The Amos review into maternity and neonatal services in England has laid out a series of recommendations aimed at overhauling a system deemed 'no longer fit for purpose.' While the findings echo previous reports, such as Donna Ockenden's review of Nottingham NHS trust, the review offers concrete steps for the government. However, critics argue it falls short on addressing systemic racism and the impact of traumatic births.
Key recommendations for transparency and accountability
A central recommendation is that families dissatisfied with an NHS trust's internal investigation should have an automatic right to request an independent external review. This addresses a recurring issue where families, like Sarah and Jack Hawkins whose daughter Harriet was stillborn in 2016 due to trust failures, had to fight for years to uncover the truth. Currently, trusts often minimise or conceal failures, undermining accountability.
The review also calls for binding national standards for maternity triage, which serves as A&E for pregnant women. Triage services have been severely understaffed and lack physical space, leading to 'deeply concerning' failures. The report urges that maternity triage be designated a safety-critical clinical environment with enforceable standards, rather than just guidance.
Establishment of a maternity commissioner
A maternity commissioner, independent of government, is proposed to provide leadership and oversight. This builds on the appointment of Labour MP Michelle Welsh as the government's first maternity adviser in May. The commissioner would drive accountability and implementation of a redesigned system, ensuring transparency across England's maternity services.
Limitations: systemic racism and traumatic births
The review acknowledges systemic racism and structural inequalities, noting that black mothers are nearly three times more likely to die in childbirth than white mothers, and black babies are twice as likely to be stillborn. However, it remains unclear how recommendations will tackle these disparities. The report urges health bodies to treat racism as a critical safety issue within a year, including independent evaluation of anti-racism training and better data recording. Yet, critics question whether these measures will reduce mortality gaps.
The Birth Trauma Association called the review a 'huge missed opportunity' for not addressing forceps-related injuries, PTSD, or the psychological impact of traumatic birth. The report does not mention these issues, leaving a gap in support for affected families.
While the Amos review provides a roadmap for reform, its success hinges on implementation. Without binding action on racism and birth trauma, families may continue to face systemic failures.
