The final Amos Report one month on: an AIMS perspective

In this piece, a month following the publication of the ‘Amos Report’, the AIMS Campaigns Team sets out some high-level perspectives on the report. The team is now busy assessing the Report’s evidence, analysis, conclusions and recommendations; sharing our views and listening to those of others; and contributing to and assessing early actions being taken by NHS England and others. AIMS has been clear for decades that transformational change across our maternity services is needed. Given that it is now more widely understood that the English maternity service is unfit for purpose, we look forward to helping define and support the systemic transformation necessary.

One month on from the publication in June 2026 of the final report and recommendations of the Independent National Maternity and Neonatal Investigation, led by Valerie Amos, it feels right for the AIMS Campaigns Team to publish some initial reflections. We do so in the knowledge that there will be further opportunities for us to engage, on both the detail of the report and on key themes identified by us, as part of a collaborative effort to use this and other reports as a platform for change. Some of that work is already underway.

Since the Report was published, there has been sustained attention on a number of its key conclusions and recommendations, as well as how this Report interacts with the latest report on maternity services in Nottingham and previous local service specific reports. There has also been much discussion about next steps. From our perspective, the next steps aren’t yet entirely clear, but we know that we will be seeing a new Modern Service Framework for maternity and neonatal services in England, and that a new statutory role of Maternity and Neonatal Commissioner for England is likely to be created.

When the report was launched, AIMS welcomed the work of Valerie Amos and her review team. Ministers had asked for an outsider's view of what is going on in our maternity and neonatal services, and that is what we got. We are grateful that Valerie Amos and her team have so clearly articulated so many of the issues in a clear and robust way. The report brings together much useful information and makes many helpful recommendations for further work. As many stakeholders were keen to see, it includes an examination of the role of the regulatory bodies, and indeed the DHSC itself, which makes absolute sense.

As might be expected, the report raises a lot of separate issues. Indeed it is stated in the report that "every element [of maternity and neonatal care] ... must be evaluated as a matter of urgency" (p61). It will not be easy to move ahead with this rather heavy burden of feeling the need to do 'everything, everywhere, all at once'. And there is a real risk that such an approach will quickly become unproductive, as the report explains so well when describing previous implementation efforts. In that context, it should help that the Taskforce and Expert Reference Groups have been set up in advance of the report's publication. This enables these bodies to move quickly to take this work to its next stages, focussing on priority actions and organising and overseeing agreed additional work. Hopefully, this makes December a reasonable if challenging deadline for the resultant plan for comprehensive reform.

We do have significant concerns, however, about whether the recommendations, as a whole, are sufficiently transformative. And these concerns were heightened by our review of the 'business as usual' approach to next steps that has been taken immediately in NHS England's new 10 Point Plan. We see a real risk that the call to embark on transformative change will fall by the wayside, if the system takes its usual approach. That is, tackling the need to improve individual parts of the system separately, without properly considering how these elements work together, or looking at the underlying factors that are driving the current systemic failures. It is these factors which need to be addressed if any reform is to succeed. If we don't do this work differently, our common endeavour will surely fail, remaining instead as a never ending Whack-A-Mole challenge. Historical evidence shows that, unless systems thinking is applied with care, outcomes in a complex system such as maternity can be the precise opposite of what is intended.

Related to this, we also question whether the report responds sufficiently to the full scope of the service, and the three shifts called for by the 10 Year Plan. Whilst 'analogue to digital' is well covered, 'hospital to community' and 'sickness to prevention' are less so. But this we can work on together. The lack of clear focus on each of the three shifts seems to be explained by the strong emphasis in the report on acute hospital-based provision and 'emergency rescue' work, perhaps illustrated well by the inaccurate claim that 'absolutely everything we do in maternity is time critical'. Crucial elements of the 'maternity care jigsaw', especially those focused on pre-pregnancy care, early intervention and care situated in the community, seem to be missing. We will need to come back to this as an early discussion point, to ensure that there is sufficient balance when coming to identify what the key transformative elements of the new plan need to be.

We must also be clear: we do not believe that the report sets out a strong case for the new Commissioner role. Those advocating for this need urgently to set out the case for how this role, as currently conceptualised, has a distinct place in an already crowded space. Thus we look forward to seeing a robust policy argument for its creation, taking into account a key lesson from the Report itself: "We have somehow allowed a plethora of other organisations to grow ... which ... have confused and actually therefore diffused responsibility and accountability." Quite so. Let us, from today, pledge to stop doing that. Any enabling legislation must offer scope for the detail of the role to be the subject of proper consultation shortly after it is established.

The Report’s recognition of racism, sexism and misogyny as defining features of how women's needs are treated in healthcare, including maternity, is welcome. We wish that it had gone further in calling out the issue of Obstetric Violence. We would also like to flag up our concern that the Report seemed to fail to recognise that both a human rights lens and a focus on relational continuity of care are crucial to any meaningful improvement. The Report has described the system to the system, yet not identified the key failing: the failure of the system to see women as rights holders and persons whose dignity and biopsychosocial needs in childbirth demand more than being 'processed' as risk units. As we have argued elsewhere (There is no plan B: continuity, accountability, and maternity reform), care built around ongoing relationships - with a known midwife or small team, rooted in the community and spanning pregnancy, birth and the postnatal period - is the only model of care capable of delivering truly safe, equitable and personalised maternity services. We look forward to coming back to this issue, as we scrutinise how the clear message in the report - of women not being listened to within a fragmented system - is taken up in the Modern Service Framework.

Finally, on a matter of process, we are disappointed that the Review Team was not set up so as to allow all stakeholders the opportunity post publication of raising questions on the report of a clarificatory nature. We would recommend that this is considered for future reviews.

The AIMS Campaigns Team fully expects to be continuing to work on the agenda set by this Report for many months and years to come, as part of the Charities’ and Third Sector Expert Reference Group and otherwise. We look forward to continuing to share our perspective with our readers, and we welcome all feedback, queries and requests for us to share our views on specific issues.

The AIMS Campaigns Team
July 30, 2026