The House of Lords is due to debate the following motion on 25 January 2024:

Baroness Taylor of Bolton (Labour) to move that this House takes note of the delivery of maternity services in England.

1. How are maternity services in England performing?

The performance of England’s NHS maternity services has been considered in various surveys, reviews and reports. This section summarises recent findings across four key themes of maternity care: maternity experiences, the quality and safety of maternity care, maternal mortality and ethnic inequalities.

1.1 Maternity experiences

England’s independent regulator for health and social care, the Care Quality Commission (CQC), has reported a decline in positive maternity experiences in recent years.

The CQC undertakes an annual maternity survey to assess the quality and safety of maternity services in England. The ‘Maternity survey 2022’ invited those over the age of 16 who had a live birth in early 2022 to take part.[1] The survey received over 20,000 responses. The results showed that experiences of maternity care had deteriorated over the last five years. Areas requiring improvement included the ‘availability of staff’, ‘confidence and trust’, and ‘communications and interactions with staff’. Key figures from the CQC’s survey included:

  • Availability of staff: For antenatal care, the proportion of survey respondents who said they were given the help they needed when they contacted a midwifery team had reduced from 74% in 2017 to 69% in 2022. For in-hospital care after birth, 57% of respondents said they were ‘always’ able to get help, compared to 59% in 2021 and 62% in 2019. For postnatal care, 70% of respondents said they were ‘always’ given the help they needed when contacting a midwifery or health visiting team, a decrease from 73% in 2021 and 79% in 2019.
  • Confidence and trust: Around two-thirds (69%) of respondents said they ‘definitely’ had confidence and trust in the staff delivering their antenatal care. The results were higher (78%) when asked about confidence in the staff involved in labour and birth, but this had decreased from 82% in 2017. For postnatal care, 71% said they ‘definitely’ had confidence and trust in the midwifery team compared to 73% in 2017.
  • Communications and interactions with staff: The proportion of respondents saying they were given appropriate advice and support when contacting a midwife or hospital at the start of their labour had decreased from 87% in 2017 to 82% in 2022. For in-hospital care, 59% of respondents said they were ‘always’ given the information they needed, a decrease from 66% in 2017.

The survey results also showed a disparity in experiences between certain groups. For example, the CQC said respondents were more likely to report poorer experiences across maternity care if they had received an emergency caesarean birth, did not have continuity of carer (no named midwife) or had not had a previous pregnancy.

Despite this, the CQC said the survey had also shown some positive results. It said 62% of respondents had reported no delay with their discharge from hospital, an increase from 55% in 2017. Additionally, the CQC said mental health support had also improved, with 85% of respondents saying they were given enough mental health support during their pregnancy compared with 83% in 2021. In terms of postnatal care, 96% of respondents said a midwife or health visitor had asked them about their mental health, compared to 95% in 2021.

1.2 Quality and safety of maternity care

The CQC has continued to raise concerns about the quality of maternity care in England over the years.

The CQC’s annual ‘State of care’ report provides an annual assessment of the quality of health and social care in England. In its ‘State of care 2021/22’ report, the regulator reiterated its ongoing concerns about both the safety and ethnic inequality of maternity services, as well as the impact of poor training, poor culture and poor risk assessments on people’s care.

The regulator continues to raise concerns about the quality of maternity services in its latest report, ‘State of care 2022/23’. Figure 9 of the report showed that 10% of maternity services were rated as ‘inadequate’ overall in 2023 compared to 6% in 2022.[2] Additionally, 39% of maternity services were rated as ‘requires improvement’ in 2023 compared to 33% in 2022. The report highlighted ‘safety’ and ‘leadership’ as areas of particular concern. It said 15% of maternity services were rated as ‘inadequate’ for their safety and 12% rated as ‘inadequate’ for being well-led.

By September 2023, the CQC said it had inspected 73% of maternity services as part of its programme of focused inspections of NHS maternity services. The CQC said it had witnessed good practice during its inspections and heard reports of staff going “above and beyond” for those using maternity services.[3] However, it described the overall picture as “one of a service and staff under huge pressure”, warning that many patients were still not receiving safe, high-quality care.

Most recently, in November 2023, around two-thirds (67%) of England’s maternity units received a CQC rating of ‘requires improvement’ or ‘inadequate’ on safety, according to a BBC analysis of CQC ratings data.[4] This compared to 55% in the previous year. The BBC highlighted that the decline in CQC safety ratings has taken place despite the introduction of various policies to transform maternity care.

1.3 Maternal mortality

The maternal mortality rate in the UK has risen to levels not reported since 2003–05, according to the latest data presented by the Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK) collaboration.[5] Maternal mortality refers to deaths due to complications from pregnancy or childbirth.

The latest data presented by the MBRRACE-UK collaboration included all women in the UK who had either died during pregnancy or within six weeks after their pregnancy had ended, between January 2020 and December 2022.[6] This data came from an investigation led by Oxford Population Health’s National Perinatal Epidemiology Unit. The investigation found that:[7]

  • The maternal death rate in 2020–22 was 13.41 deaths per 100,000 maternities. This was significantly higher than the maternal death rate of 8.79 deaths per 100,000 maternities reported in 2017–19. Even when Covid-19 deaths were excluded from the results, the death rate for 2020–22 remained higher than the rate in 2017–19.
  • The leading cause of death was thrombosis and thromboembolism, followed by Covid-19, heart disease and mental health-related causes.
  • The maternal death rate was three times higher for Black women compared to White women and two times higher for women from Asian ethnic backgrounds.
  • Women living in the most deprived areas had a maternal mortality rate more than twice as high as women living in the least deprived areas.

The data was published by the MBRRACE-UK collaboration ahead of its ‘Saving lives, improving mothers’ care’ report due to be published later in 2024.

1.4 Ethnic inequalities

Ethnic inequalities in maternity service care and maternal outcomes have been reported for several years. Two recent reports on midwifery and maternity services have highlighted the issue further.

The CQC commissioned a “small, bespoke” piece of research in July 2023 to examine ethnic inequalities in maternity care.[8] This involved interviewing midwives from ethnic minority groups about their experiences working in maternity services. The CQC said interviewees had reported racial stereotypes and a lack of cultural awareness amongst maternity service staff. The interviewees had also referred to a culture where staff tolerated discrimination from colleagues.

As part of its research, the CQC also looked at the maternity service experience of people from ethnic minority groups who have a long-term condition. The regulator said it found a lack of cultural competency to be a barrier to receiving good quality care.

Maternal support organisations such as Five X More have campaigned to address disparities in maternal outcomes for Black mothers.[9] This includes hosting Black maternal health awareness week to raise awareness about disparities in maternal outcomes and empower Black women to make informed choices throughout their pregnancy and after childbirth.[10]

The underlying causes of ethnic disparities in maternal mortality have been found to be complex and multifaceted. However, factors believed to contribute to the problem include pre-existing health conditions, socioeconomic factors such as deprivation and factors such as bias, microaggressions and racism.[11] However, as highlighted in the 2023 report by the House of Commons Women and Equalities Committee, the causes of disparity are not fully understood.[12] The committee warned that “fixating” on any one cause risked “oversimplifying” the problem.

To explore inequalities in maternity care, the government established the Maternity Disparities Taskforce in February 2022.[13] The taskforce consists of experts from the health system, government departments and the voluntary sector who are considering evidence-based interventions to tackle maternal disparities. During 2023, the government said the taskforce was focusing its work on preconception care.[14]

2. What problems have recent independent investigations into maternity services found?

Various independent investigations into failings by specific NHS maternity units across England have been undertaken during the last 10 years. This included an investigation in 2015 into the provision of maternity care at the University Hospitals of Morecambe Bay NHS Foundation Trust between 2004 and 2013.[15] An investigation also took place in 2020 into the quality of maternity services at the Shrewsbury and Telford Hospital NHS Trust between 2000 and 2019.[16] Both reports highlighted major service failings in maternity care across both NHS trusts.

The most recent independent report to be published followed an investigation into maternity services within East Kent Hospitals University NHS Foundation Trust. This section summarises the findings of that investigation.

2.1 Independent investigation into East Kent maternity services

In 2020, NHS England and NHS Improvement commissioned Dr Bill Kirkup to lead an independent investigation into maternity and neonatal services in East Kent. This was prompted by the deaths of several babies in East Kent hospitals over several years. The investigation panel examined the performance of two maternity hospitals between 2009 and 2020: the Queen Elizabeth The Queen Mother Hospital in Margate and the William Harvey Hospital in Ashford.

The investigation’s report, published in October 2022, said the panel had found a clear pattern of suboptimal clinical care at the hospitals which had led to significant harm.[17] This included a failure to listen to families involved and service providers acting in a way which made families’ experiences “unacceptably and distressingly poor”. The panel argued that problems should have been effectively addressed because the individual and collective behaviours of service providers were visible to senior managers in various reports from 2009 and 2020.

The consequences of not addressing the problems were stark, the panel stated. Had care been delivered to nationally recognised standards, the clinical outcome could have been different in 97 (48%) of the 202 cases assessed by the panel. Additionally, the panel said the clinical outcome could have been different in 45 (69%) of the 65 baby deaths it assessed. The panel said it had “no doubt” these numbers were minimum estimates of the frequency of harm over that period.

To address the problems, the panel gave four broad areas for action:[18]

  • more effective monitoring of maternity service performance to identify poorly performing units
  • compassionate care to be embedded into services to ensure all interactions with patients are based on kindness and respect
  • improved teamworking in maternity and neonatal services based on common goals
  • a change in organisational behaviour in times of criticism to ensure openness, honesty, disclosure and learning outweighs any perceived benefit of denial, deflection and concealment

The panel gave recommendations for these four areas for action.[19] Recommendations included:

  • establishing a task force to support the introduction of mandatory maternity and neonatal outcome measures that could highlight significant trends in maternity service unit performance
  • commissioning of reports on how compassionate care could be embedded into service
  • reporting from relevant bodies on how teamworking in maternity and neonatal care could be improved
  • introducing legislation to place a duty on public bodies to not deny, deflect and conceal information from families and other bodies

Shortly after the publication of the panel’s report, the CQC carried out unannounced focused inspections of the maternity services at the Queen Elizabeth The Queen Mother Hospital in Margate and the William Harvey Hospital in Ashford in January 2023. Inspectors reported that the maternity service ratings at both hospitals had dropped from ‘requires improvement’ to ‘inadequate’ and said East Kent Hospitals University NHS Foundation Trust was required to make immediate improvements.[20]

In August 2023, the government published its full response to the independent investigation report into maternity services at East Kent hospitals.[21] This set out new actions the government would take to address the problems in maternity services nationwide, in addition to various actions that were already planned or being implemented. New actions included the minister for mental health and women’s health strategy chairing a new ‘maternity and neonatal care national oversight group’. The government said this group would bring together key stakeholders including the NHS and CQC to ensure improvements in maternity services were implemented across England in an effective and coordinated way. At a local level in East Kent, the government said it would convene a local forum for the NHS, CQC and MPs to share information and updates.

2.2 Ongoing investigations

An independent review of maternity services at the Nottingham University Hospitals NHS Trust was established in May 2022.[22] This was in response to “significant” concerns raised by local families about the quality and safety of maternity services in the area. This independent review is reported to be the UK’s largest ever maternity services review, with around 1,700 families’ cases reportedly being examined.[23] The investigation remains ongoing.

3. What recent policies have been introduced to address the problems?

The government has described the NHS as one of the safest places in the world to give birth.[24] However, the government and NHS have published various targets, programmes, strategies and action plans over the years to improve maternity services in England.

For instance, following several inquiries into patient safety, the government set a national maternity safety ambition to halve the 2010 rates of stillbirths, neonatal and maternal deaths, and brain injuries during or soon after birth in England by 2025.[25] This ambition also includes a target to reduce the national rate of pre-term births from 8% to 6% by 2025. More information on progress made towards this target can be found in section 3.3.

Targets for improving maternity services have recently been set out in several plans such as: NHS England’s three-year delivery plan for maternity and neonatal services, the government’s women’s health strategy, and the NHS long term plan. These plans are being implemented concurrently and remain ongoing. This section summarises the content of these plans.

Information on other policies on maternity services can be found in the House of Commons Library briefing ‘Quality and safety of maternity care (England)’ (8 December 2023).

3.1 NHS three-year delivery plan for maternity and neonatal services

NHS England published the ‘Three year delivery plan for maternity and neonatal services’ in March 2023. This brought together existing national commitments alongside recommendations made in independent reports into maternity services.

The three-year plan sets out how the NHS will make maternity and neonatal care “safer, more personalised and more equitable for women, babies and families”.[26] It contains various responsibilities and commitments for NHS trusts, integrated care boards and NHS England to deliver on. The plan has four key focus areas:

  • Listening to women and families with compassion to promote safer care. Key commitments include access for pregnant women and new mothers to pelvic health services in every area across England by 2024.[27] Another commitment includes the implementation of local plans to reduce inequalities in experience for women and babies.
  • Supporting the workforce to develop skills and capacity to provide high-quality care. Key commitments include regular workforce planning to ensure trusts can meet required staffing levels by 2027/28.[28] Additionally, supporting the retention and recruitment of staff through action plans.
  • Developing and sustaining a culture of safety, learning and support to benefit everyone. Key commitments include guidance and leadership training to empower staff to work professionally and compassionately.[29] Additionally, listening and acting upon issues raised by staff and service users through feedback channels such as the maternity and neonatal voices partnerships (MNVPs).
  • Meeting and improving standards and structures that underpin safer, personalised and more equitable care. Key commitments include providing an updated version of the ‘Saving babies’ lives care bundle’ by 2024.[30] This refers to a package of interventions aimed at reducing stillbirth, neonatal brain injury, neonatal death and preterm birth. Additionally, by 2024, the NHS is required to publish refreshed data and recording standards to help with the collection of meaningful, standardised data to help improve care.

In October 2023, NHS England provided a progress update on the three-year plan.[31] It described multiple actions that had been taken to meet commitments under the four key themes. Actions taken under theme 1 (listening to women and families) and theme 2 (workforce) included all local maternity and neonatal systems implementing an equity and equality action plan to help address health inequalities. It stated that MNVPs had been established in every system to work with families and improve care. It also said additional investment by NHS England had meant an increase in certain staffing levels and a reduction of midwifery vacancies. Progress made towards theme 3 (development culture) and theme 4 (standards and structures) included more than half of perinatal leadership teams starting a culture and leadership programme to help create a positive working culture. Other actions included an ongoing programme of work to improve the use of data in maternity services and the publication of an updated ‘Saving babies’ lives’ care bundle which trusts are expected to implement by March 2024.

3.2 Women’s health strategy for England 2022

The ‘Women’s health strategy for England’ is the government’s 10-year plan aimed at improving the health of women and girls. Published in 2022, it contains a range of targets for areas such as fertility, pregnancy, pregnancy loss and postnatal support. This includes ambitions for the NHS to be “the best place in the world to give birth through personalised, individualised and high-quality care” and to reduce disparities in care for mothers and babies.[32]

The plan contains various actions for the government and other organisations such as NHS England. The government said it had been taking the following actions towards its 10-year plan:

  • The expansion of personalised maternity care.[33] This refers to care that is centred around the woman, her baby and her family. The government said the expansion of personalised maternity care would be done through various programmes, including the creation of maternal medicine networks.
  • To support new mothers and parents, the government made a £302mn investment in the family hubs and the ‘start for life’ programme.[34]
  • To support bereaved families, the government said it would introduce a pregnancy loss certificate in England.[35] This followed an interim recommendation made by the independent ‘Pregnancy loss review’ and would enable parents who have experienced a pre-24 week pregnancy loss to obtain a certificate of recognition if they wished. In July 2023, the government said it had begun to “develop and assess” the certificate service in advance of a public launch.[36]
  • The government has commissioned various research projects from the National Institute for Health and Care Research to look into the safety of maternity services for women and babies.[37] This included a £5mn policy research unit based at the University of Oxford that would research priority areas within maternal and neonatal health and care.

One year after the strategy’s launch, the government announced some additional measures to support the health and wellbeing of women and girls.[38] This included the development of a new artificial intelligence tool to identify early risks in maternity units and the launch of a women’s health area on the NHS website with information on a range of health issues, including pregnancy.

3.3 NHS long term plan

In 2019, ‘The NHS long term plan’ set out various actions to achieve the government’s national maternity safety ambition to halve the 2010 rate of stillbirths, maternal mortality, neonatal mortality and serious brain injury by 2025. Actions included:[39]

  • expanding the roll-out of maternity digital care records so that all women can access maternity notes and information digitally by 2023/24
  • improving access to and quality of perinatal mental health care for mothers, their partners and children
  • improving access to postnatal physiotherapy to support women recovering from birth

The national maternity safety ambition has not yet been reached, according to the government.[40] Parliamentary Under Secretary of State for Health Lord Markham said the latest data from 2021 and 2022 showed that the stillbirth rate had reduced by 23% since 2010 and the neonatal mortality rate for babies born over the 24-week gestational age of viability reduced by 30%. For pre-term births, the minister said the proportion of babies born with a gestational age under 37 weeks had reduced from around 8% of all births in 2017 to 7.7% in 2021. Additionally, Lord Markham said the overall rate of brain injuries that occurred during or soon after birth had reduced to 4.2 per 1,000 births in 2019, which was 2% lower than the 2010 baseline. However, the minister highlighted that these latest figures coincided with the Covid-19 pandemic and were out of date. Lord Markham said the data would not reflect recent efforts and initiatives made to improve outcomes.

4. What have representative organisations and campaign groups said?

Organisations have raised various concerns about maternity services in England. This includes concerns about the oversight of maternity services by NHS trust boards, as well as maternity staff shortages.

Regular oversight of the safety and quality of maternity and neonatal services in England by NHS trust boards has recently been the subject of research by the joint policy unit run by the UK pregnancy and baby loss charities Sands and Tommy’s Policy Unit.[41] Researchers reviewed publicly available board papers and minutes of seven NHS trust boards to analyse how effective board oversight of maternity and neonatal services was. The policy unit said its findings had shown board papers were not always effective at giving the board an understanding of how maternity services were performing and the challenges they faced.[42] Researchers provided various examples of ways they believed trust boards could gain a fuller understanding of the performance of maternity units, including clearer guidance on the minimum performance metrics to be submitted to NHS trust boards.[43]

On staff shortages, the Royal College of Midwives (RCM) has described the impact of staff shortages on women as “stark and sobering”.[44] The RCM estimated the NHS had a current shortfall of the equivalent of 2,500 full-time midwives.

The parent-led Maternity Safety Alliance (MSA) has called for the government to carry out a statutory public inquiry into the state of maternity services in England.[45] The alliance has raised concerns that problems in the maternity system continue to persist despite reviews and independent investigations into service failings. The internet forum Mumsnet has recently announced its support for the MSA’s campaign.[46] The government has recently confirmed it has no current plans to commission a public inquiry into the future of maternity services.[47]

5. Read more

Cover image by Harald Landsrath on Pixabay.


  1. Care Quality Commission, ‘Maternity survey 2022’, 11 January 2023. Return to text
  2. Care Quality Commission, ‘State of care 2022/23’, updated 15 November 2023. Return to text
  3. As above. Return to text
  4. BBC News, ‘Most NHS maternity units not safe enough, says regulator’, 16 November 2023. Return to text
  5. The MBRRACE-UK collaboration is led by the National Perinatal Epidemiology Unit at the University of Oxford. It was appointed by the Healthcare Quality Improvement Partnership (HQIP) to undertake the Maternal, Newborn and Infant Clinical Outcome Review Programme. This programme is commissioned by HQIP on behalf of NHS England, NHS Wales, the Health and Social Care Division of the Scottish Government, the Department of Health, Social Services and Public Safety of Northern Ireland, the states of Jersey, Guernsey and the Isle of Man. Return to text
  6. MBRRACE-UK, ‘Maternal mortality 2020–22’, January 2024. Return to text
  7. University of Oxford, ‘Maternal death rates in the UK have increased to levels not seen for almost 20 years’, 11 January 2024. Return to text
  8. Care Quality Commission, ‘Inequalities’, 20 October 2023. Return to text
  9. Five X More, ‘Five X More: About’, accessed 15 January 2024. Return to text
  10. Five X More, ‘Black maternal health awareness week 2023’, accessed 15 January 2024. Return to text
  11. House of Commons Women and Equalities Committee, ‘Black maternal health’, 18 April 2023, HC 94 of session 2022–23. Return to text
  12. As above, p 11. Return to text
  13. Department of Health and Social Care, ‘New taskforce to level-up maternity care and tackle disparities’, 23 February 2022. Return to text
  14. Department of Health and Social Care blog, ‘Maternity and neonatal care: How are we improving services?’, 31 July 2023. Return to text
  15. Dr Bill Kirkup, ‘The report of the Morecambe Bay investigation’, March 2015. Return to text
  16. Department of Health and Social Care, ‘Ockenden report, final: Findings, conclusions and essential actions from the independent review of maternity services at the Shrewsbury and Telford Hospital NHS Trust’, 30 March 2022. Return to text
  17. Department of Health and Social Care, ‘Reading the signals: Maternity and neonatal services in East Kent—the report of the independent investigation’, October 2022, p 1. Return to text
  18. As above, pp 157–64. Return to text
  19. As above. Return to text
  20. Care Quality Commission, ‘CQC takes action to drive improvements in the quality and safety of maternity services at East Kent Hospitals University NHS Foundation Trust’, 26 May 2023. Return to text
  21. Department of Health and Social Care, ‘Government response to ‘Reading the signals: Maternity and neonatal services in East Kent—the report of the independent investigation’’, 3 August 2023. Return to text
  22. Ockenden Maternity Review, ‘Independent review of maternity services at the Nottingham University Hospitals NHS Trust’, accessed 15 January 2024. Return to text
  23. Michael Buchanan and Liam Barnes, ‘Nottingham maternity review to become UK’s largest’, BBC News, 10 July 2023. Return to text
  24. Department of Health and Social Care blog, ‘Maternity and neonatal care: How are we improving services?’, 31 July 2023. Return to text
  25. Department of Health, ‘Safer maternity care’, November 2017, p 9. Return to text
  26. NHS England, ‘Three year delivery plan for maternity and neonatal services’, March 2023. Return to text
  27. As above, p 8. Return to text
  28. As above, p 16. Return to text
  29. As above, p 24. Return to text
  30. As above, p 31. Return to text
  31. NHS England, ‘Update from the maternity and neonatal programme’, 5 October 2023. Return to text
  32. Department of Health and Social Care, ‘Women’s health strategy for England’, August 2022, CP 736, p 68. Return to text
  33. As above, p 73. Return to text
  34. As above, p 74. Return to text
  35. As above, p 75. Return to text
  36. Department of Health and Social Care, ‘Government response to the independent pregnancy loss review: Care and support when baby loss occurs before 24 weeks’ gestation’, 22 July 2023. Return to text
  37. Department of Health and Social Care, ‘Women’s health strategy for England’, August 2022, CP 736, p 77. Return to text
  38. Department of Health and Social Care, ‘Boost for women and girls as women’s health strategy turns one’, 22 July 2023. Return to text
  39. NHS England, ‘The NHS long term plan’, January 2019, pp 46–9. Return to text
  40. House of Lords, ‘Written question: Infant mortality (HL428)’, 21 December 2023. Return to text
  41. Sands and Tommy’s Policy Unit, ‘Better board oversight needed to save babies’ lives’, November 2023. Return to text
  42. As above, p 5. Return to text
  43. As above, p 7. Return to text
  44. Royal College of Midwives, ‘England: State of maternity services 2023’, July 2023, p 3. Return to text
  45. Maternity Safety Alliance, ‘We’re calling for a national public inquiry on maternity safety’, accessed 15 January 2024. Return to text
  46. Mumsnet, ‘Mumsnet partners with Maternity Safety Alliance following string of maternity scandals and data which reveals 67% of maternity services in England deemed not to be safe enough’, 12 December 2023. Return to text
  47. House of Lords, ‘Written question: Maternity services: Royal commissions (HL824)’, 18 December 2023. Return to text