National review of maternity care in challenging circumstances

7. We accept this recommendation. A review of maternity care, which will also consider neonatal care and paediatrics in the context of maternity care, is underway. 8. In its report to Cumbria Clinical Commissioning Group, the Royal College of Obstetricians and Gynaecologists highlighted the association between frequent exposure to complex cases and more favourable outcomes for patients across all aspects of clinical care. The report suggests that some units, particularly rural and isolated units, need to develop innovative models of care that enable clinicians to maintain their skills and competencies and staffing structures to ensure safe levels of expert clinical coverage. 9. NHS England announced a review of maternity services on 3 March 2015. Baroness Cumberlege is the independent Chair leading the review and is being supported by a core team of experts, including Catherine Calderwood, the Chief Medical Officer for Scotland, who worked on the Morecambe Bay Investigation and James Titcombe OBE, one of the family members affected by the failings at Morecambe Bay. The Review will develop proposals for the future shape of modern, high quality and sustainable maternity services across England. The terms of reference set out three complementary objectives: • review the UK and international evidence and make recommendations on safe and efficient models of maternity services, including midwife-led units • ensure that the NHS supports and enables women to make safe and appropriate choices of maternity care for them and their babies • support NHS staff including midwives to provide responsive care. 10. The review will pay particular attention to the challenges of achieving the objectives in more geographically isolated areas. It will also consider the links between the different models of maternity care and neonatal units, ensuring access to appropriate levels of more intensive care following birth, if they are needed. It is expected to conclude and publish proposals by the end of the year.

The Thirlwall Inquiry has noted action taken in response to this recommendation.

NHS England announced a review of maternity services on 3 March 2015, chaired by Baroness Cumberlege to consider how maternity services need to change to meet the needs of the population, and ensure learning from the Morecambe Bay investigation could be embedded throughout the NHS. Its terms of reference included an expectation that it would pay particular attention to the challenges of more geographically isolated areas, as highlighted in the Morecambe Bay Investigation report. Better Births, the report of the independent maternity review, was published on 23 February 2016. Four Years On: A review of progress report set out progress made.

Extensive engagement during the Better Births review (see recommendation 20) made it clear that a single model for maternity services in rural areas was not feasible due to significant local differences between units. Having considered the Kirkup recommendation, NHS England therefore concluded it would not be appropriate to review requirements in the way proposed (see recommendation 21 for more details about work on rural services). Subsequently, and in response to Better Births, a specific review of neonatal critical care, chaired by Professor Neil Marlow, was undertaken. NHS England published an action plan in 2019 to implement the recommendations of the Neonatal Critical Care Transformation Review.

In 2023, NHS England published the Three Year Delivery Plan for Maternity and Neonatal Services which built on the work and recommendations of the Better Births report. This plan sets out how the NHS will make maternity and neonatal care safer, more personalised, and more equitable for women, babies, and families.

Baroness Cumberlege’s review’s terms of reference included an expectation that it would pay particular attention to the challenges of more geographically isolated areas, as highlighted in the Morecambe Bay Investigation report. Better Births, the report of the independent maternity review, was published on 23 February 2016.

Subsequently, and in response to Better Births, a specific review of neonatal critical care, chaired by Professor Neil Marlow, was undertaken and is now being implemented.

The National Maternity Review report, ‘Better Births - Improving outcomes of maternity services in England, A Five Year Forward View for maternity care’ reviewed maternity services across the country including in rural and isolated areas. It found that in a number of rural areas, small obstetric units see a low number of births and face challenges in employing sufficient numbers of staff.

As part of the New Care Models programme, NHS England alongside the other arm’s length bodies, has established 50 vanguards to explore how new models of care can address the quality, care and efficiency challenges faced by the National Health Service; this includes services that are rural, geographically isolated or difficult to recruit to. Examples of best practice and shared learning from these Vanguard sites are continually made available to the wider NHS, through reports, publications, press and media.

Department of Health response (July 2015): “We accept this recommendation. A review of maternity care, which will also consider neonatal care and paediatrics in the context of maternity care, is underway.” (p. 67)

“NHS England announced a review of maternity services on 3 March 2015. Baroness Cumberlege is the independent Chair leading the review and is being supported by a core team of experts.” (p. 67)