Maternity services in England

NHS maternity services provide good outcomes and positive experiences for most women, but there are significant and unexplained variations in performance around the country, according to today’s report from the National Audit Office.

Since the Department’s 2007 Maternity Matters strategy, there has been improvement in maternity services, with more midwifery-led units, greater consultant presence on labour wards, and progress against the government’s commitment to increase midwife numbers. However, there is wide variation between trusts in performance in respect of quality and safety, cost and efficiency.

The Department did not fully consider the implications of delivering the ambitions set out in its strategy. The Department has failed to demonstrate that it satisfactorily considered the achievability and affordability of implementing the strategy, and it has not regularly or comprehensively monitored national progress against it.

Today’s report points out that, in 2011, one in 133 babies was stillborn or died within several days of birth. The mortality rate has fallen over time, but comparisons with the other UK nations suggest scope for further improvement. The performance of individual trusts in relation to rates of complication and medical intervention varies widely. Litigation in maternity care is rising. Trusts paid £482 million for maternity clinical negligence cover in 2012-13, equating to around a fifth of spending on maternity services.

Increasing the presence of consultants on labour wards may result in better decision-making and outcomes. The level of consultant presence has substantially improved but over half of maternity units (including all of the largest units) do not meet recommended levels.

The number of midwives has increased but the NHS is not meeting a widely recognised benchmark of one midwife to 29.5 births. The government has commissioned more places to study midwifery, but it is unclear whether these will be enough to meet future demand for maternity care. Meeting the benchmark would require around 2,300 additional midwives nationally.

In 2010, 84 per cent of women reported that the care they received during labour and birth was excellent or very good. In terms of choice of place of birth, 79 per cent of women are currently within a 30-minute drive of both an obstetric and midwifery-led unit, compared with 59 per cent in 2007. However, choice is restricted where units have to close because of a lack of physical capacity or midwives. Over a quarter of units closed for half a day or more between April and September 2012.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Modelling of maternity services in England

“NHS maternity services provide good outcomes and positive experiences for most women during a very important time in their lives. Since the Department of Health’s 2007 strategy, there have been improvements in maternity services, but the variation in performance across the country, and our findings on how services are being managed, demonstrate there is substantial scope for further improvement.The Department’s implementation of its strategy has not matched its ambition."

Amyas Morse, head of the National Audit Office, 8 November 2013

Notes for Editors

694,241
Live births in England in 2012

£2.6bn
Cost of NHS maternity care in 2012-13

1 in 133
Babies are stillborn or die within 7 days of birth

87 per cent
Of women gave birth in obstetric units in hospital in 2012

84 per cent
Of women reported that the care they received during labour and birth was excellent or very good in 2010, compared with 75 per cent in 2007

£482 million
Cost of maternity clinical negligence cover in 2012-13

12 per cent
Increase in the number of midwives since 2007

2,300
Shortfall in midwives in 2012, calculated using a widely recognised benchmark of 29.5 births per midwife per year

152
Midwifery-led units in June 2013, an increase from 87 in April 2007

79 per cent
Of women are within a 30-minute drive of both an obstetric unit and a midwifery-led unit, compared with 59 per cent in 2007

28 per cent
Of maternity units reported that they closed to admissions for half a day or more between April and September 2012

  1. Press notices and reports are available from the date of publication on the NAO website, which is at www.nao.org.uk. Hard copies can be obtained from The Stationery Office on 0845 702 3474.
  2. The National Audit Office scrutinises public spending for Parliament and is independent of government. The Comptroller and Auditor General (C&AG), Amyas Morse, is an Officer of the House of Commons and leads the NAO, which employs some 860 staff. Our studies evaluate the value for money of public spending, nationally and locally. Our recommendations and reports on good practice help government improve public services, and our work led to audited savings of almost £1.2 billion in 2012.

Contact

Angharad Thomas
Direct line: 020 7798 7208 Mobile: 07985 274421 Email: pressoffice@nao.gsi.gov.uk

PN: 62/13