The Maternity Catastrophe
A national disgrace, the systemic and repeated failure of maternity care should make anyone with a heart angry but fixing it will be a super human challenge.
There’s something about that football competition after the main piece and there are a few words of sadness at the end. Enjoy is probably not the right term, but do try.
I started to write a piece on the Amos and Ockenden reports on maternity services a couple of weeks ago but reading the reports made me far to angry turning my output into a stream of invective. Pointing out the obvious, that if men had babies1 this stuff wouldn’t have got into such a mess, was about the only piece of the bleedin’ obvious I could make stick.
Valerie Amos is as solid a citizen as we have. The cabinet will mean what they say on improvement and that things must change. What makes me angry is all that sincerity will almost certainly fail as it is up against an ingrained culture in a medical backwater. Yet as Donna Ockenden rightly states these really are matters of life and preventable death:
“A civilised National Health Service will be judged not only by the excellence it achieves, but by the harm it prevents. In maternity care, where trust is absolute and vulnerability acute, failures carry consequences measured across lifetimes.”2
Difficult read, more difficult change
Valerie Amos report on maternity services3 is a difficult read. Alongside Donna Ockenden’s recent report on Nottingham University Hospital’s maternity services 4they reveal a breathtaking series of failures and a near conspiracy of lies and deception covering up failings of staff, bureaucracy, and governance. Neither is any of this new. Previous national reviews and inquiries into individual hospitals, including another by Donna Ockenden into Shrewsbury and Telford Hospital’s maternity services5 have revealed gaping holes in the standard of care women should reasonably expect in a wealthy, developed country and a health service with innovative care and fantastic breakthroughs in treatment under its belt.
I have heard it said of the Ockenden report that a logical response would be to shut down the Nottingham facility and start again. A reasonable thought, given the string of avoidable human tragedies documented, the only problem being that women in Nottingham are still likely to get pregnant and will have to go somewhere.
But this hypothetical dilemma is at the heart of the response for which Valerie Amos calls. To succeed her recommendations require wholesale changes in attitudes, culture and process. I do not diminish the importance of maternity services by saying that some of the problems documented are not specific to maternity, but are symptomatic of a wider, deeply embedded NHS culture that requires change. Were I saying this as a male interested in public policy I could be thought to be widening the issue to muddy the waters. As it is, however, it isn’t just me. Justine Roberts6, the founder of Mumsnet, sums it up perfectly:
“It is the same handful of experiences repeating across every specialty, every region and every life stage…
“… The Government’s response to Amos is welcome as far as it goes: a Maternity and Neonatal Commissioner, £41 million for facilities, new triage standards, a National Action Plan due in December. But every one of those is a structure, and structures are the thing we’ve never been short of. Culture is what happens in the gaps between structures. It’s whether a woman who says “this pain isn’t normal” gets investigated or patted. It’s whether a midwife who raises the alarm is thanked or briefed against. It’s whether trust directors turn up to the inquiry or, as in Nottingham, half of them simply don’t bother.”
Dealing with a rogue department or three is one thing, re-inventing an NHS culture that ‘does things TO people’ toward one that ‘does things WITH people’ is quite another. So while I very much hope we see that tiring cliché ‘real change’ I am sceptical partly because of the globally change requirement and also because of several other NHS realities. As Justine Roberts puts it:
“If reports and frameworks saved lives, English maternity care would be the safest on earth. But the problem in the NHS isn’t the frameworks, it’s the culture, and at the heart of that culture sits one brutally simple fact: women are not believed.”
Just not sexy enough
Ironically despite in the great majority of cases starting with sex, maternity care really isn’t sexy. It is a ‘routine one-off’ episode from which a ‘natural’ recovery can be expected, in fact it’s not an illness as such. After all, if having children was all that complicated the species would have faded away long since, would it not? Childbirth is something that women just do, don’t they? Call the midwife and all that? Hot water and towels, etc, etc? No need for doctors and hospitals, just get one of those inflatable pools on off you go. Anaesthetic is for wimps – natural childbirth, that’s what women should do. As for the bit afterwards, well, you’ll get the hang of it. What’s all the fuss about?
I’m being ironic, in case you haven’t noticed, but reading these reports that’s the impression you end up with – calm down, it’s normal, women exaggerating – especially if they are black or asian.
Maternity for many women is their first significant experience of the NHS – the average age for a new mother in the UK is just under 30 and thus those women are less likely to have needed treatment for serious conditions and more likely to be healthy. A friend of mine said, “childbirth is like visiting New York – you can watch all the movies but nothing prepares you for the scale of the event”. Fair to say new mothers are less likely to know what to expect from NHS clinicians. It’s certainly true that for most people the breadth of their experience of the NHS increases with age. Well, it would, wouldn’t it – four of the five most frequent reasons for NHS treatment have an age-related element and the longer you live the more likely you will need treatment for one, other, or if you’re on a bad luck accumulator. all four: musculoskeletal conditions, cardiovascular, respiratory, and cancers. These are huge fields and command huge charitable focus, research budgets and governmental priority – they are ‘sexy medicine’. 20% of the UK’s total clinical research spend goes on cancer research – about £1 billion. Reproductive health and childbirth gets between 2% and 2.5% – about £112 million, of that pregnancy and maternity specific research gets roughly £51m. Or maybe look at it this way, for every £1 spent on clinical care for cancer 12p is spent on research, for cardiovascular care it is 7p, for maternity it is 1p.7 Just not sexy.
No reader could fail to gain the impression that neo-natal care would seem to be a massive inconvenience for the NHS, undeserving of priority, lacking in resources and not subject to the same targets, attention and marathon running from which the “big killers” benefit. When do you last remember coming across someone raising funds for their local maternity unit?
Anyway, it only happens to women. In creating the level of priority Valerie Amos’ report rightly demands runs against the culture, not only of NHS maternity care but of the entire NHS care structure with the teaching hospital consultant at the apex. Good luck with changing that.
Not listening to women rings true
The number one finding of Valerie Amos’s report is that women are not being listened to, their concerns are dismissed, they are told what’s happening to them is “normal”, and so on, even when it isn’t. Again, the detailed evidence is depressing, too often distressing, and much of it avoidable – if, that is, under resourcing is regarded as avoidable. If it was any one thing it would be a lot easier to solve the problem – money, sure, that’s a big thing, but it goes well beyond money into management cultures, staff attitudes, failure to understand different cultures, you name it. What’s wrong, just about everything.
Amos is systematic and thorough. Alongside much qualitative evidence some would doubtless dismiss as anecdotal. But the ‘anecdotal’ evidence chimes with individual experience. I have heard far too many ‘anecdotes’ from friends and family and a few I’ve witnessed directly for the reports to seem like someone else’s fantasy, in maternity and in the NHS in general. The Mumsnet collation of nearly 100,000 posts into their report “Medical Misogyny: a lifetime of failure”8 adds substantial weight to the argument, it is an awful lot to dismiss as annecdotal evidence.
Not listening to the patient is not unique to maternity services, but is all the more problematic when you are dealing with a seriously stressful, painful, personal, and emotional process and women who are in the main ‘inexperienced patients’. While I understand the need of staff in the NHS to protect themselves from ‘becoming too involved’ in a profession where death is a day to day reality it still amazes me that in a service dealing with people in vulnerable states there is a remarkable lack of people skills and basic empathy.
How does this come about? I’m not of the view that NHS Midwifery is populated by people who go into the profession hating the patients – but according to these reports and a few things I’ve seen and heard too many of the achieve and exhibit that mindset. Something happens. Understanding what happens and why is central to dealing with the problem. In a system where 12 hour shifts, four days a week, is somehow regarded as ‘normal’ and working contexts of organised chaos are routine empathy is extinguished.
What do we do to support those working in such a high stress, massively emotional environment? Not very much. How does the NHS prevent burn out? It doesn’t. Something tells me that sending people on a few courses and telling them to be nicer and less racist ain’t going to cut it.
Then the buildings make it even worse
What about the context in which these under funded, over burdened, ground down desensitised staff do their 12 hour shifts?
98 out of 100 births in the UK take place in hospitals. There are about 700,000 babies born in the UK each year – that’s about 1,900 a day (about 1,500 in England, around 77% of those in 155 Obstetric units - so about 7.5 babies per unit per day, roughly one of those will need some kind of specialist neo-natal care). Put that way it doesn’t sound too many, even though the patterns of demand are a great deal less even that a simple mean would indicate, it should not beyond a country like the UK to manage this level of demand. But this is not happening.
In a way even more depressing, these latest headline grabbers are by no means the first reports into maternity and neo-natal care. The 2025 Maternity and Neonatal Infrastructure Review9 looks at the state of buildings and equipment. Of the very many statistics, this one leapt out:
“Since the most recent version of the Maternity and Neonatal Health Building Note (HBN) in 2013, 35% of maternity and neonatal facilities have undergone some level of refurbishment work, of which 5% included a new build element. Following these improvements, survey results captured that 57% of the estate is compliant in all 4 safety areas of: electrical, water, fire safety and hazardous substances (COSHH).”
Which of course means that 43% don’t meet those standards, which in places that are meant to be safe environments is more than a little hopeless. This is specifically about buildings, which is bad enough, but when various damning statistics on staffing and resources are combined there is a 75% probability that a woman will receive maternity care in a manner which is in some way below the standard they might expect.
A quick glance at the easily available international comparative data and the UK doesn’t look terrible good. Maternal mortality in the UK is higher than most other European countries.10 Though rates vary from year to year, levels a consistently higher than Italy, France, Germany, and Spain. Infant mortality, though very low, is also generally higher than European neighbours.
As for recording events and circumstances of maternity episodes in a form that would be an effective basis for research, should it be funded, that would rely on effective, in-situ IT systems collecting useful data, rather than a lump of iron better suited to keeping a door open, but I’m repeating myself. Again.
This can’t go on, or can it?
I have already gone on long enough. Donna Ockenden’s first report found that better care at Shrewsbury and Telford might have saved the lives of 201 babies. Her report on Nottingham found 520 mothers and babies suffered avoidable harm of which 162 had died, yet half of the Trust’s senior directors refused to take part in the review. She has another report in progress on the Leeds Teaching Hospitals, oh and there were those by others at Morcambe Bay and East Kent, and the facilities stuff and Amos, and ,,,
There have been some serious people to hold the post of Health Secretary. Since the NHS was created five women have held the post covering 8 of those 78 years. Yvette Cooper, appointed this week by Andy Burnham,11 the only Prime Minister to have served as Health Secretary, is the sixth. Her agenda is vast, the challenges are enormous and who knows how long she will have in the job. But I’m certain she will sincerely want to see some movement in the right direction and change as well as good intentions. Whether she will get it: the evidence is not good, cultural change is necessarily a long term business, and despite the series of reports above and more, here we still are.
… it is now. At last.
It was far too long. For people who don’t do football – and there are quite a number, I know how you feel. Every summer Wimbledon lasts for about 100 days, grinding out tedium across the both the national broadcaster’s two terrestrial channels – and now they have lights and a roof there is no stopping it. So an inescapable 39 day football tournament, eleven days longer than the 2022 edition, I understand your pain and by the time the knockout stage started I was flagging.
Anyway, it’s all over now for another four years and what already presents is the prospect of an even more bloated, even more excessive, even more tedious competition where no sense of proportion is the norm and the idea that all this kicking a ball around is meant to be fun somehow slides away into the South Atlantic.
There is a view, held by F*** and also some people who aren’t greedy and corrupt, that the introduction of more African and Asian teams broadened the competition, brought in different styles, more well known and emerging players and so made for a better tournament, and thus is good for football. It’s a valid opinion and a reasonable point, however, to claim there is no downside is not credible. The point about Africa is entirely valid. At the previous tournament Africa had a mere five places, which, given the contribution of Africa players to the top leagues is a serious underrepresentation. But increasing African representation meant reducing elsewhere, which reduces income, so the only practical way was to expand the tournament. But the African sides performed poorly. Only Tunisia failed to get out of their group, but only Morocco and Egypt made the round of 16.
Overall the expanded tournament saw a marked drop in quality, in particular the marginal qualifiers from Asia and indeed UEFA: Sweden and the Czech Republic, to name but two, are terrible teams who squeaked in by the back door, Uzbekistan and Jordan added little other than bulking out a schedule already big enough.
Sure, there was the occasional exciting game between poor sides – that’s always true, but there were a lot more ‘who cares’ games and the unsatisfactory business of third place qualification created an extra round of 32 which really only got in the way. All of the third place qualifiers went out in the round of 32 with the sole exception of Paraguay who kicked their way through old school South American style against a bad German side having a bad night.
The only surprise package was Norway, but if you looked at their qualification record it should not have been a surprise. Norway are an average team with a few good players and one exceptional world-class centre forward. Any team with Erling Haarland would be likely to reach the last 16 and possibly the quarter finals.
So 64 teams, no thanks, though it has the virtue of avoiding the third place nonsense and what’s another 24 matches (and another 6-8 days)? But it would be back to 32 and a manageable World Cup for me, but it won’t happen because, well, money. I’ve come across some interesting stuff on qualification process, but it needs some processing, thus I’m going to return to it next time.12 What else was new?
Breaking the Laws
The changes to the laws of the game at World Cups affect the game down the line. As ever the changes and various refereeing directives produced mixed results.
Implicit in the changes aimed at quickening up play was an admission that the addition of more and more ‘added time’ for this reason or that introduced in 2022 had been counterproductive. Nobody liked adding 13 minutes are the end of the match, or 20+ minutes overall because it affects television schedules, transport networks, policing costs, stadium costs (staff time) and so on, plus it’s imprecise anyway and athletes end up playing routinely for longer – which is kind of OK at a World Cup somewhere warm but not so clever on the famed wet night in Thromso. The IFB and the F*** Refs found a fair sanction that deters – the basis of any effective law making, hand possession to the other team - simple. Less so for substitutions where the sanction is less clear, but overall it worked. Once the compulsory three minutes advertising break was factored out, games once again had sensible amounts of added time. The domestic leagues should follow suit – let’s see what happens. Sadly, I expect the ad/drinks break to stay in 2030 – it’s too nice an earner for F*** and Spain, Portugal and Morocco are not known for being cool in July.
The use of VAR was, despite the ongoing campaign from the BBC and noises from the likes of the Lineker podcast, greatly improved. Chips in balls and line technology by and large worked, making dodgy corner and out of play decisions fewer. Offside was fast and very largely correct with the law as it stands – i.e. contradictory and favouring defenders. And while some of the higher profile decisions still involved a wait and introduced an element of ‘re-refereeing’ and a degree of inconsistency, overall such decisions were fewer – the chatter, as ever, just focused on the worst decisions. It was always going to take time to get this right, by and large it is improving. Going back to where it all started, the game had become too fast, too skilled and the dark arts too smart for a single referee to manage without help. Viewers, managers, pundits demanded technology based solutions. Well, be careful what you wish for, but take it away and within weeks the very same rent-a-mouths would want it back.
Less clear, ‘letting the game flow’ and the standards of fair and unfair ‘contact’ in a contact sport. OK, so when a player goes down holding their leg and the contact was with the other one there is something murky afoot, and it happens too often. But how often have you collided with someone when running full pelt and fallen over? It’s long ago, but it hurts. Stopping the game or not stopping the game can disadvantage one team or the other – but that’s kind of random, as is the business of expecting a player to leave the field after treatment - accident or foul, the advantage can be perverse. These is not a situation where a single answer can work. Also, letting the game flow too often meant letting fouls go and certainly in terms of body checks, was for me a step backwards from the protection of skill.
But there was a great deal that Pierre Luigi Nosferatu and his crew didn’t get to grips with – wrestling at corners, failing to retreat 10 yards at routine free kicks, and shirt pulling are consistent each dog the game and each has a workable solution: At corners, redefine ‘in play’ (the Shearer solution) and holding by a forward results in a goal kick, by a defender award a penalty and it would stop pretty quick. Fail to retreat 10 and the kick goes forward 10 (the rugby union solution, admittedly less clear cut). Both of these would need minor changes to the laws - so we can only wish. But how much shirt holding is too much? I’ve said this before – any at all - that’s what the law says, a clarification might help but it only needs a refereeing directive.
The final bit of back sliding was referees taking too much talk from players not wearing the armband. This was a big step forward in the domestic game in recent seasons but more and more mobbing of the ref crept in as the competition went on. But for this to work, referees need to be sensible about discerning ‘dissent’ and ‘frustration’. There is a big difference between charging and yelling at the ref and waving arms around a bit – dare I say common sense.
But was it any good?
Was it a great World Cup? No. Was it a good World Cup? In some respects, though mostly it was pretty average. I probably watched too many early games, but it became hard to stay interested in a group stage that produced dead rubbers because of the half witted notion of using head-to-head records instead of goal difference as the first tie break factor. I’d say there were a dozen or so decent matches during the group stage but the good ones were very good. By the time the competition woke up we were at the quarter finals. A minority of the 24 previous knock out games were much good - six of the sixteen and three of the eight is a poor return and that’s down to lack of quality, though not necessarily without excitement. This is mostly a matter of opinion, but not entirely. If only one team turns up and you get a one-sided mis match (France 2 Morocco 0) it isn’t great entertainment. If one team is entirely outclassed (Spain 3 Austria 0) it’s equally dull. The semi finals were the real deal, the final, however, killed it a little. 2022 was hard act to follow. Which bring’s me to Spain, worthy winners, class football, but ‘keep the ball’ is not always a great watch when it’s not your team doing it. Blood and thunder Argentina – far more fun, usually, but they couldn’t get to that in the final because Spain wouldn’t let them have the ball. Once down to 10 men the Messi dilemma came into focus – carrying a passenger at 11 v 11 was one thing, but effectively defending as 9 v 11 meant Spain scoring was only a matter of time. Yet Scaloni couldn’t replace Messi, not because of any feared backlash, but because even though he was a passenger he was also Argentina’s only source of hope. The final stages reminded me of Italia 90 – the semi finals had the edge, the final was ugly attrition and the probable eclipse of one an all time great – it takes two teams to make a football match. I think England v Spain would have been a better game, but I couldn’t see a different result.
Historically Spain were the great underachievers. They ended that, but it took time. They now do what they do now and how do you beat them? They don’t play like Real Madrid as a team of individual brilliance, they play like Barcelona in a line established by Johan Cruyff continuing through Pep Guardiola and adopted into their coaching system. When it works it’s glorious, why it was a surprise that Spain outplayed France s beyond me – they had already beaten two decent sides in Portugal and Belgium and they were able to turn it up a notch. As for the greatest player, I said Mbappe was suspect in his defensive work and so it proved when he failed to go with the runner for the second Spanish goal. England has dealt with Messi well until they lost the plot and gave him the space to create for 10 crucial minutes, but Spain completed the job by denying him the ball. Any man who can’t run has his limits – even for the greatest of all time there comes a game too far. So for a change not a forward, Rodri (Rodrigo Hernández Cascante) rightly took the honour as player of the tournament. He probably is the best midfielder of his type since Zidane. Otherwise, and it is easy to dismiss what we have, Jude Bellingham is right up there, and he’s still only 23.
And I will leave it with this for now. I think England did very well - getting to the semi finals is a successful tournament. I didn’t expect them to get past the last 16, even though Mexico aren’t a particularly good side, I simply thought the occasion nd the altitude would be too much to play. I was looking forward to them meeting Brazil – it would have been a decent game and I think on what we have seen England would have won it. They justified their ranking by getting to the semi final and went a step further by beating France in the ‘shadow final’. But ten bad minutes – because let’s not forget that they almost got through for the 1-0 win – switching off against Messi does not mean they suddenly become a bad side. In fact they are a much better side than they were at the 2022 edition. That five of the team would not be out of place in the Spanish starting 11 says a great deal. What’s there not to be proud of?
The King is Dead
It’s a bit ridiculous when public figures/entertainers who you have never met die and everyone rushes to react. But Kevin Keegan’s death feels personal because it IS – KK ‘got’ us. He understood and bought into the City, the North East and the club that represents us. He was in tune. He was proud, principled, stubborn, and prepared to walk away. KK was hope, and became one of us. It didn’t matter that his greatest achievements on the pitch were at Liverpool and SV Hamburg, it didn’t matter that his England days were over - that he didn’t need to come to NUFC was almost the point. We fell for each other, the irrational love of NUFC and its heroes. When he came back as manager at the club’s nadir it was an act of faith and one the region repaid. Everything Newcastle United is now and will be in the future started with Kevin Keegan, the Messiah. Football is mostly failure with a few fleeting moments, but what moments he gave us and they never die. RIP.
Enough for this week, thanks for reading
Till next time take care
John x
They don’t – whatever some of the ridiculous language in the NHS might imply.
Ockenden Report, 4 below.
“Independent Investigation into Maternity and Neonatal Services in England Final report and recommendations” Valerie Amos. July 2026
“FINDINGS, CONCLUSIONS AND ESSENTIAL ACTIONS from the Independent Review of Maternity Services at Nottingham University Hospitals NHS Trust” Donna Ockenden, HMSO 24 June 2026
“FINDINGS, CONCLUSIONS AND ESSENTIAL ACTIONS from the Independent Review of maternity services at The Shrewsbury and Telford Hospital NHS Trust” Donna Ockenden, HMSO 30 March 2022
Justine Roberts “The NHS has a culture problem: it doesn’t believe women” Dispatches from tthe Mumsnet Frontline. Substack. 15 June 2026.
Figures from Gov.uk, IFS, ONS, HRCS, UKCRC, Rand Europe, and JPU.
Mumsnet. 2026. ??
Gov.uk
OECD, also World Bank
Here I refer to Prime Ministers since the formation of the NHS in 1948. Before that is not pertinent.
… and if I can be bothered I’ll work out the probability of Scotland drawing Brazil as often as they have.