Hospitals across England have been instructed to establish 24/7 hotlines for pregnant women experiencing concerns, a move designed to mitigate avoidable deaths and harm.
NHS England mandates that all hospitals implement this service by the end of the current financial year. The lines will be staffed by dedicated midwives, ensuring they are not diverted by other duties on labor wards. Pregnant individuals who still have anxieties after a phone consultation will be advised to seek in-person assessment, which must occur within 15 minutes of arrival.
This directive is part of a new 10-Point Plan for maternity and neonatal services, introduced following a meeting convened by NHS England chief executive Sir Jim Mackey. The meeting addressed findings from two major maternity reviews that highlighted serious issues with maternity triage and potentially life-threatening delays when women seek help or arrive at hospitals.
The National Maternity and Neonatal Investigation, chaired by Baroness Valerie Amos, concluded that the NHS continues to cause harm, disregard women's concerns, and cover up mistakes, despite numerous past recommendations. This report was released shortly after an inquiry into Nottingham University Hospitals NHS Trust, led by senior midwife Donna Ockenden, which found that systemic failures at the trust led to over 500 mothers and babies suffering avoidable harm or death.
According to the Amos review, maternity triage has become the de facto emergency service for pregnancy, where issues like reduced fetal movement, abdominal pain, bleeding, headaches, or signs of labor are often first reported. However, the investigation noted repeated instances of triage not functioning effectively due to insufficient staff, a lack of experienced decision-makers, and inadequate bed and cot capacity. These deficiencies can lead to missed early warning signs and delayed critical decisions, resulting in serious and irreversible consequences.
The Ockenden report further detailed concerns regarding telephone triage, including women being discouraged from attending hospital, delays in assessment upon arrival, poor assessment quality, inadequate documentation, and delayed escalation of care. The report cited evidence of poor telephone risk assessment, where mothers' pain was minimized or ignored, and they were not invited for review, leading some to call multiple times before being admitted and experiencing fear and vulnerability at home.
In a letter to health leaders, Sir Jim Mackey emphasized the need for collective action to rebuild trust and confidence in maternity and neonatal care, stating, "This must be a turning point for the NHS. We cannot allow failures in care to persist and be followed by reviews that continuously highlight the same themes."
The 10-Point Plan requires all trusts to conduct a board-level audit within three months to ensure maternity triage services are consistently safe, responsive, and adequately resourced. New guidance from NHS England will support this, emphasizing dedicated midwifery staffing for call handling and assessments, separate from labor ward duties. It also calls for sufficient clinical, antenatal, and bed capacity, with clear escalation routes available at all times.
Additional components of the plan include the right for families to seek a second opinion if they feel their concerns are not being taken seriously, improvements to patient experience surveys, and a review of how trusts respond to identified failings.
The Ockenden report provided examples of critical failures, such as a mother who was repeatedly discouraged from coming to the hospital despite experiencing continuous pain after her waters broke. Upon eventual arrival and examination, she was found to be nearly fully dilated, and her baby suffered a serious brain injury due to lack of oxygen during birth. Another case involved a high-risk mother who was told she was not in labor because she could sustain an 18-minute conversation, leading to delayed escalation and a baby born in poor condition.
Kate Brintworth, chief midwifery officer for England, stated that the current situation must change. "Too many women, babies and families have been harmed, bereaved or badly let down by maternity care, and too often women and families who raised concerns were not listened to," she said. She added that the new system aims to provide pregnant women and new parents with the assurance that a midwife will always be available to address emergency concerns, offering specialist advice immediately rather than delayed callbacks or voicemails. Creating dedicated teams away from busy labor wards will also allow midwives more time and space for thorough risk assessments, enabling faster, safer decisions and improved care.