The state of health care and adult social care in England 2024/25

Every pregnant woman wants a positive birth experience – and every member of staff working in a maternity service wants to provide safe, high-quality care. In most situations that’s what happens, but sadly it’s not always the case.

Too many women are still not receiving the high-quality maternity care they deserve, with almost half (47%) of services reviewed through our National review of maternity services in England 2022 to 2024 rated as either requires improvement (36%) or inadequate (12%). Under our assessment framework introduced in 2024, we have published the findings of inspections for 15 maternity services. Of these, two-thirds of services (66.7%) have been rated as inadequate or requires improvement, with a third (33.3%) rated as good. No services have been rated as outstanding.

Since 2015 there has been a national ambition to halve the rates of stillbirths to 2.6 per 1,000 births by 2030. While some progress has been made towards this goal, in 2023 the stillbirth rate was 3.9 per 1,000 births.

When things go wrong, the consequences for mothers, babies, their families – and staff – can be devastating. To support services to provide bereaved parents with answers, ensure learning from incidents and prevent future deaths, the national Perinatal Mortality Review Tool (PMRT) was launched in 2018. As stated in the Sixth annual report of the national Perinatal Mortality Review Tool, “The review of care when a baby has died is part of routine maternity and neonatal care and is not an optional extra.”

The sixth annual report, which was based on 4,311 reviews completed from January to December 2023, found that 95% of reviews identified areas for improvement in care, and 30% of reviews identified at least one issue with care that may have made a difference to the outcome for the baby.

Concerns around the quality of care in maternity services are longstanding. Over the last 10 years there have been a number of high-profile investigations into the quality of care at individual maternity services, including Dr Bill Kirkup’s reviews at Morecambe Bay and East Kent, and Donna Ockenden’s investigations at Shrewsbury and Telford, and Nottingham.

In May 2024, the final report of All Parliamentary Party Group (APPG) on Birth Trauma suggested these may not be isolated cases, with the investigation finding a pattern of poor maternity care across the country. Similarly, our National review of maternity services in England 2022 to 2024, published in September 2024, found that issues identified through the Kirkup and Ockenden reviews are not confined to a few hospitals, but are widespread across the country.

Across all these reports, the same themes have been emerging, including:

• workforce challenges
• lack of leadership and oversight
• poor working cultures and siloed working
• poor risk assessment
• lack of communication
• failures to investigate and learn when things go wrong.

To keep people safe and ensure they receive consistently safe, good quality care, we expect services to make sure there are appropriate staffing levels and skill mix. However, our national maternity inspection programme found that chronic issues around recruitment and retention were a key barrier to high-quality care.

This was supported by the findings of the APPG on Birth Trauma. Evidence provided to the APPG revealed endemic issues with under-staffing, a poor physical environment and a harmful working culture. It also suggested that midwives in particular experience high levels of stress and burnout.

This was supported by the findings from NHS England’s Maternity and neonatal infrastructure review. Published in September 2025, the review found a clear link between the condition of service infrastructure, the experience of people who use services and staff, and safety.

Latest figures from the 2024 NHS Staff Survey continue to suggest that midwives are experiencing challenges related to work-life balance and wellbeing. The results show that, compared with all staff groups:

• 50% said they cannot meet conflicting demands at work (27% overall)
• 45% reported achieving a good balance (57% overall)
• 57% reported finding their work emotionally exhausting (34% overall)
• 65% said they felt worn out at the end of the shift (42% overall).

Despite the challenges, 68% of midwives reported feeling enthusiastic about their job, which also reflects the trend across all staff groups (68%).

In 2024, the Royal College of Midwives (RCM) estimated that there was a national shortfall of around 2,500 midwives. RCM’s data published in June 2025 shows that as at March 2025 the number of midwives on the register had increased by 5.6% from March 2024. However, results from RCM’s survey published in the same month show that funding cuts and recruitment freezes mean that midwifery managers are still struggling to hire any, or as many, midwives as they need.

Analysis of maternity inspection reports published between January 2024 and June 2025 also shows ongoing concerns with staffing. Issues included a lack of staff and in some cases a lack of suitably qualified or senior staff, leading at times to an inadequate mix of skills on wards.

The impact of staffing shortages on midwives was reflected in the findings in the NHS Staff Survey, which showed that only 16% of midwives felt there were enough staff at their organisation for them to do their job properly (compared with 34% overall).

Recent inspection reports continue to show challenges with risk assessments. Not all services are able to properly assess and manage risks. Some do not always complete proper risk assessments, or do not properly record these in a way that makes for safe care across the maternity pathway. Where risks are identified, they are not always acted on promptly and effectively.

Ongoing concerns about the learning culture was another theme emerging from our analysis of recent inspection reports. Some staff told us that they were not always encouraged to report incidents, or that services did not always systematically embed learning from incidents. While the NHS staff survey suggests a high proportion of midwives feel their organisation encourages them to report errors, near misses or incidents (91% compared with 83% overall), only 55% are confident their organisation would address their concern (compared with 57% overall).

It is shocking that despite the same issues being repeatedly reported over the last 10 years, efforts to address the underlying causes of poor maternity care have continued to fall short. To address this, in its final report the APPG on Birth Trauma called in the government to introduce a National Maternity Improvement Strategy, led by a new Maternity Commissioner who will report to the Prime Minister.

Maternity care in England is at a significant point of transition. In September 2025, the government announced the terms of reference for the National maternity and neonatal investigation. As well as helping bereaved and harmed families to receive justice and accountability in the future, the investigation aims to conduct and publish 14 local investigations of maternity and neonatal services in NHS trusts. The national investigation not only gives renewed focus on longstanding issues, but presents a real opportunity for change.

Inequalities in maternity care

As highlighted in our report National review of maternity services in England, 2022 to 2024, and our 2023/24 State of Care report, some women with protected characteristics under the Equality Act 2010 are at greater risk of harm. Latest data from MBRRACE-UK shows that, compared with women from white ethnic groups, Black women were more than twice as likely to die during or up to 6 weeks after pregnancy, and Asian women were 1.3 times more likely to die during the same period.

This is supported by the findings of the Black Maternal Experiences Survey by FiveXMore. Published in July 2025, the survey gathered the experiences of Black and Black mixed-heritage women across the UK who had been pregnant between July 2021 and March 2025. Of the 845 responses analysed, the survey found:

• 60% of Black women rated their antenatal care as good or high quality
• 54% experienced challenges with healthcare professionals
• 28% of Black women reported discrimination and, of these, 25% said that this was due to issues around race
• 45% raised concerns during labour or birth; of these, 49% felt their concerns were not properly addressed
• 23% of Black women did not receive the pain relief they requested, and 40% of these women were given no explanation
• Only 39% received advice on nutrition, and just 27% were spoken to about exercise at their booking appointment
• Just 1 in 5 women (20%) had been informed on how to make a complaint, and only 8% pursued a formal process.

The report describes how more Black women are better informed and ready to advocate for themselves when entering maternity care, but that this is more often because they feel they must fight to be heard. It highlights that racism, both structural and interpersonal, continues to shape Black women’s maternity experiences, with poor communication, lack of empathy and unequal power dynamics leaving them feeling unsupported and unsafe.

Our national maternity inspection programme found huge differences in the way NHS trusts collect and use demographic data, particularly ethnicity data, to address health inequalities in their local populations. We also found that communication with women and their families is not always good enough, particularly for women whose first language is not English. This affects their ability to consent to treatment and can perpetuate levels of fear and anxiety.