3rd Report - Black Maternal Health

Safe maternity care for Black women is dependent on a workforce equipped to understand and respect their needs. Given the current disparities in maternity outcomes for Black women it is indefensible that cultural competency training is optional for NHS staff and leaders working in maternity services, and especially midwives. (Conclusion, Paragraph 26)

We recommend the Department work with the NHS, the Royal College of Midwives, and the NMC to introduce mandatory, ongoing cultural competency training for all midwives, informed by co-production. A working group should review and update training materials to ensure they meet the needs of all ethnic groups. (Recommendation, Paragraph 27)

NHS leaders have a vital role in improving maternity outcomes for Black women and addressing the underlying culture and racism that underpin those outcomes. However, the current system does not incentivise leaders to focus on this issue or effectively hold to account Trusts that fail to make progress.(Conclusion, Paragraph 36)

The NHS leadership framework should set clear expectations for tackling racism and fostering an inclusive culture, reflected in chief executives’ performance agreements. It must also equip Ministers to hold Trust leaders accountable for creating anti-racist organisations and improving maternity outcome inequalities. (Recommendation, Paragraph 37)

Addressing the current lack of diverse representation within NHS leadership and midwifery education is one practical action that can be taken to address concerns. When those entrusted with shaping clinical knowledge and practice and leading our healthcare organisations overwhelmingly reflect a single demographic, it limits the breadth of what is taught, prioritised, and thus, how care is delivered. (Conclusion, Paragraph 38)

The Government should also ensure the forthcoming workforce plan explicitly includes targets and strategies to diversify NHS leadership, specifically maternity service leaders and educators. This must be 32 accompanied with robust monitoring mechanisms that can be used to track progress and hold Trusts to account for their performance. (Recommendation, Paragraph 39)

While there have been multiple initiatives aimed at improving Black maternal health, progress remains too slow. We welcome the announcement of a rapid national investigation into maternity and neonatal care and the Secretary of State’s commitment to inequality being an integral part of its work. (Conclusion, Paragraph 43)

We hope that the national investigation will serve as a turning point for the country’s maternity services, and particularly the experience of Black women, by laying the foundation for a more transparent, accountable, and equitable maternity system. We will monitor the progress of the inquiry closely and intend to revisit its findings, with a view to undertaking further scrutiny at an appropriate stage. (Conclusion, Paragraph 44)

We recommend that addressing racial disparities in maternal outcomes is one of the investigation’s core aims, and that this features prominently in the terms of reference for the second stage. We recommend that the investigation aligns with the priorities outlined by the Health Services Safety Investigations Body, specifically the defining of an accountability framework for maternity and neonatal services. Additionally, we recommend that the review carefully considers the impact of the significant reduction of ringfenced funding as outlined in this report. (Recommendation, Paragraph 45) Workforce

Workforce shortages remain a major barrier to safe maternity care, despite recent recruitment progress. We are disappointed the Government suspended its continuity of carer target, which is especially important for marginalised women, including Black women, who face greater challenges in being heard by the healthcare system. (Conclusion, Paragraph 62)

The Government must give firm commitments in the refreshed Long Term Workforce Plan to deliver safe staffing levels for maternity services. Without this, safe and sustainable maternity care will remain out of reach. As part of the workforce plan the Government must commit to rapidly reaching a level of staffing that will allow it to recommit to its continuity of carer target. (Recommendation, Paragraph 63)

Suspending adoption of RCOG’s safe staffing tool has left Trusts without clear guidance on safe staffing levels, perpetuating poor workforce supply and undermining efforts to stabilise and support maternity teams. (Conclusion, Paragraph 64) 33

We urge the Department to update and publish the tool produced by RCOG in time for the rollout of the upcoming refreshed Workforce Plan, so that every maternity unit can use it to plan effectively, ensure appropriate staffing and deliver consistent, safe care to all mothers and their babies. (Recommendation, Paragraph 65) Data

Collecting robust, consistent, and equity-focused data on ethnicity and maternal morbidity is essential to enable health services to monitor and improve their services guiding improvements in maternal outcomes. Without it, it is significantly harder to produce accurate comparisons across all ethnic groups and evaluate disparities in maternal outcomes amongst different ethnicities, and gaps may obscure the true extent of disparities in outcomes for Black and other minority ethnic women. (Conclusion, Paragraph 79)

We are pleased that the Government has agreed an Ethnicity Recording Improvement Plan and look forward to seeing the details when it is published. (Conclusion, Paragraph 80)

We recommend that this Plan should include details on staff training, support for data collection, and accountability measures to ensure Trusts meet their responsibilities. The Government must establish transparent mechanisms to monitor compliance and address failures in timely, accurate reporting, and outline these in its response to this report. (Recommendation, Paragraph 81)

We are concerned that progress on developing a maternal morbidity indicator has been unacceptably slow, despite a Government commitment to do so over two years ago. We recommend the Department work with the National Institute for Health and Care Research to accelerate development and provide a clear timetable in response to this report. (Recommendation, Paragraph 82) Funding

We are concerned by the Government’s decision to cut the Maternity Service Development Fund from £95 million to £2 million. While ICBs still have access to this funding, maternity services must now compete with other local priorities. While performance metrics in the 2025–26 NHS Assessment Framework aim to ensure accountability, they do not guarantee sufficient funding will be directed towards maternity services. Without sustained oversight and dedicated investment, maternity care risks losing momentum, 34 widening disparities, including in Black maternal care, and compromising critical reforms. We are also concerned about how the dissolution of NHS England and its absorption into the Department of Health and Social Care might impact the NHS’s ability to monitor maternity spending and maintain national oversight of progress. (Conclusion, Paragraph 90)

We strongly recommend that the Government restore the dedicated ring- fenced funding for the Service Development Fund for maternity care to £95 million. Properly targeted we believe this investment has the potential to reduce the substantial cost of maternity negligence claims to the NHS and more than pay for itself. (Recommendation, Paragraph 91)

More broadly, the Government must ensure that maternity services continue to be a priority within ICB funding allocations. We ask the Government to set out in its response to this Report how it will monitor ICB investment in these services, including the impact of the removal of the ringfence if that decision is not reversed, and how it will intervene if it sees evidence that ICBs are underinvesting in maternity services. (Recommendation, Paragraph 92) 35