‘Threadbare’ NHS maternity care will lead to tragic consequences, health chiefs warn

New mothers are being left dangerously at risk by “threadbare” NHS maternity care with mental health and community services slashed, top health chiefs have warned.

Worrying gaps have emerged in mental health support, as the latest figures from the Royal College of Psychiatrists reveal up to 1,200 women a year suffer from postpartum psychosis.

Donna Ockenden, who led a damning review into failings at Shrewsbury maternity services, described the support as “a house of cards” as she urged the government to pledge more support to women.

In an exclusive interview with The Independent, she said: “The safety net in terms of services, one by one, has become more threadbare. I hear this from new mothers, midwives on the ground and health visiting colleagues.

“We’ve cut services and therefore reduced the  ability of midwives and the perinatal team to give the care that they want to give. All of these issues stack up like a house of cards and we know how easy it is for a house of cards to fall over.”

Her fears were echoed by Bill Kirkup, author of another major review into maternity failings in East Kent, who said the paucity of support would lead to “tragic consequences”.

The Independent can reveal:

The NHS had a target for 66,000 expecting and recent mothers to receive contact from specialist mental health services by April 2024. The most recently published data up to December shows 57,000 women had access – up by one-third from the previous year, but still falling short of the target.

Meanwhile, recent figures show suicide was the leading cause of death for women in the 12 months after birth.

Threadbare

In April 2019, the NHS pledged to roll out maternal mental health hubs for women which would include those who had suffered birth trauma to every part of England.

However, sources speaking to The Independent confirmed the hubs are not available in every area and in some places have even had to close due to funding cuts.

Ms Ockenden, who led the Shrewsbury maternity review and is leading an inquiry into maternity care in Nottingham said support services, such as health visits for struggling mothers are now “threadbare” in many areas.

She said while there has been investment into maternity services of £180m a year since the Shrewsbury report in 2020, “that is nowhere near enough after more than a decade of underfunding”.

Since September 2009 the number of health visitors in community services dropped from 8,100 to 5,627 in January 2024. Figures for 2022-23 show almost 20 per cent of babies and mothers missed out on their 6 to 8-week health visitor review.

She warned she’d been told these services have been “vapourised” in the last 10 years with workers unable to provide comprehensive support for newborns and mothers.

Ms Ockenden, called for the urgent reintroduction of the Sure Start programme of community and family hubs, not more than a ”pram push away” where women and families could access a range of services on their doorsteps including help on employment, childcare, health and education.

Most of these centres have  been cut or closed down, which Ms Ockenden said was ‘extremely shortsighted.’

Dr Bill Kirkup who led another major review into maternity failings in East Kent said mental health support services are “very patchy.”

“People are not being well cared for just because of lack of mental health resources…with the nature of postnatal support because of the pressure on services some places have slipped from the standards that we used to provide… it’s difficult to ask for that support, it’s not readily available. It’s very easy for them to be forgotten. It can have tragic consequences.”

NHS England mental health director Claire Murdoch has said 1 in 9 mothers access support during pregnancy.

“Cruelly wrenched from our lives”

It was 2016 when, while cradling her grandson, Lynn Richardson walked in to see that her daughter Rebecca Kruza had taken her own life just 8 months after giving birth.

Ms Kruza has suffered a traumatic birth while under the care of East Kent Hospitals Foundation Trust, which has also been at the centre of a major scandal. Her mother said “she was utterly traumatised by [the] delivery.”

This was the beginning of months of struggle for Rebecca, who was “exhausted” and having to “battle” for care for her developing depression and anxiety, according to her mother.

One round of antidepressant medication did not work for her and she was then referred for Cognitive Behavioural Therapy, where problems are discussed with a therapist.

However, CBT did not improve her mental health, and according to her mother other NHS services failed to recognise the serious deterioration in her health.

The only service available was admission to the closest inpatient mental health unit for mothers and babies.

Eventually, she felt forced to seek a private psychiatrist via the Priory Group. Emails to her psychiatrist, seen by The Independent, reveal she was questioning whether the medication she was given causes “awful thoughts” and insomnia. In another email, she asks if any alternatives to anti-depressant medication are possible, due to the “awful” side effects she thought the drug was having.

In 2004 the American drug regulator the FDA issued a “black box warning” over mitrazapine that it can cause depression, anxiety and even prompt suicidal thoughts in some users.

Ms Richardson is calling for “Rebecca’s Law” to be developed which would require drugs like Mitrazapine to be classified with warnings in the UK and is campaigning for respite centres for mothers.

“At Rebecca’s funeral, almost 7 years ago, I vowed to see the failings corrected that so cruelly wrenched her from our lives. I long for the day when I can mourn her instead of this endless grief, which is all I can do while the battle continues, she said.

A spokesperson for Priory said: “This was a tragic situation for everyone involved and our thoughts remain with Rebecca’s family. As highlighted during the inquest in 2018, Rebecca’s treatment was tailored to meet her needs balanced against her experience of side effects and tolerance of anti-depressant medication, with consultations aimed at sustaining engagement and providing the support she needed.

“We conducted a full investigation into the care Rebecca received with us, shared these findings with the coroner and co-operated fully with the inquest into Rebecca’s death.”

The government was approached for comment.

If you are experiencing feelings of distress, or are struggling to cope, you can speak to the Samaritans, in confidence, on 116 123 (UK and ROI), email jo@samaritans.org, or visit the Samaritans website to find details of your nearest branch. If you are based in the USA, and you or someone you know needs mental health assistance right now, call or text 988, or visit 988lifeline.org to access online chat from the 988 Suicide and Crisis Lifeline. This is a free, confidential crisis hotline that is available to everyone 24 hours a day, seven days a week. If you are in another country, you can go to www.befrienders.org to find a helpline near you.