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Insufficient maternity training putting mothers and babies at risk, finds report

Mother holding baby's hand.


NHS trusts are delivering less maternity training – including around reducing avoidable harm and death – than they did three years ago, a report has found.

The report from UK maternity charity Baby Lifeline based on 124 maternity units in England, published today, found 97% said there had been signficant barriers to training – such as staffing, venue ability and inadequate IT to access online training – since the Covid-19 pandemic began.

It noted that the average spend on maternity training was £34,290 in 2020/21 compared to £59,873 in 2017/18, with NHS trusts delivering less training to staff than in 2017/18.

The report authors said: ‘This is a worrying decline, because training is a central recommendation for improving safety in maternity services in most reports investigating avoidable harm in maternity and the deaths of mothers and babies.’

They also discovered ‘patchy’ training related to avoidable deaths and harm, with fewer than one quarter of maternity services providing all the training outlined in the Saving Babies’ Lives Care Bundle, which was introduced in 2019 to reduce stillbirths and neonatal deaths.

In addition, one in four trusts did not consider the needs of the local population when deciding training priorities – despite University of Oxford research from 2015 showing risk factors for mother and baby death include deprivation, maternal age and ethnic group.

The report authors called for government funding for the direct costs of training including staff backfill, and investment in systems and infrastructure to allow training to take place.

It also said workforce shortages across maternity services must be fixed, with the Royal College of Midwifery estimating that the NHS in England is short of 2,000 midwives.

Other recommendations to keep mothers and babies safe included:

  • Nationally agreed specification of ongoing training competencies for all staff, the compliance of which is externally validated or nationally.
  • Maternity services should use local population data to determine clinical and social risk factors and determinants of health, which should then guide their training priorities.
  • A nationally agreed method of monitoring training, and an auditing system developed to support professionals on the frontline to collect and utilise the data easily.

Judy Ledger, chief executive of Baby Lifeline, said: ‘How many more reports into maternity services with similar findings will there be, and how many more families have to suffer, before we see the changes we need? 

‘Time and again evidence shows that training investment can save lives, and the pandemic has widened existing, detrimental gaps that years of chronic under-funding and staff shortages have created.’

Earlier this year, NHS England and Improvement announced a £95m investment to make maternity in England safer after the care scandal at Shrewsbury and Telford Hospital Trust.

This came in response to an independent inquiry into maternity failings at the Shropshire hospitals, launched in 2017 and led by midwife Donna Ockenden, which is looking into 1,862 cases, including preventable infant fatalities, mostly between 2000 and 2019.

The review’s first report, published last year, identified seven ‘immediate and essential actions’ to improve maternity care, including staff training together and listening to the views of women.