AIMS Response to the Call for Comments on the Setting Up of the National Maternity and Neonatal Taskforce in England

AIMS was consulted in our Stakeholder Council role, as part of wider consultation.

Submitted December 9, 2025

Dear Taskforce Support Team

Thank you for inviting Stakeholder Council member comments on the arrangements for the Taskforce. It has been useful to read the Reflections and Initial Impressions from the Investigation Team today in that context.

We will organise our main feedback under the themes of purpose, people, and process. Paying good attention to these, we believe, will underpin the best possible outcome from this work.

But first, why is effecting change in the maternity and neonatal services seemingly so hard? AIMS has been part of the effort to ensure the implementation of the previous national inquiry in England - Better Births - and other inquiries before that, and we want to share four inter-related concerns in that context:

1. Where is the power to effect and enforce change? NHS maternity and neonatal services sit within a highly devolved health service, with power distributed widely. There is no central command structure that can easily ‘just make things happen’. We have witnessed the failure of various attempts at national target-setting, and seen the unintended (negative) consequences of implementation done badly. And if no-one is really in charge at a national level, with real power to effect change, then no-one is easily accountable. So just how do we get from here to a safe, personalised and equitable service for all across England?
2. The lack of transparency and openness in the maternity services is really quite remarkable. It oftentimes feels as if all involved have been given orders to start from a position of utmost secrecy. This culture hinders the public scrutiny of services. Without having access to good up-to-date and accessible information about what’s going on, it is really hard to understand systemic weaknesses and offer effective solutions. The Taskforce, through its work, has an opportunity to model the level of transparency and openness that we wish to see from the entire system. Let’s take it.
3. What can be done about lack of staff buy-in? Despite Better Births having become national policy, there have been - and still are - senior staff across the NHS (including in NHS England) who never bought into the Better Births vision endorsed by Ministers, nor the individual policies intended to drive up standards as part of that transformation attempt. There seems to be some misunderstanding of ‘public service’ here. In that context, it is little surprise that implementation has been poor. The system threw multiple committees and ‘task and finish’ groups at this work, but were perhaps missing the vital first stage of shared understanding and consensus building; thereafter, there was a lack of change management/ implementation science expertise to support implementation. We can learn from this. On the other hand, there has been a good focus on improving leadership across the NHS, which should help, but this work is still in its infancy, with simple outstanding questions for example about whether each Trust, below CEO level, should have a single leader for these services. At present, it’s a team.
4. Why will this Investigation make a difference, where others have failed? Review fatigue is real. Having to tell our stories over and over - just as in the maternity context - is no way to proceed. Action not taken and promises broken destroy trust. In that context, plenty of people have been quick to say that another investigation was not needed, that ‘we know what needs to be done’. But knowledge alone doesn’t bring about change. An imposed national vision alone doesn’t bring change. Doing it better this time around will demand Taskforce members with highly-developed critical thinking skills and a willingness to test and challenge. They should be there to work together for the common good, not simply to represent their own experiences or specialisms. We need systems thinkers around the table, who appreciate that every action will have a range of consequences - some not always obvious. The plan for every member of the Taskforce’s contributions to be underpinned by an expert reference group - to design in inclusion - seems absolutely right in this context: this will be challenging work, and we need to bring in all the talents.
5. It is women - not families - who become pregnant and give birth. This point is key to understanding the task of the maternity service improvement, but seems to have been overlooked in much of the debate to date. There’s much talk nowadays of a ‘family first approach’. Indeed, the taskforce is focussed on ensuring the involvement of families. A few years ago, the talk was more around the importance of listening to women - understanding that it is women themselves who - quite literally - have most ‘skin in the game’, who can provide a vital contribution to maternity safety, and who hold the rights over their own bodies. So it needs to be BOTH/AND. Whilst a ‘family first’ approach might make some sense when considering a range of improvements and implementation strategies, especially in the neonatal services, we wish to offer a clear warning. It is hugely important not to lose focus on the unique role of the pregnant woman in all this; on the labouring and birthing woman, on the new mum. And, indeed, birth mums throughout their lifecourse. Our services must understand, uphold and respect each woman’s human rights - in law - to make decisions about her body. The language of women’s ‘wishes’ and ‘desires’ that we’ve seen to date (as opposed to the language of clinical decision making) is extremely worrying. And as part of the work of the Taskforce, we need to include and hear from women themselves; we cannot assume that an approach based only around ‘family voices’ is sufficient or appropriate.

Now onto our comments about the materials shared on the setting up of the Taskforce:

A: Purpose

1. Following the announcement of the Investigation, we agree that it is vital to put arrangements in place to ensure that the Investigation’s outputs lead to real improvements in practice. This stage was notably missing following previous reviews. We thus welcome the setting up of the Taskforce. We see it as key to supporting the Secretary of State that the Taskforce should be able not only to review the outputs with him but also to assess the evidence and offer challenge as appropriate, leading to a trustworthy and trusted vision of change that can then be turned into a robust and meaningful implementation plan, the new national action plan.

2. We are also pleased to see the explicit expectation that the Taskforce will then carry on to support the Secretary of State as he oversees national implementation and how it is leading to improved services. We draw your attention, however, to the level of local oversight, monitoring and challenge that will also be necessary at this stage. What will be the role for Integrated Care, Trust Boards and local Maternity and Neonatal Voice Partnerships, and how will their perspectives be included in the Taskforce?

3. As part of this process, we would like to highlight how a key goal in all this must be to increase mutual understanding about the nature of the problems that the maternity and neonatal services face, as well as the resources available to tackle these. Such a conciliatory approach will be vital to ensure the proper implementation of the resultant action plan, so that the maternity and neonatal service received by every woman, baby and family across England meets the highest possible standard.

B: People

1. It is right that the women who use the maternity services and their families should be central to this stage of work, and so we are pleased to see that the taskforce includes them in a variety of ways, both on the Taskforce itself and via the structure of expert reference groups. But please see our important note above in terms of the specific importance of women in this context. Are men/non-birthing partners in these groups as equals in commenting on provision of care to women? How will you be assured that women are being heard?

2. We support the inclusion of those who have suffered harm ‘in its broadest sense’; it seems appropriate for a list of types of harm to be drawn up, to ensure that this ambition is achieved. Building on this, we also believe that it is essential to also include service users who can speak to ‘what works’; this is also key to ascertaining how service improvement might better prevent harm, especially early on in the maternity journey. We look forward to seeing how this can be accommodated with the proposed task force structure.

3. We ask for further consideration of how professional bodies are involved: rather than the Royal Colleges each taking a separate seat, for example, we suggest that they - together with any further professional groups identified - should instead form an expert reference group, and take just one seat on the Taskforce. This would allow space for a further expert reference group - vital in our devolved healthcare system - to represent ICB and Trust leaders, to be represented on the Taskforce; they seem to be overlooked in the current proposals. We would also like to see implementation science, change management and cultural change expertise being represented on the Taskforce, as distinct from and in addition to the important and necessary input from specialist maternity researchers.

4. We consider the Stakeholder Council to be an expert reference group in this context, and it would be helpful if that was made clear.

5. Ultimately, it is vital that everyone with an interest in maternity and neonatal service improvement should know that they have a genuine voice in this process - in practice, this means that collectively and individually the work of the members of the Taskforce should be as much externally as internally focused. This might include (a) a duty to speak with, listen to and bring in the knowledge of others in their field of expertise; b) actively listening to, considering and respecting the views of others on the taskforce and beyond; (c) engaging in learning about perspectives other than their own, and exercise the critical thinking skills necessary to think about how to integrate the complexity of evidence and views in order to join in arriving at a rational, ethical and democratically fair plan and deployment of resources in maternity and neonatal care. Transparency here will be vital to underpin trust.

6. It would be helpful if further information was set out about the political advisory panel: who will be on it/ how will they be selected etc.

C: Process

1. It is vital that every member of each expert reference group feels - and indeed is - properly included in the Taskforce work, both in terms of hearing what’s going on and being heard. To achieve this, we call for the Taskforce to start from a position of absolute transparency. It follows from this that we recommend that Taskforce papers are made public documents and that all meetings are livestreamed, with recordings being made publicly accessible. This will allow for the utmost transparency and involvement of every person involved in the process. Without such instant feedback on Taskforce discussions, it will also be practically very difficult for the Expert Reference Groups to do their work, and in turn to properly brief ‘their’ Taskforce members for the next meeting, given the pressure of time.

2. It is important that the Taskforce should have sufficient capacity and time to do their work, and we strongly question whether the suggested length of meetings will be sufficient, given the diversity of perspectives being sought.

3. We also suggest that there should be some interim joint working sessions, involving not just Taskforce members but all Expert Reference Group members. One way this could be done is by bringing everyone together in a full day national working party in advance of the Taskforce conclusions being finalised.

4. We assume that each of the Investigation recommendations will be clear about their specific evidence base, and it would also seem vital for the Taskforce to work with a guiding principle of being evidence-based in their work. This may include challenging recommendations, whether from the current Investigation or those made previously. We would like to see this specified in the Taskforce ToR.

Thank you very much for your work on all this. We stand ready to elaborate on any of the points above as necessary. We look forward to playing our part in the Taskforce’s work as part of our Stakeholder Council role.

Jo Dagustun
Member of the Stakeholder Council and AIMS Volunteer
On behalf of AIMS - the Association for Improvements in the Maternity Services