Background

Multiple inquiries and reports into England’s maternity services have identified areas that require action and improvement across government and the NHS. These include The Morecombe Bay Investigation in 2015 (Kirkup, 2015), The Ockenden Review in 2020 (DHSC, 2022a), The East Kent Review in 2020 (DHSC, 2023), and the ongoing independent review of maternity services at Nottingham University Hospitals (Ockenden Maternity Review, 2022). Lord Darzi’s Independent investigation of the NHS in England described maternity care as being “a succession of scandals and inquiries” (Darzi, 2024).

There have been a considerable number of regulatory, policy and guidance frameworks focused on maternity services in recent years, all aiming to improve services and reduce inequalities in care.[1] The Three-Year Delivery Plan for Maternity and Neonatal Services (NHS England, 2023), looked to consolidate earlier work and brought together four key themes: listening to women and families with compassion, supporting the workforce, developing and sustaining a culture of safety, and meeting and improving standards and structures. Most recently, NHS England published their ‘patient safety healthcare inequalities reduction framework’, which sets out 5 principles to reduce patient safety healthcare inequalities across the NHS to support trusts and their staff in fostering a culture of safe, inclusive care (NHS 2025).

NHSE also previously identified maternity in its Core20PLUS5 framework as one of five clinical priorities. The aim was set out for NHS trusts, foundation trusts and systems to “ensure continuity of care for women from Black, Asian and minority ethnic communities and from the most deprived groups. This model of care requires appropriate staffing levels to be implemented safely” (NHS England, 2021a).

Nevertheless, the Care Quality Commission’s (CQC) most recent national maternity inspection programme found that 47% of services required improvement or were inadequate (CQC, 2024). CQC has raised safety concerns around lack of training, limited engagement with communities, ability to conduct risk assessments, and lack of challenge among senior leadership – which has led to the “normalisation” of poor care (CQC, 2024). Elsewhere, the regulator has highlighted inequalities in maternal outcomes, identifying that black women have the highest rate of readmission to hospital during the six-week postpartum period (CQC, 2022).

Trusts have undertaken a great deal of work to improve care within maternity services in light of recommendations from independent reviews and policy guidance. This includes the development and implementation of Equity and Equality Action Plans (NHS England, 2021b), alongside system partners in their Local Maternity and Neonatal System (LMNS). However, we know that variation between trusts remains and the drivers of this need to be better understood and fully addressed.

In 2024, the National Institute for Health and Care Research (NIHR) launched a ‘challenge’ funding call focused on finding new ways to tackle maternity disparities, which brings together a diverse research consortium (NIHR, 2024). This work will provide vital information and evidence to inform decision making and best practice to improve the quality of maternal and neonatal care. There is clear benefit in aligning any government policies and interventions with the outputs of this research to ensure a cohesive and coordinated approach to developing evidence-based maternity care. We expect NHSE to publish a set of interventions aimed at improving equity and equality in maternity services later this year (Hansard, 2025), which we hope will pursue an evidence-based approach and which will support the broader goals of the 10YHP.

We are also mindful of the potential impact of the continued changes to the operating environment and ongoing financial constraints for trusts and systems. Recent reports have indicated that ring-fenced funding for maternity improvements has reduced from £95m overall in 2024-25 to just £2m for 2025-26, with the remaining amount being absorbed into total ICB baselines (Launder & Anderson, 2025). We and other stakeholders are concerned that these cuts will damage work to improve maternity services, with the Royal College of Midwives (RCM) calling the cuts “shocking”, noting that “these cuts go against the Government's very own commitment to reduce inequalities and poor outcomes for Black, Asian and minority ethnic women” (RCM, 2025).

[1]These have included Better Births Programme (National Maternity Review, 2016), The NHS Long Term Plan (NHS England, 2019a), Saving Babies Lives Care Bundle (NHS England, 2019b), the Maternity Transformation Programme (NHS England, 2024a), NHS Patient Safety Strategy (NHS England, 2024b), and most recently the Three-Year Delivery Plan for Maternity and Neonatal Services (NHS England, 2023). In 2020, NHS England (NHSE) provided a package of additional support for black, Asian and ethnic minority women in response to evidence that these women were more likely to be admitted to hospital with Covid-19 during pregnancy (NHS England, 2020). Local systems were tasked with developing Equity and Equality Action Plans (NHS England, 2021b) to outline how the they will improve maternity and perinatal services in their region. Commitments within the Women’s Health Strategy for England stated an aim for the NHS to be “the best place in the world to give birth through personalised, individualised, and high-quality care” (DHSC, 2022b). Alongside this, the government’s manifesto committed to setting an “explicit target to close the black and Asian maternal mortality gap” (Labour Party, 2024).

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