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Damning verdict on maternity care in England as two thirds of units found to be unsafe

Safety watchdog has warned over emerging ‘two tier’ system in the NHS

Rebecca Thomas
Health Correspondent
,Jane Kirby
Friday 20 October 2023 08:32 BST
Families affected by maternity care failing at NHS trust 'expect action'

NHS maternity services are getting worse with two-thirds of units in England now deemed unsafe as staff and hospitals find themselves under “huge pressure”, a damning report has warned.

Some 65 per cent of maternity services are now regarded as inadequate or require improvement for safety, up from 54 per cent last year, the Care Quality Commission (CQC) has found. Of these, 15 per cent are inadequate.

When looking at overall ratings, one in 10 maternity units are now rated inadequate, while 39 per cent are under the rating requires improvement.

The worsening picture of maternity care in England follows major scandals in Shrewsbury and Nottingham uncovered by The Independent.

The report says the “overarching picture” is “one of a service and staff under huge pressure”. Staff cover “is often fragile, with the rotas relying on every consultant being available”.

It added: “On top of this, consultants face additional pressure from, for example, having to cover registrar rotas and extra on-call shifts to meet the needs of their service.”

One patient told the CQC: “I couldn’t move and asked someone to help me feed my baby and was told ‘you can do it yourself’ … [The midwife] also told me that she was very busy and had other patients that took priority – when I still couldn’t move.”

The report further pointed to issues with governance and lack of oversight from NHS boards, as well as delays to care and lack of one-to-one attention during labour. The report also highlighted poor communication.

The watchdog has said a similar picture has emerged for ambulance services, with 60 per cent deemed to be inadequate or requiring improvement on safety – double last year.

Mental healthcare was also highlighted as an area of concern with 40 per cent rated inadequate or required improvement for safety.

Inspectors pointed to a lack of beds, meaning people can be “cared for in inappropriate environments – often in emergency departments”.

“One acute trust told us that there had been 42 mental health patients waiting for over 36 hours in the emergency department in one month alone.” the report said.

In its wide-ranging report, the CQC warned that healthcare risks becoming a two-tier system, with society divided into those who can pay for care and those who cannot.

It said: “Getting access to services remains a fundamental problem… Along the health and care journey, people are struggling to get the care they need when they need it.”

Factors such as long waits for hospital treatment, waits to see GPs and for referrals, combined with a lack of staff, “increase the risk of a two-tier system of healthcare, with people who can’t afford to pay having to wait longer for care and risking deteriorating health”.

During a press conference watchdog officials said: “More and more people are entering that long-wait category and it's becoming harder to prioritise and deprioritise people, when as I say we are, they are seeing a number of people who, who have effectively not been sustained on electric backlogs arriving into A&E with a serious condition.”

Research by YouGov showed that eight in 10 of those who used private healthcare last year would previously have used the NHS, while another study found 56 per cent of people had tried to use the NHS before going private.

The CQC added: “People may also be forced to make difficult financial choices. We heard from someone who receives benefits who resorted to extracting their own tooth because they were unable to find an NHS dentist.

“They then had to pay £1,200 on a credit card for private treatment, doing without household essentials until the debt was paid.”

CQC chief executive Ian Trenholm said the ongoing strike action by NHS staff – who are unhappy with pay and conditions – has contributed to backlogs.

Sally Warren, director of policy at think tank The King’s Fund, said: “This comprehensive report reveals the sad reality that the quality of care that patients need and deserve is not being met in many parts of the NHS and social care.”

A Department of Health and Social Care spokeswoman said: “We are delivering on three major recovery plans to improve access to urgent and emergency, primary and elective care, and have made progress to significantly reduce the longest waits for routine treatment, despite pressures including industrial action.

“There are record numbers of staff working in the NHS and our historic Long Term Workforce Plan will retain and recruit hundreds of thousands more staff alongside harnessing technology to reform the way we work and save staff time.”

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