mean, maternity

has lots of odd features, looking at it from the perspective of the rest of healthcare.

And as you say, mothers are tending to be older and heavier and have some other complications.

But generally speaking, the majority of the time, it's dealing with people who are in reasonably good and are going to have reasonably good outcomes.

But the tragedy is that we seem to be doing it words and words.

And I'm not saying that the biggest factor in all of this is either the professional divides or in particular the focus on natural birth but I am saying it's a factor in that.

A number of people have commented recently on the fact that midwives don't generally train as nurses first and the adverse consequences of that and I agree with that.

If you look over the last 10, 15 years, we have highlighted a number of hospitals, not just in maternity, that have apparently not been good and often of course it's blame the manager and the manager is either brilliant or is hopeless but ironically in the last four or five years we've seen hospitals that were hailed as being absolutely brilliant with fantastic heroic leadership at the top of them and gongs being handed out and all the rest of it and then either when that person moves it isn't sustained or maybe it wasn't really as good as we thought it was in the first place do we really have a feel for when things are going well and when things are not

Yep

... yeah, yeah.

Uh, I mean, I think there are two cornerstones of it, if you can have two cornerstones.

[laughs] Um, the two cornerstones are firstly the modern services framework, which is gonna draw all of this together and say, "These are the standards that everybody needs to work to." Not aspire to, but work to.

Uh, and secondly, the maternity services commissioner, which would be the, um, driving force behind the, um- Modern services framework.

I think the rest of it is also important, but I think it flows through those two principally, and I think they're the way to make sure that it happens, um, in a kind of coordinated and consistent way.

I think there are two other things that I wouldn't want to lose sight of, um, that are really important.

... it's, it's a thread that runs through both of them, and I'm just very keen to sort of hear about how, how you would envisage that working, because, uh, to, it's a very big step to say that a regulator is unable to inspect these services adequately.