We inspected hospital maternity units that had not been inspected since before 2021, focusing on the safe and well-led key questions. The findings in this report are based on inspections of 92 NHS trusts across 131 locations. Overall ratings were determined using our ratings principles.

Inspectors working on the programme received additional training and structured support to prepare for the role This included briefings on the maternity pathway from midwives and senior specialists in our secondary care team. This covered what to expect when on site and the terminology used, as well as opportunities to shadow other inspectors and work with specialist advisors on site. Inspectors received specific guidance and used standardised templates to promote consistency, and could access additional support from a remote senior specialist at all times.

In 2019/20, we carried out 9 pilot inspections to develop a focused approach to inspecting maternity services. Learning from the pilots informed the National maternity inspection programme.

The aims of the National maternity inspection programme were to:

• show how services are responding to current challenges and what extra help they may need
• give women and their families an up-to-date view of the quality of maternity care at their local hospital trust
• show hospitals an objective assessment of what they are doing well and how they can improve
• help CQC understand what is working well so we can share good practice to help services learn and improve
• show where national action is needed to combat the challenges facing services.

This report explores the findings from our inspection programme to give a national view of the current state of maternity services in England. Evidence used in this report includes:

• inspection reports (thematic analysis of the first 85 published inspection reports alongside engagement with the inspection teams involved in all 131 inspections)
• responses received through our Give feedback on care service (around 10,000 maternity responses analysed for the report)
• open responses to the 2023 Maternity survey (around 1,250 responses)
• interviews with 10 midwives and 10 obstetricians from ethnic minority backgrounds
• focus groups with maternity leaders and frontline staff across 16 trusts to help us understand how trusts were ensuring that women from ethnic minority backgrounds had equitable access to pain relief.

As part of the programme, we commissioned THIS Institute to evaluate how we carried out the inspection programme and identify where we can improve. The final section of this report summarises this evaluation.