BY stewartb

The report from the All-Party Parliamentary Group (APPG) in the UK Parliament on birth trauma published today does of course address a really important topic. It merits and has received a lot of attention from the mainstream media: BBC Radio 4’s Today programme this morning gave it a lot of attention.

My interest – as in the main blog post – is in the nature of the APPG’s process – its research scope, its evidence base and the nature of its recommendations. After listening to media reports and skimming through the final report, the following observation seem worth offering:

• the APPG’s initial call for evidence was opened up to the whole of the UK
• its final report uses as its primary source of evidence personal testimonies. I can find no data on the provenance of its anecdotal evidence base – from England, NI, Scotland or Wales
• the report poses the question ‘why this Inquiry?’ – all information given in justification relates to failings (including major hospital scandals) in NHS England
• the APPG held oral evidence sessions – I have been unable to find transcripts of these sessions. I wanted to ascertain what evidence from professional or advocacy groups (if any) was taken that related specifically to NI, Scotland and Wales
• the report makes reference in various places to ‘NHS Trusts’ – without qualification. This is always a red flag: how much is the UK being equated with England?
• the report in its recommendations may have forgotten about or is seeking to bypass devolution: having told us it is UK-wide in scope, it ‘calls on the UK Government to publish a National Maternity Improvement Strategy, led by a new Maternity Commissioner who will report to the Prime Minister‘ without making clear whether or not this Strategy and this Commissioner would be just for England or for the whole UK
• it praises the UK government: ‘We welcome the UK government’s decision to include birth trauma in the Women’s Health Strategy, an important step in recognising the importance of birth trauma and making it possible to take steps to address it’ – however, the formal title of the praiseworthy strategy is ‘Women’s Health Strategy for England’!
• it expresses concern and make recommendations regarding support for ethic minorities but then in its related recommendation only indicates that ‘NHS England’ should do something to address the matter. Why only NHS England if this is a UK-wide Inquiry, given no further explanation?
• throughout, the report appears to use the terms ‘NHS England’ and ‘NHS’ as synonyms
• it makes multiple defences to a ‘maternity system‘ – it is unclear whether this is the NHS England ‘system’ or if this ‘system’ also includes what is provided in NI, Scotland and Wales. One ‘maternity system’ but four distinct health systems?

One could go on in a similar vein!

As the main blog post makes clear, references to Scotland or NHS Scotland are extremely limited. Candidly, this report despite claiming to be UK-wide in scope provides: (i) no explicit evidence on the nature and extent of ‘problems’ or any failings in NI, Scotland and Wales – it simply fails to follow through on its claimed UK-wide scope, it fails to provide relevant evidence and insight beyond England; (ii) no insights into current practice – including any difference in practices – in NI, Scotland and Wales, good or bad; and (iii) no clarity over the proposed scope of its recommendations in the context of a devolved – not a single – health (and therefore maternity) ‘system’.

I’m motivated to write this primarily by an interest in how Westminster works and how the media report on its output in the context of a UK with multiple governments and parliaments. If my primary concern was to seek insight into the subject matter of the Inquiry as it pertains to NI, Scotland or Wales then after reading this report I would remain wholly in the dark! One wonders why it decided to embrace a UK-wide remit only to report so inadequately the evidence – however limited – it may have gathered from the UK outside England. A false prospectus?

Notwithstanding this serious limitation, the tenor of the report and its coverage in the news media is that it is providing important evidence on the dire quality of maternity services across the UK. Whatever the situation in NI, Scotland and Wales may actually be, based on the contents of the final report of this specific inquiry such negative implications are not evidence based.