Patient Safety Watch: Swinging a ‘wrecking ball’ through safety work

Good afternoon and welcome to this fortnight’s edition of the Patient Safety Watch newsletter.

In this edition, we’re covering changes to maternity safety funding as well as reasons for optimism, including encouraging new data on maternity outcomes and new efforts to tackle health inequalities. Let’s dive in.

Maternity safety funding blow

The government has removed ringfencing from maternity safety funding, meaning the money now goes into general integrated care board budgets, with no guarantee it will be spent on maternity safety improvement. The change, revealed by HSJ, has drawn sharp criticism from senior figures and maternity campaigners.

Senior midwife Donna Ockenden described the decision as “a profound disappointment” that raises “significant concern about safety and wellbeing”. Royal College of Midwives chief Gill Walton warned: “This is more than shocking – it will rip the heart out of efforts to improve maternity safety.” She added: “The government has taken a wrecking ball to work being done across the country to make care safer.”

Jeremy Hunt raised this issue in Parliament this week and in a subsequent letter to health and social care secretary Wes Streeting.

My view? Giving ICBs greater flexibility may seem sensible in principle, but with the NHS under enormous financial pressure, removing ringfencing raises real risks this money could be diverted elsewhere. That would be a major setback for efforts to improve maternity safety and must not be allowed to happen.

Encouraging signs: UK perinatal mortality falls

There is, however, some more encouraging news. The latest MBRRACE-UK Perinatal Mortality Surveillance Report has shown a decline in perinatal mortality across the UK. The extended perinatal mortality rate (which includes stillbirths and neonatal deaths) dropped to 4.84 per 1,000 births in 2023 (down from 5.04 in 2022), driven primarily by a reduction in stillbirths.

But the report also highlighted ongoing inequalities. Babies born to mothers from the most deprived areas, as well as those from Black and Asian communities, continued to face significantly higher risks. It is also worth noting that while stillbirth rates have improved, neonatal mortality remains above pre-pandemic levels (1.63 per 1,000 in 2023 vs. 1.53 in 2020).

Still, the longer-term trend is encouraging. In 2013, the perinatal mortality rate in England was 6.09 per 1,000 births. A decade later, it’s 4.88. With around 570,000 births in 2023 (according to Office for National Statistics data), this suggests approximately 690 fewer babies died than would have if rates hadn’t improved.

No one could doubt the need for much more to be done to improve maternity safety, but it’s important to acknowledge that national efforts to drive change have not been in vain.

In other patient safety news…

Royal college: Emergency care delays for older people a growing safety risk

The Royal College of Emergency Medicine reports that more than a million patients aged 60 or older waited more than 12 hours in accident and emergency departments last year. Meanwhile, many aged 75 or older were not screened for key risks like falls, delirium, and frailty. RCEM president Adrian Boyle called it “an alarming threat to patient safety”.

Coroner criticises trust’s ‘poor’ and ‘defensive’ approach to investigations

HSJ has reported that a coroner has criticised Royal Berkshire Foundation Trust’s approach to investigations following three deaths within three months, all of which came after surgery by one particular surgeon.

Heidi Connor, senior coroner for Berkshire, described the trust’s structured judgement reviews – which investigate care failings following a patient death – to be “at best, poor” and “at worst, defensive”, adding the organisation’s overall death investigation process “is not working well”.

The comments were made in the prevention of future deaths report into the passing of 52-year-old Lorraine Parker, the most recent of the three patients to die.

Former health ombudsman criticises ‘near complete’ leadership failure at mental health services

BBC News has reported that former health ombudsman Sir Rob Behrens has condemned the “near complete failure” of leadership at Essex’s mental health services, highlighting the deaths of two 20-year-old men under the care of the former North Essex Trust.

Speaking at the Lampard Inquiry, which is investigating more than 2,000 deaths concerning the services across 24 years, he cited multiple failings, falsified records, and a lack of accountability. Sir Rob warned that the issues in Essex are mirrored elsewhere in the NHS and criticised the fragmented complaints system that leaves families unsure where to turn.

Partnership to tackle racial health inequalities

The NHS Race and Health Observatory has launched a two-year partnership with the National Institute for Health and Care Excellence to reduce racial bias in clinical guidelines. The focus includes maternal health, mental health, genomics, and hypertension.

A welcome move toward more equitable care.

Sharing some good stuff…

Spotlight: Empowering patients and families

Former Action against Medical Accidents chief executive Peter Walsh has written a compelling and thought-provoking editorial asking whether recent UK initiatives – like Martha’s Rule, Patient Safety Partners, and the Harmed Patient Pathway – signal a true shift toward empowering patients and families in patient safety, or just “another false dawn”. He highlights the need for cultural change, genuine independence, and sustained investment to make real progress. 

Podcast pick: Why is it so hard to do less in healthcare?

A new, must-listen episode from THIS Institute explores the persistent challenge of overuse in healthcare – from unnecessary tests to overtreatment. Host Tara Lamont is joined by Heather Cassie, Claire Hastings and Jane O’Hara to discuss why doing less is so difficult, even when it is better for patients.

New ‘Being Fair’ tool to support a just culture in the NHS

NHS England has launched the “Being Fair” tool to help organisations respond fairly when safety incidents raise concerns about an individual’s conduct. Replacing the 2018 Just Culture Guide, it aligns with the Patient Safety Incident Response Framework and promotes a learning-focused, system-aware approach. Developed with input from staff, regulators, and patients, it supports consistent, compassionate decision-making and helps strengthen safety culture.

Share your work at #MatSafety2025

Do you have a quality improvement project in maternity care that’s making a difference? Baby Lifeline is keen to hear from you. The National Maternity Safety Conference 2025 (a must attend event for anyone interested in improving maternity care) is now inviting poster abstract submissions – a fantastic opportunity to showcase best practice and real-world impact to a national audience.

The conference is especially looking for projects with outcome data that demonstrate measurable improvements in safety and care. The deadline for submissions is 30 June 2025. Submit your abstract here.

That’s all for this edition. Please look out for the next newsletter from Jeremy in two weeks. Could the long-awaited review of the patient safety landscape from Penny Dash finally be published by then? We shall see…

In the meantime, thanks for reading and stay safe.

James