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The state of health care and adult social care in England 2020/21
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The state of health care and adult social care in England 2020/21

In the current backdrop of ongoing COVID 19 cases across the UK the Care Quality Commission (CQC), the current regulator for health and social care, has produced their report of the state of the services in England. Though the report is a summary across all services it does include salient messages for maternity services.

The points it raises covers issues around:

  • people struggling to obtain care during the last year during the pandemic,
  • increasing inequalities of care, particularly for those from Black and Asian communities
  • increased mental health needs and lack of services, especially for those with learning disability
  • the strain on the workforce
  • difficulties with digital exclusion.

However, on a positive note, for those able to access care the experience was mainly positive. All of these situations are true for maternity as well as all other services. The pandemic has had an impact on everyone.


The comments on maternity services particularly pointed to the slowness of improvement in aspects of safety, such as improving the culture of teamwork and engagement in training, with lack of learning from “things going wrong”. Lack of equitable access for all groups of service users is raised as well as lack of engagement in services from local women. This was in particular around Black and Asian groups, and the need for improved inclusion, information and support. The poor levels of offering vitamin D was cited as a concern. They identified how continuity of carer teams particularly benefitted these women and families and the report states:

At the time of our inspections, just over half of the services we visited had active continuity of carer teams providing support to small numbers of women identified as higher risk. Where services did not have these teams in place, we heard that they had been put on hold or disbanded, primarily due to staffing issues in the pandemic.

The comments on staffing levels and the difficulties for the workforces as a whole particularly caught my eye as we have covered this on previous blogs here and here. Maternity was not mentioned directly but could be reflected in the statements made. It was concerning to read that in June 2021 and report from the Samaritans stated healthcare workers as one of five groups whose risk of suicide may have been increased due to the pandemic. Though we know many are voting with their feet out of the service door, it is disturbing to think some may slip through the net with severe mental wellbeing issues. We do need to look out for our colleagues during such a difficult time. The CQC raise the concern in their summary:


The system has not collapsed – but the system is composed of individuals, both those who deliver and receive care, and the toll taken on many of these individuals has been heavy. As we approach winter, the workforce who face the challenges ahead are exhausted and depleted, which has implications for the quality of care. They cannot work any harder – they need support to work differently.


It is going to take time to resolve this crisis, which has been seen to be coming for a number of years. Whatever it takes to get that support in place needs to be done now if we are going to come back from the brink.

Jenny Hall

November 2021

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