By Lorin Lakasing, author of “Delivering the truth: Why NHS maternity care is broken and how we can fix it together”
The UK’s maternity services are not in great shape. As is the case with the NHS in general, headlines and political posturing often include the word crisis. The usual suspects are underfunding, understaffing, and lack of proper training, but we somehow keep missing a key issue: we have created a system where the people with the most knowledge and experience—frontline clinicians—are systematically ignored. We also fail to see the causes of a perfect storm that’s driving experienced staff from the profession, making care less safe.
The frontline staff: Blamed but not heard
Walk into any maternity unit and you’ll find midwives and obstetricians working under impossible conditions. They’re managing multiple high-risk cases simultaneously, following protocols that change all too often, and doing it all whilst knowing that one mistake—or even one perceived mistake—could lead to damaging or unfair criticism.
The pressure has transformed how care is delivered. Where once clinical judgement guided decisions, now it’s tick-box exercises and defensive medicine. Staff follow rigid protocols not because they improve outcomes, but because they believe they will provide protection when things go wrong.
The managers: Building bureaucracy instead of better care
For three decades, NHS managers have responded to every crisis the same way: more protocols, more paperwork, more processes. Each national inquiry produces recommendations that sound sensible in Whitehall but create chaos on the ward.
The Care Quality Commission ratings system exemplifies this dysfunction. Trusts pour resources into achieving “Outstanding” ratings, creating entire departments devoted to compliance and data collection. But ask any frontline clinician whether these ratings correlate with actual care quality, and you’ll get a bitter laugh. Units can achieve top ratings whilst haemorrhaging experienced staff and failing patients daily.
The financial incentive schemes are even worse. Managers chase targets that boost funding but may not actually improve patient outcomes. They restructure services based on spreadsheets rather than clinical need. They introduce “efficiency savings” that invariably mean fewer staff doing more work with less support.
Consider how maternity services have been reorganised repeatedly over recent years. Each restructure promises to “streamline” care and “enhance patient experience”. In reality, they disrupt established teams, break relationships between staff and communities, and create confusion about who’s responsible for what. The only consistent outcome is more middle management posts to oversee the chaos.
The service users: When Google becomes more trusted than your doctor
Here’s an uncomfortable truth: patients aren’t passive victims in this crisis. The rise of online health forums and social media groups has created parallel healthcare systems where misinformation spreads faster than evidence-based advice.
These online communities are seductive. They offer certainty where doctors hedge, emotional support where NHS services feel cold, and offer validation where medical professionals express concern. They’re available 24/7, never judge, and always have someone who’ll tell you exactly what you want to hear. And they can be dangerous.
They can promote ideologies with no evidence base, discourage necessary medical procedures, and create unrealistic expectations about what’s possible and safe, framing normal pregnancy anxiety as intuition that trumps medical expertise.
The media and politicians: Fanning the flames
Overlay these three groups (frontline staff, managers, and service users) with a media that thrives on conflict and politicians who exploit it. Every maternity tragedy becomes front-page news, with coverage following a predictable pattern.
Journalists interview bereaved families, letting raw emotion drive the narrative. They might include a defensive statement from the Trust’s communications team. They rarely, if ever, speak to frontline staff. The complex reality—understaffing, impossible protocols, patients who refused advice—gets reduced to “gross failures” and calls for “lessons to be learned”.
Politicians then wade in, promising “full investigations” and “accountability”. They name and shame supposedly failing units, causing pregnant women to panic and attempt transfers to other hospitals, overwhelming those services in turn. They announce new targets and inspection regimes that sound tough but simply add to the bureaucratic burden without addressing fundamental problems.
What they don’t do is ask hard questions about why women trust internet strangers more than medical professionals. They don’t examine how their own policies created the conditions for tragedy. They certainly don’t commit to the long-term, cross-party consensus needed for real reform.
Breaking the spiral: What needs to happen now
Solutions exist, but they require honest acknowledgement of how we got here and genuine commitment to systemic change.
First, we must start listening to frontline staff. Not through tick-box consultations or staff surveys that disappear into management reports, but genuine engagement about what’s going wrong and how to fix it. These people know where the problems lie. They see every day what works and what doesn’t. Yet they’re the last people anyone asks.
Second, we need to fundamentally restructure how maternity services are managed. Strip away the layers of bureaucracy. Abolish targets that don’t directly relate to clinical outcomes. Stop reorganising services every few years based on political whims. Put clinicians back in charge of clinical decisions.
Third, we must rebuild trust between patients and professionals. This means consistent care from professionals who have time to build relationships. It means honest conversations about risk that don’t get overruled by patient demand or management pressure. It means acknowledging that whilst patient choice matters, clinical expertise matters more when lives are at stake.
Fourth, politicians need to take NHS maternity services out of the electoral cycle. Jeremy Hunt’s initiative to reduce stillbirths was unusual in that the policy was designed to potentially outlive his tenure because reducing the stillbirth rate (the UK has one of the highest in the developed world) mattered more than political credit. We need more of this long-term thinking, preferably through cross-party agreement that survives changes of government.
Finally, we need public education about pregnancy and birth that’s based on evidence, not ideology. The online forums aren’t going away, but we can provide better alternatives. We can teach critical thinking about health information. We can be honest about what the NHS can and can’t provide, rather than making promises we can’t keep.
ABOUT THE AUTHOR
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, revealing the reasons why major stakeholders in this vital service have inadvertently been encouraged to pursue different agendas, and how that has made effective, collaborative working towards optimal clinical outcomes almost impossible.