Quick summary: Transforming NHS maternity services requires a shift away from short term political cycles towards a cross party commitment that spans decades rather than five year election periods. While politicians often promise rapid improvements to score points, true progress in clinical safety and staff well being only occurs when reforms are insulated from partisan interference and grounded in long term global evidence. Establishing an independent commission to oversee these generational changes is the only way to ensure that healthcare policy prioritised outcomes over optics and provides lasting stability for both families and frontline clinicians.
Soon after his appointment as Health Secretary, Wes Streeting described NHS maternity care as a “cause for national shame”. He promised regular meetings with bereaved families, ordered a rapid investigation, and appointed Baroness Amos to chair it. She, in turn, pledged to “carry the weight of the loss suffered by families”, provide “answers families are seeking”, and identify “areas of care requiring urgent reform”.
These promises sound compassionate and decisive. But they’re also precisely the kind of promises that have prevented real improvement in maternity services for decades. Because fixing NHS maternity care isn’t a problem that yields to political timescales. It’s a generational challenge that requires interrogating all contributory factors and coming up with a plan that will ensure sustained commitment to the cause long after the politicians making promises have left office.
The political cycle versus clinical reality
Here’s the fundamental mismatch: politicians operate on five year cycles at most. They need visible wins within two to three years to build momentum for re-election. But transforming maternity services, rebuilding training programmes, changing institutional cultures, restoring staff morale, re-evaluating which areas need resources and which have wasted resources, takes decades. By the time real improvements are evident, the politicians who initiated the necessary changes are long gone. But our current short-term thinking means that blaming the “other side” for failures and taking credit for successes that have nothing to do with the incumbent government is routine.
Quick fixes are easy. The tragedy is that politicians know this. They understand that real reform takes time. But the political incentives push them towards theatrical gestures rather than the tedious groundwork needed to effect real change. Worse still, each new government feels compelled to revise or rebrand their predecessor’s initiatives, ensuring that even well-intentioned reforms never have time to embed properly.
The Parliamentary pantomime
Watch Prime Minister’s Questions any Wednesday and you’ll see why public services struggle to improve. MPs trade barbs about maternity failures, using bereaved families’ pain to score political points. They berate each other with statistics, lay rhetorical traps, and compete to sound most outraged about the latest scandal. It’s compelling theatre but disastrous governance.
This adversarial pantomime isn’t just undignified; it actively prevents improvement by weaponising reforms and turning every tragedy into ammunition for the other side. Admitting that solutions will take decades invites ridicule about “lacking ambition”, so politicians promise impossible timescales instead.
The promise trap
Streeting’s promise that Baroness Amos will provide “answers families are seeking” is particularly troubling. What answers could possibly satisfy parents who’ve lost a baby? That the system failed them? They know that. That lessons will be learned? They’ve heard that before. That someone will be held accountable? Financial compensation might soften the blow for some, but generally the narratives around investigations just perpetuate the blame cycle that makes staff defensive and problems harder to solve. It also gives parents the false impression that every poor outcome is somehow avoidable and that no factor other than poor maternity care was responsible.
The promise to identify areas requiring “urgent reform” is equally problematic. After twenty-five years of enquiries and 748 recommendations, we know exactly what the problems are. We don’t need more identification; we need the political courage to admit that reform will take a generation and the commitment to see it through regardless of who gets the credit. But that’s not what wins elections. Instead, they promise rapid transformation, immediate accountability, and urgent action. When these promises inevitably fail, public trust is eroded further, making the next round of reforms even harder to implement.
When politicians get it right
Occasionally politicians put clinical outcomes before credit. Jeremy Hunt’s stillbirth reduction initiative stands out precisely because it was designed to outlive his tenure as Health Secretary.
The UK had one of the highest stillbirth rates in the developed world, a genuine cause for national shame. The vision was good but unfortunately remained unachieved because resources were spent on implementing processes rather than on frontline care where the action to achieve results really takes place. But it got closer than most.
A non-maternity example is the introduction of the NHS itself in 1948, which was a cross-party achievement that took years to implement. Aneurin Bevan knew he was creating something special that would take decades to mature and admitted from the outset that it would need tweaks along the way, something that many have forgotten when we discuss the NHS today. The political consensus that created and sustained the NHS through its early years is exactly what’s missing now.
Learning from others
Politicians seem quick to cite but slow to understand successful global healthcare models. For example, the Nordic maternity outcomes, among the best in the world, were not achieved through naming and shaming units or constant reorganisation. It was through boring and consistent work across political divides. Norway invested in continuity of care models where the same midwife plans tailored care and works with women through pregnancy, birth, and postnatal care. This took years to implement and required significant restructuring. But they stuck with it through multiple governments because they agreed the evidence supported it, regardless of who proposed it.
Similarly, Finland’s maternity package system, also known as the “baby box”, was introduced in 1938 and refined continuously since. Every pregnant woman receives a box containing essential items for their baby, but more importantly, they only get it if they engage with maternity care from early in gestation and attend regularly throughout the pregnancy. This simple intervention, sustained across eight decades and countless governments, helped Finland achieve one of the world’s lowest maternal and infant mortality rates.
More recent examples include New Zealand, which restructured midwifery care in the 1990s to allow for autonomous midwifery practice. This was controversial, took years to implement, and required sustained cross-party support. Or Estonia, where maternity services were transformed after independence and the country now boasts better outcomes than the UK despite spending less per capita.
The key? Political consensus that maternity care programmes should transcend party politics. No incoming government scrapped them to make their mark. No opposition attacked them for political gain. They understood that consistency mattered more than credit.
The cross-party solution
Here’s what should really shame politicians. We’re not facing unique challenges. We’re not poorer than countries with better outcomes. We just refuse to learn from them and implement what works because it doesn’t fit our political culture.
What the NHS needs, and what many of my frontline colleagues advocate, is to take maternity services out of the political cycle altogether. Create a cross-party commission responsible for long-term strategy. Basic healthcare shouldn’t swing wildly based on electoral results.
This isn’t unprecedented. The Low Pay Commission, which sets minimum wage rates, operates across party lines with remarkable success. The Office for Budget Responsibility provides independent economic forecasting that all parties accept. The Committee on Climate Change shapes long-term environmental policy beyond electoral cycles.
A similar body for NHS maternity services could see politicians from all parties working together, advised directly by practising clinicians.
We need to move away from partisan politics and the pointless bureaucracy this promotes because this approach has not served us well.
Practical steps politicians could take tomorrow
If politicians genuinely want to improve maternity services rather than just appearing to, here’s what they could do immediately:
First, establish a cross-party agreement that maternity services are off-limits for political point-scoring and establish cross-party governance of the NHS with direct input from frontline clinicians.
Second, commit to ten year minimum timescales for major reforms. If you’re restructuring teaching, training, teamwork, introducing clinical safety strategies that are fit for purpose, implementing effective staff management, and risk profiling patients properly, this will take decades to embed before results can be evaluated or processes altered purposefully.
Third, take advice from global healthcare models with better outcomes and check if this can be applied to the NHS model. Recognise that changes in practice can only be achieved through education and support, typically by senior colleagues in active practice, not by directives e-mailed to shop floor staff sent by managers working from home.
Fourth, create ring-fenced funding streams for frontline maternity services that can’t be raided for managerial processes.
Fifth, recognise that change for the sake of change wastes resources and concentrate on implementing ones that are of proven value instead. Conversely, it is important to find the courage to abolish those that have not proven their worth.
A different kind of political courage
Real political courage isn’t promising bereaved families that you’ll fix everything quickly. It’s admitting you can’t. It’s explaining that meaningful change takes decades, that you’re starting work others will finish, and that you need their patience rather than their votes.
Imagine if a Secretary of State for Health said: “NHS maternity services need a generation to rebuild. I need opposition support because this transcends party politics. We’ll study what works globally and implement it consistently, even if it’s boring and doesn’t make headlines.”
That would be genuinely revolutionary.
Dr Lorin Lakasing is an NHS consultant in obstetrics and fetal medicine with 30 years of clinical experience in maternity care. Her latest book, “Delivering the Truth“, examines why major stakeholders have been pushed towards competing agendas and what it will take to restore safe, effective care.