Looking back at failure and forward to improvement: Will Wes Streeting’s proposed maternity plan lead to change?

At the June 2025 Royal College of Obstetrics and Gynaecology (RCOG) World Congress, Secretary of State for Health and Social Care Wes Streeting, called out, with the frankness that has been his characteristic since taking up his post last year, the unacceptable state of current NHS maternity care. He also outlined key elements of a plan to improve.

Although mentioned again in the 10 year plan for health, the detail, for now, is limited. But two key elements are prominent. First, a rapid investigation into ten maternity units across England will take a system wide look at maternity and neonatal care, reporting by the end of 2025. As well as delivering “truth and accountability” for families affected by poor care, the investigation seeks to bring together lessons from past inquiries and create a single set of actions for national maternity improvement.1 Second, a National Maternity and Neonatal Taskforce, comprising experts, families, and staff, will be established to drive improvement.1

The announcement has been broadly well received by organisations representing those using and delivering maternity services,12 and the commitment to working with families is welcome.2 But will it work?

One question is the extent to which this new investigation is the right approach to support the needed improvement.3 While each failure to deliver good care is distinct, and each involves terrible human suffering and grief, many of their features are strikingly repetitive and well known. They arise from complex tangles of behaviours and systems, poor clinical practice, weak teamwork, dysfunctional organisations lacking good management systems, and degraded cultures and professional conduct involving disrespect both to families and colleagues. Problems evade detection and effective action over long periods, and sometimes secrecy and protectionism are entrenched.45678 Given that similar challenges have been observed by public inquiries and reviews across multiple sectors of the NHS over several decades,9 any further investigation is unlikely to add much to the sum of knowledge about the problems of maternity services. It will also delay action, and it may add further to the evident demoralisation of maternity staff.

It may, however, serve two purposes. One of these, if appropriately supported by the taskforce, is to arrive at a single set of actions for maternity services. These are currently challenged by “priority thickets”10 of goals and recommendations. Last year’s Maternity and Newborn Safety Investigation programme annual report alone contained 78 pages of recommendations,11 adding to the hundreds of recommendations from other bodies and from maternity care inquiries from the first12 to the most recent.13 The volume of recommendations, which may themselves compete, conflict, or fail to cohere, is itself a threat to improvement. Consolidating and prioritising recommendations would be a major step forward in providing clarity and direction to services. But the scale of the task should not be underestimated. Arriving at consensus on which actions should be priorities requires a systematic, scientific, multi stakeholder approach.14

Implementing the actions may be even more challenging. The taskforce should recognise that retrospective analysis of past failures will not on its own provide a road map for improvement. Investigations can be prone to the “tombstone effect,”15 where they operate mainly to memorialise rather than to provoke real change. The route out of failure therefore needs to be evidence based, co-produced, and based on an understanding of how maternity care is delivered every day.716 It requires an understanding of the work of implementation, proper appreciation of workforce issues, and a genuine commitment to learning and evaluation, given the many previous attempts at improving maternity services.17

A second important purpose the investigation may serve is for families, who deserve explanations for their suffering and the dignifying of their experiences. For this new investigation to succeed in this purpose, centering the experiences of families must not be tokenistic. Anything that falls short of sincere co-production might even compound the harm they have already suffered.18

Harmed families also need accountability for failures. However, investigations are arguably better at “backward looking” accountability (identifying responsibilities for past failures) than “forward looking” accountability (articulating responsibilities for putting things right).19 Put simply, Streeting’s plans will need to be rigorous in identifying problems, but also authoritative in directing future action, if they are to feel more than just performative.

One way of tackling this web of purposes and stakeholder needs is through restorative approaches of the type used by the Ministry of Health in New Zealand in response to harms associated with use of surgical mesh.20 Such approaches ask institutions to explicitly: acknowledge the harm and involve the affected community; respond to the human impacts and needs involved; clarify obligations; and take responsibility for harm and repair. Bringing staff on this journey will be key, given the centrality of the workforce to better care.20

Maternity services have reached a collective nadir. We cannot afford another failed improvement effort. Streeting’s plan can only support the transformation needed if it acknowledges the past and takes a responsible, evidence based, and collaborative approach to the future.