The state of care in England’s maternity services

The latest Care Quality Commission (CQC) report on the state of care in England is far from an encouraging read.1 Although the healthcare system is under serious strain, maternity services are among the areas identified as especially challenged. The problems identified in maternity care, while shocking, come as no surprise. The sector is seeing repeated high profile organisational failures and soaring clinical negligence claims, together with grim evidence of ongoing variation in outcomes, culture, and workforce challenges and inequities linked to socioeconomic status and ethnicity.234

The cybernetic model of regulation offers a potentially useful way of understanding where effort needs to be directed.5 In this model, regulation comprises three interlinked elements: standard setting, monitoring, and mechanisms to secure improvement; absence of (or flaws in) any of the three elements makes failure more likely. Standard setting and monitoring, though imperfect, are the stronger elements of England’s current health and …