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The health service is considering changes to managers' contracts so it is easier to hold them to account for failings in maternity care, the NHS England chief executive has revealed.
Sir Jim Mackey said 'a lot of people often leave' when things go wrong, making it difficult for the health service to sanction them or force them to co-operate with investigations.
Speaking at a conference hosted by the Institute for Public Policy Research (IPPR) think-tank in London today, Sir Jim admitted failings identified in maternity reports have become 'horribly repetitive' and likened them to 'terrible child protection reports and failures'.
He said there is a need to develop clearer expectations and standards for individuals and NHS trusts and ensure they are held to account.
It comes after former midwife Donna Ockenden this week published her report into the biggest maternity scandal in NHS history, which found hundreds of babies and mothers died or were left seriously injured at Nottingham University Hospitals NHS Trust.
She said there was a 'toxic' culture, in which women were routinely ignored and mistakes covered up.
It is understood that half of the 60 former senior executives and directors she approached refused to answer questions about their role in the scandal.
Sir Jim described the inquiry findings as 'shocking' and admitted there is an 'awful lot in it' about the NHS's 'inability to listen and tailor services to respond appropriately'.
Sir Jim Mackey said 'a lot of people often leave' when things go wrong, making it difficult for the health service to sanction them or force them to co-operate with investigations
It comes after former midwife Donna Ockenden this week published her report into the biggest maternity scandal in NHS history, which found hundreds of babies and mothers died or were left seriously injured at Nottingham University Hospitals NHS Trust
He is meeting NHS trust leaders and nursing and medical directors on Tuesday to discuss maternity care and vowed to 'move very quickly' to make improvements.
There have been 'repeated horrors and failures in the service in lots of ways' with a 'lot of repetition' and 'probably too little action', Sir Jim said.
'We'll just need to be really crisp and clear about who needs to do what to deliver what we need to do,' he added.
Sir Jim said: 'Everybody needs to be accountable for their actions. We're looking at changes we can make to leaders' contracts.
'A lot of people often leave, and then it's very difficult to hold them accountable for what happened on their watch.
'We're going to try and make some changes to make it more easy to hold them to account.
'Where individuals are elsewhere in the service there are processes ongoing to determine whether that is right and what we can do about it, so that everybody's held accountable.'
Shrewsbury and Telford NHS Trust, East Kent Hospitals and Mid and South Essex NHS Trust have all faced high profile maternity scandals, with others still rumbling on.
Sir Jim said there have been 'so many views of different reports' that it becomes difficult to stay on top of them and know 'what good looks like'.
The health service will now look to consolidate standards and regulations in light of the separate Amos review into maternity, which is due to be published next week and examines maternity care at 14 trusts.
There will be 'a single set of actions for the NHS, for every part of the NHS, national, local, individual organisations, our colleagues – professional expectations and standards as well – so that we can hold everybody to upheld the actions,' Sir Jim said.
He warned 'professional tribalism' between doctors and midwives was often a factor in poor maternity care and it is crucial relations are improved between the different factions.
He also highlighted a lack of basic compassion and suggested previous leaders could have done a better job at bringing previous recommendations into one place, so they were easier to implement.
Sir Jim said he had been an NHS chief executive for '20-odd years' and would not be able to describe all the organisations and bodies involved in the oversight and regulation of maternity.
He believes there are 'far too many' and there is a need to consolidate to get 'one single version of the truth'.
He said it is a 'time for action' and NHS leaders have 'got to pull together and start doing it now'.
The model of NHS maternity care also needs updating to reflect the fact there are more older mums and more with drug and alcohol issues, he added, rather than working with a system that was designed for the UK as it was 20 or 30 years ago.