Rebuilding Trust in Maternity Services: From Listening to Action

Baroness Amos’ interim report on maternity services is deeply troubling.

For people preparing to welcome a child, reading about inconsistent care, failings and experiences of racism will be very unsettling.

At such a significant moment in life, people deserve safe, compassionate and equitable care. When that confidence is shaken, the impact is far reaching.

Rebuilding trust in maternity care is long-term work. It requires leadership, transparency and structured collaboration with communities.

From repeated findings to real change

Maternity services have been the subject of multiple inquiries and listening exercises. While each has brought important insights and opportunities for people to tell their stories – a difficult truth is emerging. We are not uncovering new problems.

People are describing the same experiences. Feeling unheard. Facing inequitable care. Struggling to navigate services. Lacking confidence in the NHS.

The challenge now is to embed continuous engagement into how services operate every day and work with people and communities to deliver actions that truly address the issues.

Holding two truths at once

Having recently led maternity communications and digital engagement work for an NHS Integrated Care Board, I have seen both the complexity of the system and the commitment of the people working within it.

I have worked alongside staff and patient representatives who are invested in improving outcomes and addressing health inequalities. I have also seen how deeply rooted and systemic some of the challenges are.

Two realities can exist at the same time:

There is excellent care happening every day.

And there are systemic issues that must be addressed openly and honestly.

The weight of inequality

The findings around racial disparities and inequitable experiences are particularly hard to read. The evidence has been clear for years that outcomes for Black women and women from ethnic minority communities are poorer than for white women.

Inequitable outcomes in maternity care are not inevitable and they are not acceptable. A child’s start in life should not be shaped by race, background or postcode.

Addressing health inequalities in maternity services requires more than policy statements. It requires inclusive engagement strategies designed to reach communities who will not engage with formal processes. It requires digital and in-person listening mechanisms that are accessible and consistent.

Trust is not rebuilt through a single engagement event or survey. It is rebuilt through consistent listening and being able to demonstrate positive change over time – otherwise people may reasonably question whether their voices are making a difference.

Continuous listening, not crisis response

One of the persistent challenges in NHS engagement is that activity often intensifies during moments of scrutiny. But trust cannot be built reactively.

Healthcare systems are not short of feedback. What is often missing is the infrastructure to learn consistently from what communities are already telling us. Repeated large-scale listening exercises risk reinforcing frustration if people do not see meaningful change follow. Trust grows not from being asked again, but from seeing action shaped by previous conversations.

There are already important listening structures in place across maternity services, including Maternity and Neonatal Voices Partnerships and local engagement forums. These groups provide vital insight and advocacy. I have had the privilege of working alongside colleagues within these structures and have seen first-hand the dedication and skill they bring. But is it enough?

The scale and complexity of the challenges facing maternity services mean that these engagement mechanisms cannot carry this responsibility alone. They require sustained investment and wider supporting infrastructure to ensure we reach more people experiencing the poorest outcomes.

The challenge now is to build on these foundations. We must amplify the voice of existing groups and connect them with broader, digitally enabled listening systems which can widen participation and create clearer feedback loops.

The role of digital communications

Whilst communications alone cannot fix structural inequalities, they can certainly widen or help close them.

When supported by a clear engagement strategy and digital infrastructure, communications become the bridge between people and services. Accessible and culturally sensitive information matters.

During my time in Greater Manchester, I worked with clinicians and patient representatives to develop an evidence-led maternity digital hub structured around the pregnancy journey.

The aim was simple: make information easier to find, easier to understand and easier to trust. The information could be translated into different languages and formats at source.

Development of the Greater Manchester Pregnancy and Maternity Hub sat within a broader maternity improvement programme. We demonstrated how we could take community insight, clinical leadership and digital engagement to build a trustworthy information offer. It became part of the infrastructure that would enable more inclusive engagement over time.

Investment, workforce and culture

If maternity services are to address the issues and rebuild trust, there must be sustained investment. Not only in workforce and safety improvements, but in engagement capability and cultural competence.

Staff working in midwifery and neonatal services under intense scrutiny need more training and time. They need clear systems that help them understand community insight and respond constructively.

Blame does not create improvement. Accountability, structured engagement and support can.

Shared responsibility

Improving maternity care is not solely the responsibility of frontline staff. Leaders, policymakers, regulators, communicators and communities all have a part to play.

Embedding community voice into healthcare decision-making requires deliberate design. It requires accessible digital platforms, strong partnerships with trusted voluntary and community organisations and governance processes that demonstrate how insight informs change.

We must create space for difficult conversations without undermining the dedication of those working tirelessly to improve outcomes. We must be honest about disparities without reducing complex challenges to simple narratives.

Above all, we must centre people who use these services, especially those who have felt unheard.

Open Voice Lab

The task now is to embed continuous, inclusive engagement and to translate it into demonstrable action. When communities can see how their voices shape change, trust has the opportunity to grow again.

Our Open Voice Lab services help organisations deliver continuous, inclusive engagement, that help to build trust. Sustainable change begins with listening well and acting consistently.

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