The rapid, independent investigation had been ordered by then Health and Social Care Secretary of State Wes Streeting to provide truth to affected families and drive urgent improvements in patient care and safety. It was also part of a wider package of actions to boost accountability and safety in the NHS.
It has developed a set of national recommendations to drive improvements in maternity and neonatal care across England, reduce inequalities in the delivery of these services and help affected families to receive justice and accountability.
In response Professor Steve Turner, President of the Royal College of Paediatrics and Child Health said:
The National Maternity and Neonatal Investigation highlights how women and families are not being listened to, racism and discrimination are embedded in a system which is slow to respond and which is fragmented. Amos is clear about the steps required to move to a caring service that has women, babies, families and safety at its core and the College stands ready to play our part in achieving this.
There are huge pressures across the NHS workforce with rota gaps, reliance on locums and loss of experienced staff eroding continuity and resilience. These pressures are contributing to staff burn out and undoubtedly present a threat to safe, high-quality care across the NHS, including our neonatology units. We remain committed to supporting our members to work effectively as part of a multidisciplinary team to provide safe, equitable and personalised and compassionate care.
I welcome the report from Baroness Amos that presents a clear analysis of the challenges facing neonatal and maternity system. Too many women, babies and families are being failed, and my thoughts are with all of those who have been affected.