Education

by Lorin Lakasing, author of Delivering the truth: Why NHS maternity care is broken and how we can fix it together

Soon after his appointment as Health Secretary, Wes Streeting described NHS maternity care as a “cause for national shame”. He promised regular meetings with bereaved families, ordered a rapid investigation and appointed Baroness Amos to chair it. These promises sound compassionate and decisive. But they’re also precisely the kind of promises that have prevented real improvement in maternity services for decades.

The tragedy is that politicians know this. They understand that real reform takes time. But the political incentives push them towards theatrical gestures rather than the tedious groundwork needed to effect real change. Worse still, each new government feels compelled to revise or rebrand their predecessor’s initiatives, ensuring that even well-intentioned reforms never have time to embed properly.

When politicians get it right

Occasionally politicians put clinical outcomes before credit. Jeremy Hunt’s stillbirth reduction initiative stands out precisely because it was designed to outlive his tenure as Health Secretary.

The UK had one of the highest stillbirth rates in the developed world – a genuine cause for national shame. The vision was good but unfortunately remained unachieved because resources were spent on implementing processes rather than on frontline care where the action to achieve results really talks place. But it got closer than most.

A non-maternity example is the introduction of the NHS itself in 1948 which was a cross-party achievement that took years to implement. Aneurin Bevan knew he was creating something special that would take decades to mature and admitted from the outset that it would need tweaks along the way, something that many have forgotten when we discuss the NHS today. The political consensus that created and sustained the NHS through its early years is exactly what’s missing now.

Learning from others

Politicians seem quick to cite but slow to understand successful global healthcare models. For example, the Nordic maternity outcomes – amongst the best in the world – were not achieved through naming and shaming units or constant reorganisation. It was through boring and consistent work across political divides. Norway invested in continuity of care models where the same midwife plans tailored care and works with women through pregnancy, birth and postnatal care. This took years to implement and required significant restructuring. But they stuck with it through multiple governments because they agreed the evidence supported it, regardless of who proposed it.

Similarly, Finland’s maternity package system, also known as the ‘baby box’, introduced in 1938 and refined continuously since. Every pregnant woman receives a box containing essential items for their baby, but more importantly, they only get it if they engage with maternity care from early in gestation and attend regularly throughout the pregnancy. This simple intervention, sustained across eight decades and countless governments, helped Finland achieve one of the world’s lowest maternal and infant mortality rates.

More recent examples include New Zealand which restructured midwifery care in the 1990s to allow for autonomous midwifery practice which was controversial, took years to implement, and required sustained cross-party support. Or Estonia where maternity services were transformed after independence and the country now boasts better outcomes than the UK despite spending less per capita.

The key? Political consensus that maternity care programmes should transcend party politics. No incoming government scrapped them to make their mark. No opposition attacked them for political gain. They understood that consistency mattered more than credit.

The cross-party solution

Here’s what should really shame politicians. We’re not facing unique challenges. We’re not poorer than countries with better outcomes. We just refuse to learn from them and implement what works because it doesn’t fit our political culture.

What the NHS needs – and what many of my frontline colleagues advocate – is to take maternity services out of the political cycle altogether. Create a cross-party commission responsible for long-term strategy. Basic healthcare shouldn’t swing wildly based on electoral results.

This isn’t unprecedented. The Low Pay Commission, which sets minimum wage rates, operates across party lines with remarkable success. The Office for Budget Responsibility provides independent economic forecasting that all parties accept. The Committee on Climate Change shapes long-term environmental policy beyond electoral cycles.

A similar body for NHS maternity services could see politicians from all parties working together, advised directly by practising clinicians.

We need to move away from partisan politics and the pointless bureaucracy this promotes because this approach has not served us well.

Practical steps politicians could take tomorrow

If politicians genuinely want to improve maternity services rather than just appearing to, here’s what they could do immediately:

First, establish a cross-party agreement that maternity services are off-limits for political point-scoring and establish cross-party governance of the NHS with direct input from frontline clinicians.

Second, commit to ten-year minimum timescales for major reforms. If you’re restructuring teaching, training, teamwork, introducing clinical safety strategies that are fit for purpose, implementing effective staff management, and risk profiling patients properly, this will take decades to embed before results can be evaluated or processes altered purposefully.

Third, take advice from global healthcare models with better outcomes and check if this can be applied to the NHS model. Recognise that changes in practise can only be achieved through education and support, typically by senior colleagues in active practice not by directives e-mailed to shop floor staff sent by managers working from home.

Fourth, create ring-fenced funding streams for frontline maternity services that can’t be raided for managerial processes.

Fifth, recognise that change for the sake of change wastes resources and concentrate on implementing ones that are of proven value instead. Conversely, it is important to find the courage to abolish those that have not proven their worth.

Real political courage isn’t promising bereaved families that you’ll fix everything quickly. It’s admitting you can’t. It’s explaining that meaningful change takes decades, that you’re starting work others will finish, that you need their patience rather than their votes.

Politicians can either continue the current approach – theatrical debates, impossible promises, constant reorganisation – and watch maternity services deteriorate further. Or show genuine leadership by admitting the political system itself is part of the problem because it forces the service to be constantly re-organised in a way that is not necessarily beneficial to patients.

Families deserve better than political theatre and NHS maternity services don’t need more political promises. They need politicians with the humility to learn from others, the courage to commit to long-term solutions, and the integrity to put mothers’ and babies’ lives before their political careers.

The current approach isn’t just failing to improve maternity services, it’s actively preventing the implementation of strategies that could save lives. And that truly is a cause for national shame.

Dr Lorin Lakasing is an NHS consultant in obstetrics and fetal medicine. She draws on her 30 years of clinical experience in maternity care to give an insider’s view of the current worrying situation and its development, and suggests how we might move towards the safe, effective NHS maternity service that everyone deserves. Her latest book, ‘Delivering the truth: Why NHS maternity care is broken and how we can fix it together’ is about the stories behind the headlines.

For further information please visit www.lorinlakasing.com/publications.html