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NHS maternity care improving but still below pre-pandemic levels

Standards of maternity care in England have improved, but NHS trusts in England are still lagging behind the levels they were at before the Covid-19 pandemic, a new survey suggests.

The Care Quality Commission (CQC) has published the results of its 2023 maternity survey, which asked more than 25,000 women and other pregnant people who had a live birth at the start of that year about their experiences before, during and immediately after birth.

“We know that maternity services up and down the country are struggling with staffing levels, and sadly this is a stark reminder of what can happen when you have too few staff”

Gill Walton

In several key areas of antenatal care, the survey indicated that trusts had improved. A total of 81% of 2023 respondents told the CQC they were always given enough time to ask questions during antenatal checkups, an increase on 77% in 2022.

Similar improvements were found in the number of people feeling “always” listened to during antenatal care (83%, up from 80% in 2022), and those being asked about mental health during checkups (75%, up from 71% in 2022).

In addition, the number of respondents who felt they were given enough support for their mental health throughout pregnancy had improved (85% in 2022, 88% in 2023).

Some areas of experience during labour improved too. For example, 94% of respondents said their partner was involved as much as they wanted during labour, up from 90% in 2022, and there was a 3% rise in the number who felt that any concerns during labour were taken seriously by staff.

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Leading figures in the profession have welcomed the news of improvements in the short term, but recognised the need to continue the trend.

Royal College of Midwives (RCM) chief executive Gill Walton said she was “pleased” to see the figures moving in the right direction.

“That is a testament to the dedication and hard work of midwives and [midwifery support workers],” said Ms Walton.

“In particular, the improvement in the mental health support women get during pregnancy, especially around the information they receive, is welcome.

“Mental ill-health ranks with physical factors as one of the leading causes of maternal deaths in the UK, so this is a positive step,” she said.

Royal College of Midwives

Gill Walton

The CQC’s figures, however, showed that, while maternity had improved in the short-term, satisfaction had not returned to pre-pandemic levels.

Of the respondents, 25% said they were left alone at some point during, or shortly after, birth at a time when it worried them, up from 22% in 2019.

Meanwhile, just short of two-thirds (63%) said they saw or spoke to a midwife as much as they wanted after birth (down from 73% in 2018).

More than a quarter (28%) told the CQC they were not always treated with kindness or understanding while in hospital after giving birth. This was lower than 2022 (29%), but an increase on 2019 when the figure was 24%.

Ms Walton highlighted the need to continue the improvement, in particular for areas of maternity care that were shown to have declined over the five-year period.

She said: “It is worrying to read that a quarter of those surveyed said they weren’t able to get the help they needed during labour and birth.

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“We know that maternity services up and down the country are struggling with staffing levels, and sadly this is a stark reminder of what can happen when you have too few staff.

“While we welcome the commitments made in the NHS Long Term Workforce Plan, we need to see action, particularly around the retention of skilled, experienced staff.”

Andrea Sutcliffe, chief executive and registrar of the Nursing and Midwifery Council (NMC), also cautiously welcomed the CQC survey’s results.

She acknowledged the impact of understaffing in recent years on the quality and accessibility of care. She said: “Today’s findings also expose the difficulties some people have in accessing high-quality care.

“This is clearly being exacerbated by well publicised staffing pressures, which can get in the way of midwives’ ability to provide safe, kind and effective care.

“We know when this happens, it can lead to worse outcomes for women and babies,” said Ms Sutcliffe.

She said “adequate resources” and multi-disciplinary teams, which were fully staffed, were “fundamental” for further improvements in maternity care.

She added that the findings also demonstrated the importance of continuity of care, wherever possible, to help women receive excellent person-centred care during pregnancy, birth and postnatally.

“At a time of growing demand, listening to the needs and experiences of women and families, and acting on what they say, has never been more important,” she said.

CQC deputy chief executiveKate Terroni said: “It is encouraging to see that satisfaction among many of those surveyed remains high, and a real positive that for some aspects of care people are reporting a better experience than in 2022.

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“That’s a direct reflection of the efforts of frontline staff working hard to provide high quality care in the face of significant challenges.

“However, it’s very clear that far too many women and people using maternity services feel their care could have been better,” she said.

“Positive feedback about the availability of staff and being able to get help or speak to a midwife while in hospital has declined over time.”

Ms Terroni said that this feeling “echoed” what the regulator had heard from staff. She said “Many have shared their own concerns about the impact of staff shortages on their ability to provide care.

“It is vital that we listen to those who use and work in maternity services to understand what makes a good experience and what needs to improve,” she said.

“This will help ensure we can better support staff to provide the level of care that they want to be able to deliver every time and ensure a consistently good maternity experience for everyone.”

She added: “We will continue to report on the findings from our recent national maternity inspection programme to highlight where we find action is needed as well as where we see things working well.”

The CQC’s survey results were an average of 121 trusts. Of these, eight performed in a way the regulator described as “better than expected” for 2023, while five had survey results “worse than expected”.

No trust was categorised as “much worse” or “much better” than expected for the 2023 survey.

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