John Oxley: The one thing worse than the state of NHS Maternity care is their inability to be honest about it

John Oxley is a consultant, writer, and broadcaster. His SubStack is Joxley Writes.

There was plenty to be shocked by in Baroness Amos’ update on her review into NHS Maternity Care.

Across multiple NHS trusts, she has so far found stories of dirty wards, neglectful care and discrimination against mothers from marginalised backgrounds. The report reinforces the impressions from other inquiries into specific trusts, where poor quality has led to lasting harm, even deaths, among mothers and babies. The review aims to provide effective, lasting recommendations for an area of the health service that is far from good enough.

It is vital work.

Maternity and neonatal care are among the most important things that the NHS does.

It is an obviously critical time for new mothers and their children, when the medical stakes can be high, and it is essential to receive the best care we can provide. Getting it wrong can mean real tragedy for people who should be anticipating one of the best parts of their lives. More than that, as a country, we want to encourage people to have more children, and difficult pregnancies with poor care tend to discourage women from trying again. Getting this right is a fundamental part of having a well-functioning state.

That the situation has got so bad, however, exemplifies one of the most alarming parts of the investigation- the NHS’s own inability to face up to its failings. Even at this preliminary stage, there is a clear indication that matters have worsened, as the organisation struggled to be honest about its failings. Baroness Amos herself spoke of repeatedly encountering instances in which the NHS “marked its own homework”, and trusts failed to admit, let alone confront or improve, poor behaviour.

Other investigations have already demonstrated this. When Nottingham University Hospitals (NUH) NHS Trust investigated the death of a newborn in their care, they concluded that “no obvious fault” had occurred. Following a challenge by parents, an external review found more than a dozen failings and that the loss of the child had been preventable. Further investigations by the Care Quality Commission found “limited evidence of managers monitoring the effectiveness of care and treatment and driving improvement”.

This pattern has been repeated across several now-infamous hospital trusts. Leeds maternity hospitals are being investigated after more than fifty potentially preventable deaths of children. Shrewsbury and Telford Hospital Trust is excluded from the Amos Review, as a police investigation is considering the “catastrophic failings” which may have led to the deaths of up to 200 babies. In each of these cases, it appears that parents’ concerns were dismissed, and the situation worsened because the NHS failed to properly investigate, acknowledge, and correct its own errors.

Such failings can be a tendency in big organisations. A sense of defensiveness proliferates. Where mistakes are made, rather than being treated as an opportunity for candid learning, they become an exercise in dismissal. This approach is partly motivated by fears of litigation liability, but it extends beyond that. It is bred from a place of complacency and arrogance, where the people in service think only of protecting their reputations and of failing to admit their own mistakes.

The maternity scandal is a devastating example, but there are others across the British state. Perhaps the most high-profile now is the Post Office scandal. Here, those at the top not only failed to accept that their system might be wrong but also continued to deny the problem even when the evidence was clear and aggressive. As ever, the ultimate result was a far larger and more devastating scandal, but one that was known only in full because of the persistence of those who had been wronged.

As the Conservative Party seeks to rebuild its position on public services, we should be prepared to confront this. Fixing these mistakes ought to be a natural issue for us. We care about waste in public services – and errors like this are often hugely costly. We are also prepared to confront vested interests, including parts of our civil service that downplay mistakes at the expense of serving the public.

More than that, it is a matter of personal freedom. Bureaucratic services and state functions should be accountable to the people who use them. The rights of the individual service user should never be subsumed to the reputation of the NHS or other bits of the state. A culture that suggests we should simply accept failings rather than properly criticise and learn is a rotten one that elevates the state’s infallibility above individuals’ rights.

Through our fourteen years in power, this was one of the things we tried to do well. As Health Secretary, Jeremy Hunt advocated greater accountability and candour regarding errors in the NHS. Progress was made, but as these current scandals show, it didn’t go far enough, and much of the good work was derailed by the pandemic. His push for patient safety was a good instinct and an approach we should resurrect as both fiscally and socially responsible.

Our approach, however, should go beyond that and refocus on the relationship between individuals and these bodies. The party should talk about choice again and how it empowers citizens rather than the system. We should talk more about making our public services accountable, especially when they go wrong. We should aim to foster a culture that embeds and sustains continuous improvement, rather than treating end users as a nuisance.

Ultimately, rebuilding trust in services like maternity care requires more than technocratic fixes or the creation of new review bodies. It requires a shift in incentives and culture. At present, too many public institutions assume that protecting the organisation is synonymous with serving the public. The opposite is true: only institutions that confront their weaknesses can hope to improve. That means encouraging staff at every level to speak up, rewarding leaders who admit problems early, and ensuring that investigative bodies are genuinely independent and empowered to pursue the truth rather than defend the system.

There is also a political dimension. If the public is to believe that government can deliver competent, humane services, ministers must be willing to challenge entrenched assumptions — including the idea that the “system knows best”. A more plural, open model in which users have genuine choice, and where performance is measured against outcomes rather than intentions, would do more to improve services than any number of press releases or reorganisations.

This should be a Conservative position, favouring the individual over the state.

The scandals in maternity units are not merely stories of individual tragedies; they are warnings about the consequences of institutional complacency. It is right that the government is investigating them, and we should support efforts to fix the problems. We should also be inspired to take them further. A party serious about renewal should treat them as the impetus for a broader, long-overdue shift towards openness, accountability, and the unglamorous work of getting essential services right.