Maternity care 'better' in the 1980s as 'breathtaking bureaucracy' drains frontline staff

Maternity care in the NHS was in many ways better in the 1980s than it is today, a senior doctor has said. Dr Lorin Lakasing, an NHS consultant in obstetrics and fetal medicine, said that over the past 30 years, growing bureaucracy has shifted the focus away from frontline care, reducing the quality of care for patients. It comes as the Health Secretary Wes Streeting said on Tuesday that the NHS is "failing women" and announced new plans to stop women being "gaslit" by the health service.

Dr Lakasing has worked in the NHS since the late 1980s and said maternity care was much more focused on patients in the early part of her career. She told The Express: "As a trainee in obstetrics, the hours were awful and there was a strict hierarchy. There was also limited diversity among both care providers and patients.

"However, there was a strong focus on outcomes, a high level of trust between doctors and patients, and care was not heavily driven by financial considerations.

"Patients experienced better continuity of care and felt well looked after. There was also strong camaraderie among colleagues, all working toward a shared goal."

She said things began to change in the mid to late 1990s, when "more guidelines, processes and systems were introduced".

This period included wider NHS reforms under Tony Blair's government, which injected funding, standardised care and increased accountability. But Dr Lakasing said it also added a lot of paperwork, with staff now having more targets to achieve and "boxes to tick" ahead of inspections.

"It is a breathtaking bureaucracy," she said, adding that "we are currently at a low point". "The analogy I would use is you go to a restaurant, you sit down for a meal, you expect to be served, but instead there are huge delays and very poor-quality outcomes because instead of having chefs, they have a bunch of people with clipboards making sure that food hygiene standards have been met."

The doctor added that although maternity care has improved overall, it has not improved as quickly as in similar countries. She thinks this is because "a significant portion is spent on processes rather than outcomes".

She said many midwives now take management roles due to better work-life balance and regular 9-5 shifts. And while more funding is available, it is not going where needed.

She explained: "Staffing is a central issue, but not in the way people think. There are enough trained midwives overall, but not enough working on the frontline.

"More funding alone will not solve the problem unless we address how it is used. We need to reassess roles and ensure more staff are in clinical positions."

She added that improving staffing levels would allow more time for meaningful patient interactions amid reports of traumatic experiences females face when giving birth.

Polling commissioned by Lime Solicitors found that nearly a third (30%) of women said their childbirth experience left them with mental health issues.

A recent review led by Baroness Amos has also revealed that maternity services in England are failing "too many" families, with problems "at every stage" of the maternity journey.

More than 8,000 people have so far submitted evidence, with poor relationships between team members, structural racism, lack of compassion and transparency, outdated facilities and insufficient staff cited as key reasons for the issues.

One mother shared her negative experience with the Express. Emma, whose name was changed for anonymity, gave birth to her son at Broomfield Hospital in 2023.

She said a nurse dropped a medical clamp during delivery and accidentally struck her baby near the eye before using the same clamp on the umbilical cord. She alleged her concerns about her baby's health were initially dismissed by the staff, but the baby was later readmitted to hospital with signs of illness and had to be treated with antibiotics and further tests.

In the early hours after birth, she was made to shower while still very weak and fainted in the bathroom.

She also recalled a doctor making an inappropriate comment during the procedure and said she was unable to challenge it at the time.

Despite later making a formal complaint, Emma was allegedly told there was insufficient evidence due to a lack of witnesses or written records.

Denise Townsend, Acting Chief Nursing Officer for Mid and South Essex NHS Foundation Trust, said: "

We are very sorry to hear about this family's distressing experience. Every parent and family has the right to highquality, compassionate care, and we take any concerns or complaints extremely seriously."