Radical whole-system change is the only way to fix NHS maternity services

The United Kingdom's National Health Service (NHS) maternity services are facing a crisis that demands a fundamental overhaul, according to recent investigations and expert analysis. The Amos inquiry, alongside the Ockenden review, has uncovered persistent systemic failures that have resulted in poor outcomes for women and babies. These reports document distressing examples of failures in compassionate care, with life-changing physical and psychological trauma caused by substandard services. The Ockenden review examined over 700 maternity cases with poor outcomes, including stillbirth, severe perineal trauma, or major haemorrhage, among more than 41,000 births between 2020 and May 2025. The Amos inquiry also found persistent inequalities, overt racism, and continuing reports of trauma within the system.

Despite these alarming findings, regular national surveys conducted by Oxford University report high and relatively stable rates of overall satisfaction with maternity care between 2006 and 2024. This apparent contradiction suggests that while many women report positive experiences, a significant minority suffer severe harm. The overall rate of maternal death in the UK was 20% higher in 2022-2024 compared to 2009-2011, according to the National Perinatal Epidemiology Unit at Oxford University. This increase in mortality has occurred alongside rapidly rising obstetric intervention rates, with labour induction increasing from about 20% before 2010 to more than 34% by 2020, before slightly reducing. These piecemeal initiatives have produced unintended consequences, potentially displacing resources and overlooking the fundamental need for skilled care, information, and trusting relationships between women and their maternity teams.

In response to these findings, Home Secretary Yvette Cooper has announced the formation of a national maternity and neonatal taskforce, which she will chair. Cooper has expressed a personal commitment to introducing a new national maternity commissioner and has stated her intention to "put the cradle back at the heart of the NHS." The taskforce has been challenged to deliver the recommendations of both the Ockenden review and the Amos inquiry. These recommendations include a fundamental reset of the relationship between services and women and families, ensuring that women, families, and frontline staff have real influence over how services are designed, delivered, and monitored. The taskforce must be bold enough to redefine what NHS maternity services can and should provide and negotiate for the resources required to implement these changes.

The consequences of failing to act on these recommendations are severe. The future health and wellbeing of the population depends on the taskforce's ability to implement radical whole-system change. The Amos inquiry's conclusion that nothing less than this level of transformation is required underscores the urgency of the situation. The taskforce faces the challenge of addressing not only the clinical outcomes but also the cultural issues within maternity services, including the undermining and villainising of midwives. For women and babies to be safe, all staff must work in supportive, well-managed, and adequately resourced environments. The political, professional, and media debate must not deflect attention from the central priority: delivering safe and equitable care based on robust evidence and genuine partnership with women and families.