New Sands and Tommy’s report calls for better board oversight of NHS maternity services

NHS Trusts should review the way they monitor the quality of their maternity services, according to a new report from the Sands and Tommy’s Joint Policy Unit.

The report says information presented to NHS Trust boards about maternity services is inconsistent and risks being a ‘tick-box exercise’ that does not help identify problems or effective ways to improve performance.

Researchers from the Joint Policy Unit looked at publicly-available board papers from seven NHS Trusts in England.

They found significant differences in the type of information presented to boards, whose members are responsible for the safety and quality of maternity and neonatal services in each trust.  

Some boards were not given the ‘key metrics’ which NHS England suggests are needed to provide an overview of maternity and neonatal service performance.

Board members were often presented with large amounts of information that was hard to digest and there was not enough analysis to help them understand if services were deteriorating or failing to meet the required standards.

The report, Better board oversight needed to save babies’ lives, concludes: “This review raises questions about Trust boards’ ability to deliver the level of oversight and scrutiny that is currently expected of them.”

It recommends that each NHS trust reviews its processes and systems, and calls for:

  • More transparency, with a warning that “too often boards appear to seek comfort from reports rather than encouraging open and honest reporting of problems”;
  • Better communication between board members and those involved directly in delivering clinical services;
  • A review of the maternity incentive scheme, which rewards trusts that can demonstrate they have met ten ‘safety actions’, to ensure it doesn’t encourage boards to prioritise ‘financial certainty and reputation management over a culture of learning and improvement’.

Georgia Stevenson, Data Evidence Lead for the Joint Policy Unit, says:

"The shocking and distressing stories emerging from the Lucy Letby case in August 2023 shone a light on the “cover-up culture” in the NHS. Although deliberate harming of babies is thankfully exceedingly rare, some of the issues raised in this case echo concerns that Trusts are failing to react to signs of poor performance in maternity and neonatal services.

"Our research raises serious questions about whether the current systems and processes enable NHS Trust boards to deliver expected oversight of maternity and neonatal service performance. Boards need clear and consistent data to enable effective scrutiny and early action to mitigate any issues identified.

"There needs to be a review of governance systems and collective effort to define what a more effective system of oversight and support which prioritises patient safety could look like."