This evaluation looks at what has gone well and what has gone less well in the national maternity inspection programme, and offers practical suggestions on how to improve it.
We commissioned the Healthcare Improvement Studies Institute (THIS Institute) and RAND Europe to carry out this evaluation. They wrote the summary below, and the full report.
Why it matters
Reviews and inquiries in recent years have raised concerns about the safety of maternity care in England. In 2022, the Care Quality Commission (CQC) began a new maternity inspection programme aiming to review all maternity services in England that had not been inspected or rated since April 2021.
In 2023, CQC commissioned The Healthcare Improvement Studies Institute (THIS Institute) and RAND Europe to evaluate this programme. The evaluation had two objectives:
- Identify and describe what good safety culture looks like in maternity and the features underpinning it;
- Look at the maternity inspection programme to learn about how it had been delivered and learn from it to inform the work of maternity services, inspectors, and the health and care system more broadly.
This report describes the work we did to evaluate the maternity inspection programme. This evaluation produced insight into what has gone well and what has gone less well in the inspection programme, and offers practical suggestions on how to improve it. Separately, we produced a learning resource, set out in a companion report, which describes what good maternity care looks like.
Our approach
We used a range of different research methods in our work to evaluate the national maternity inspection programme, including:
- reviews of existing publications to identify the challenges involved in inspection, and the evidence for how best to regulate services;
- a review of 25 documents describing the national maternity inspection programme and looking at how inspections are intended to work;
- interviews with 23 people involved in the programme (including inspectors, managers in CQC, and people from organisations that were inspected) to look at how inspections work in practice.
What we found
Programme documents were clear and consistent about the aims of the inspection programme. Broadly, what was described in the documents was reflected in what happened during inspections. For example, inspections focused on two key aspects of quality: how safe maternity services are, and how well managed and well led they are. But some other issues that inspections were meant to focus on, for example relating to how services tried to address inequality, were more challenging for inspectors to cover.
Participants in interviews generally supported and agreed with the aims of the programme and the approach it took. But people also reported challenges in putting the programme into practice. For example, some people in inspection teams felt that they could have benefitted from learning more about the maternity setting at the start of the programme, and found that it was difficult to do justice to services in the time allocated for the inspection programme. Some people also expressed doubts about the fairness and consistency of the ratings given by inspectors. Participants offered ideas for how inspections and regulation might be improved.
The evaluation offers a snapshot of a programme that was evolving while being delivered at pace. It found some gaps between how the programme was expected to work and how it worked in practice, and identified suggestions about how best to develop, organise, and enhance inspections.