Patient safety campaigner James Titcombe has stepped down from NHS England’s national maternity review amid concerns it is failing to follow an evidence based approach and is excluding patients who have suffered harm.

  • James Titcombe says he faced pressure from other panel members
  • Review is weighted in favour of professional bodies and trade unions, he says
  • Review chair says panel will “listen carefully to people who have had traumatic experiences”

In a letter to review chair Baroness Cumberlege, Mr Titcombe said he could no longer support the review. He said: “I feel that the balance of the maternity review is weighted towards the professional voice. Those who have suffered avoidable harm or loss (the very people whose insights and experience we most need to learn from) are not, in my view, properly represented and are not being heard as clearly as they should.”

He also described how he had been put under pressure, including by one member of the panel who wrote to the Care Quality Commission where Mr Titcombe works as a national patient safety adviser.

James Titcombe

James Titcombe said he could no longer support the national maternity review

He was asked to join the review following an inquiry into poor care at the University Hospitals of Morecambe Bay Foundation Trust, which was published in March. Mr Titcombe campaigned for this inquiry after the death of his son Joshua in October 2008.

Mr Titcombe’s decision to step down from the review follows previous concerns that it was not addressing variation in maternity services. This led to Bill Kirkup, who led the Morecambe Bay inquiry, being asked to join the review as a special adviser last month.

In his letter, Mr Titcombe said: “After much consideration I have come to the decision that I can no longer support the national maternity review and I am therefore stepping down from membership of the panel.

“I’m concerned that the review isn’t following an evidenced based approach. The work looking at evidence about the current quality and variation in safety is only just starting (it was only instigated at all as an afterthought). Robust evidence (including identification of the gaps) should surely form the starting point of this review, the basis from which the review team together should develop its ideas, proposals for improvement and further work streams.”

Mr Titcombe said his request for Dr Kirkup to give a presentation on his findings from the Morecambe Bay inquiry was turned down “despite the misunderstandings and concerns that clearly exist about the Morecambe Bay investigation and what it found”.

He said there had been “little engagement” with patient safety organisations such as Action Against Medical Accidents or the Patients Association. Professional bodies such as the Royal College of Midwives have been involved.

He added: “I have also felt considerable pressure when I’ve commented critically about the RCM’s response to the Kirkup report. This has come from a variety of places, including a letter from a panel member to my employer which was sent without my knowledge.”

Mr Titcombe recommended the panel develop a strategy for a solid evidence base and that it should include “professionals with direct experience of achieving quality improvement in maternity services”.

Baroness Cumberlege said: “I would like to thank James Titcombe for his important contributions to the review so far, and hope he will continue to participate.

“The review has and continues to listen carefully to people who have had traumatic experiences and poor care. Understanding how things go wrong is the first step to improving care.

“Our team is made up of people with all sorts of experiences of maternity care, including professionals and members of the public. Maintaining this balance is important. I will shortly announce the appointment of a team member who can offer a perspective of where maternity services do not perform well.”

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