Submission to the Health and Social Care Committee inquiry into the safety of maternity services in England

Despite the pressures facing the health and care system, and its staff, over the last few years, quality overall has in most cases been maintained and most people have a good or excellent experience of care. However, we note that there is variation between trusts in the quality of maternity care, the drivers of which need to be better understood and fully addressed.

We understand from trusts that although there is considerable scope for improvement, good progress is being made in maternity care; recommendations from the inquiry could therefore helpfully add value to existing improvement programmes locally and nationally.

Trusts tell us how important meaningful patient engagement has been in successful maternity improvement. We are hopeful the forthcoming introduction of Patient Safety Partners, part of the National Patient Safety Strategy, expected next year will further embed and build on this.

It would be helpful for the inquiry to explore how systemic barriers such as the mismatch between demand for services and the available funding and workforce capacity, can impact on safety.

The NHS has rightly been developing a learning culture but despite progress and commitment from providers, a blame culture arguably still exists within the NHS. Compassionate and inclusive leadership from provider boards remains fundamental in addressing this but positive behaviours must also be modelled at all levels of the system including by national and regional bodies. NHS Providers recognises the value of ‘just culture,’ however the definition used across all policy needs to be aligned, for example in the National Patient Safety Strategy and We are the NHS – the People Plan.

HSIB’s role should be to develop independent, expert-led analysis of the contributory factors behind patient safety incidents in healthcare and why they recur, by gaining a systemic view and supporting high standards in local investigations. In our view, the role of HSIB would therefore complement local learning and trusts’ efforts to support continuous learning and improvement as well as to meet their obligations to staff and patients.

We welcomed the proposal that maternity investigations will return to the NHS next year, as there has been a risk within these specialist investigation programmes that the role of HSIB could prevent trusts from fulfilling their current responsibilities and implementing the learning following a serious incident. Any long term move for investigations to be led by an external body may damage trusts’ ability to remain accountable for the quality of care provided by their organisation.