, often when a caesarean would have been a safer option, to keep surgery rates low.
An older but similar maternity scandal this time at Morecambe Bay NHS trust also reported the dangers of fixating on natural/normal births.
The 2015 inquiry, which found 11 babies and one mother suffered avoidable deaths, ruled a group of midwives’ overzealous pursuit of natural childbirth had ‘led at times to inappropriate and unsafe care’.
Historically, the idea of a ‘normal birth’ has been promoted by respected bodies.
The Royal College of Midwives formally abandoned its ‘normal birth’ campaign in 2017, after previously praising trusts for keeping C-sections rates low. It now admits to ‘regretting’ that decision.
In the wake of the Shrewsbury report, multiple women told how they felt pressured into not having a C-section.
One of these was minister Anne-Marie Trevelyan, who revealed in 2022 she had been ‘told I wasn’t going to have a Caesarean section’ during the difficult birth of her first child.
Recalling her experience, she told LBC that after the birth of her son she realised it was ‘ridiculous’ she didn’t have a C-section and that’s ‘absolutely’ what she should have had. Ms Trevelyan added she was left ‘very damaged’ but fortunately her son was fine.
C-sections have been on the rise for years in a trend partly pinned on increasing obesity levels.
Some studies have found being overweight in pregnancy increases the chances of needing a C-section.
Pregnant women in their late 30s and 40s, who are an increasing proportion of mothers, are also more likely to need a C-section due to the increased likelihood of complications.
An NHS spokesman said: ‘Each birth is different, and it is important that every pregnant woman and their maternity team are able to discuss and assess the risks and benefits of each delivery method as part of a personalised care and support plan, to ensure the best possible outcome for mums and their babies.’
How the Shrewsbury maternity scandal unfolded…
2002
A parliamentary report highlights how Shrewsbury and Telford Hospital Trust (SaTH) has one of the lowest caesarean rates in country, at just 10 per cent of births.
2007
A leading number of maternity organisations sign a ‘normal birth consensus statement’ discouraging medical interventions like caesareans where possible.
Royal Shrewsbury Hospital in Shropshire
At this time, the then health regulator Health Care Commission warns SaTH there were issues in how staff were monitoring foetal heart rates after incidents where babies were injured.
2009
Kate Stanton-Davies dies just hours after being born while under the care of Shrewsbury staff. Her parents begin to campaign for an investigation into what went wrong.
2013
Shrewsbury’s maternity services faced an internal investigation in 2013, but it concluded it was ‘safe’ and of ‘good quality’.
2015
An inquiry into failings at Morecambe Bay NHS trust – where 11 babies and one mother suffered avoidable deaths – found a group of midwives’ overzealous pursuit of natural childbirth had ‘led at times to inappropriate and unsafe care’.
It said the entire NHS should learn from the failings observed.
2016
Pippa Griffiths dies shortly after being born while being cared for by Shrewsbury staff.
Her parents join forces with Kate Stanton-Davies’s mother and father in calling for an investigation into maternity services at the trust.
2017
Donna Ockenden, chair of the Independent Review into Maternity Services at the Shrewsbury and Telford Hospital NHS Trust
Then health secretary Jeremy Hunt orders an inquiry into the trust which will eventually be headed by midwife Donna Ockenden. The original scope of the inquiry encompasses just 23 cases.
2018
Former health secretary Matt Hancock said the Ockenden review is being expanded to include hundreds of cases.
Also in this year the trust is rated inadequate for safety by health watchdog the Care Quality Commission.
2020
Ms Ockenden announces the investigation is now looking at cases involving 1,862 families and releases early recommendations ahead of the full report.
2021
The Princess Royal Hospital in Telford, Shropshire, which is also part of the scandal-hit trust
The inquiry findings are delayed to 22 March 2022 due to an influx of new information from Shrewsbury and Telford Hospital Trust. The final report was originally due in December 2021.
2022
The report is delayed again this time by a few weeks due to ‘parliamentary processes’.
Today’s final report detailing the harrowing scale of deaths and injuries among babies and women over two decades of the trust’s care is published.
