National survey shows decline in positive maternity experiences

Published: 11 January 2023 Page last updated: 11 January 2023

Findings from a survey of more than 20,900 women who gave birth in February 2022 show fewer reporting positively about their experience of maternity care, with a notable decline in the number able to get help from staff when they needed it, compared to five years ago.

Published today (Wednesday 11 January 2023), the findings of CQC’s latest national maternity survey capture what people using maternity services in 2022 felt about the care they received while pregnant, during labour and delivery, and once at home in the weeks following the arrival of their baby.

This year’s results show that many respondents were still positive about their interactions with staff. Most (80%) said midwives ‘always’ listened to them at their antenatal check-ups and just under three-quarters (71%) said they were ‘always’ involved in decisions about their postnatal care. The results also show slight improvements compared to previous years - with an increase in the number of women who said they experienced no delay in their discharge from hospital (up from 55% in 2017 to 62% in 2022).

In 2022, nearly three-quarters (71%) said their midwife definitely asked about their mental health during antenatal check-ups; compared with 69% who said this in 2021 and 67% in 2019. And, 85% felt they were given enough support for their mental health during their pregnancy; compared with 83% in 2021.

However, for some women the care they received fell short of expectations and satisfaction levels have fallen in many question areas. Of those questions where positive results have seen a downward trend, results for 2022 were at the lowest point since 2017 in 10 cases.

The proportion of respondents who said they were given appropriate advice and support when they contacted a midwife or hospital at the start of their labour dropped from 87% in 2017 to 82% in 2022. And in 2022, fewer people surveyed felt they were ‘always’ given the information and explanations they needed while in hospital - 66% in 2017 compared to 59% in 2022.

Availability of staff was also an area where more people expressed concern. In 2022, those surveyed were less likely to say they were ‘always’ able to get a member of staff to help them when they needed attention during labour and birth; 63% compared with 65% in 2021 and 72% in 2019. Results were lower still for care in hospital after the birth; with 57% who said they were ‘always’ able to get help - compared with 59% in 2021 and 62% in 2019.

The survey has been carried out regularly since 2007, as part of CQC’s NHS patient survey programme. This year for the first time, new trend analysis was undertaken on 26 survey questions to understand how experiences have changed in the last five years. That analysis identified a statistically significant decline in positive responses to 21 of the 26 questions.

Key findings from the survey include:

  • Just over two-thirds of those surveyed (69%) reported ‘definitely’ having confidence and trust in the staff delivering their antenatal care. Results were higher for staff involved in labour and birth (78%).
  • While the majority of women (86%) surveyed in 2022 said they were ‘always’ spoken to in a way they could understand during labour and birth, this was a decline from 90% who said this in 2019.
  • The proportion of respondents who felt that they were ‘always’ treated with kindness and understanding while in hospital after the birth of their baby remained relatively high at 71%, however had fallen from 74% in 2017.
  • Less than half (41%) of those surveyed said their partner or someone else close to them was able to stay with them as much as they wanted during their stay in hospital. This was an increase compared with the 34% who said this in 2021, but the results were still well below pre-pandemic levels (74% in 2019).
  • Just under a fifth of people who responded to the survey (19%) said they were not offered any choices about where to have their baby.
  • The proportion who said that they ‘definitely’ received help and advice from health professionals about their baby’s health and progress after giving birth if they needed it, increased from 60% in 2021 to 63% in 2022. However, overall results since 2017 (71%) show a downward trend.
  • Less than half of respondents (45%) said they could ‘always’ get support or advice about feeding their baby during evenings, nights or weekends, in the six to eight-week period after having their baby – down from 56% who said this in 2017.

Commenting on the survey, Victoria Vallance, CQC’s Director of Secondary and Specialist Care, said:

“It is good to see that satisfaction among many of those surveyed remains high and there are some improvements in terms of mental health support and hospital discharge delays – despite challenges that we know services are facing. However, these results show that far too many women feel their care could have been better.

“The trend analysis carried out this year reveals a concerning decline over time, particularly in relation to accessing information and support and getting help when it was most needed. This reflects the increasing pressures on frontline staff as they continue in their efforts to provide high quality maternity care with the resources available. It also echoes what maternity staff attending CQC’s roundtable event last year told us about the exceptionally demanding circumstances in which they are operating and the need for greater support to help manage the challenges they face.

“It is vital that we listen to those who use and work in maternity services to understand what makes a good experience and what needs to improve. This will help ensure we can better support staff to provide the level of care that they want to be able to deliver every time and ensure a consistently good maternity experience for everyone. I hope that all trusts will use their individual survey results to help identify what changes can be made to drive up quality in their own services.

“CQC is committed to doing all we can to help accelerate those improvement efforts. We recently began a new programme of maternity inspections which has a strong focus on capturing the experience of women and families. These inspections are providing an up to date assessment of the quality and safety of all NHS hospital maternity services across England so we can identify what works well and share that good practice to support learning and improvement at a local and national level.”

This is the ninth survey of its kind that CQC has carried out to help trusts better understand the experiences of women using maternity services and involved 121 NHS acute trusts. The results are used by CQC as part of its wider monitoring of hospital services and will feed into the regulators current maternity inspection programme.

Questionnaires for the next CQC maternity survey will be sent out from April this year. The 2023 survey will ask women who gave birth in January, February and March 2023 about their experience of care. For 2023, changes have been made to the survey questions to try to better detect disparities in experience between different population groups, including those from Black and minority ethnic backgrounds. CQC is encouraging people who receive the 2023 maternity survey via email or post to participate. This will help ensure the insight gathered is representative and reflects the views and experiences of all those receiving NHS maternity care in England so that targeted action can be taken to address areas where improvements are required.

About the Care Quality Commission

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