The summer recess is over, and the new UK labour government are in full swing. Yet all is quiet on the maternity front. Neil Stewart, Editorial Director, Maternity and midwifery forum unpacks the silence, questioning the next steps.
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“Events dear boy, events”, the reply of Conservative Prime Minister Harold McMillian when asked what was the greatest challenge a statesman faced.
After the UK general election it feels that the future of midwifery is currently at the mercy of “events” for there is very little clarity on the future in the statements that were made during the election or since.
It would be wonderful to have a clear statement from Health Secretary Wes Streeting promising on midwifery numbers, safety, development of the profession, continuity of care and how we are going to get there, but it looks like the challenges of midwifery are stuck in a long queue of problems he plans to tackle to fix “the broken NHS”
An experienced and well-regarded former minister, Baroness Gillian Merron has been appointed as a new minister and maternity and midwifery appears among a long list of her responsibilities for women and for safety – but patient safety comes first in the title.
And it is that responsibility for safety that is the prism through which maternity services are being currently viewed. The next big events are likely to be the next Ockenden report on Nottingham University Hospital. How that is received will have a big effect on the direction of the debate about safe childbirth.
While the teachers have had the one-word inspection judgements of OFSTED removed because of their stigma, maternity units are still judged by CQC on a similar system with news headlines saying up to 70% of maternity units are having problems – while the actual report says 10% are “inadequate” and 39% “needs improvement”. But how pregnant women view this one word judgement as other than “unsafe” is unclear. And while the theory is that a blunt judgement will spur improvement the practice is that it often demoralised and spreads doubt and fear in staff.
We are also now increasingly in the world of contested statistics and the Lucy Letby case, which has sent such a shock of fear through neonatal intensive care nurses that many are leaving in fear of being blamed for child deaths, is opening up new debates.
In some ways what the statisticians are saying is just as shocking, that the deaths in the Letby case may not be out of line with other units, that there are lots of other high levels of sudden deaths, that it is more systemic than the court case heard.
That does not tell us whether Letby is innocent or guilty, but it does remind everyone to be careful with judgments and what can be read in different ways by difference audiences.
There were plenty of numbers thrown around at the time of the various maternity unit media scandals but there were also complaints that the statistics highlighted were selective, media driven and open to questions about how far from the norm they really were. There is no doubt that the subsequent inquiries reveal a body of failure and neglect, cultures of disrespect and a long tail of birth traumas that were not even in the first terms of reference. What if the problem is systemic, not confined to a few places, what is the solution then and how do we find out?
Let us hope that the next steps for maternity services are dictated by cool analysis, a view on what women want, improving safety and not by “events”.
Neil Stewart
Editorial Director, Maternity and Midwifery Forum
September 2024