Parliament’s Health and Social Care Committee have recently published a report commenting on the safety of maternity services in England, which have been heavily scrutinised over recent years.
The report lists the findings in an extensive evaluation; the first of its kind commissioned by the Health and Social Care Committee and carried out by an independent panel of experts. It is no doubt that such a review was necessary following on from the 2015 Kirkup review (also known as The Morecambe Bay Investigation) which uncovered ‘serious and shocking’ problems with maternity care at one NHS Trust. This independent review made clear the lessons that must be learnt and a consequential focus arose on improving the safety of maternity services in England. The catastrophic failings of several other trusts have also been well documented.
Despite a commitment to improving the maternity services provided by the NHS and a welcomed 30% fall in neonatal deaths and 25% drop in stillbirths over the last decade, it is simply not enough given the estimated preventable 1,000 babies that die every year as a result of poor maternity services.
The report summarised that the services provided by maternity units across England are labelled as ‘requires improvement’. An extremely concerning finding. In fact, more than a third of the specific ratings for maternity services identified requirements to improve safety, larger than in any other speciality.
Professor Ted Baker, Chief Inspector of hospitals for the Care Quality Commission, an independent regulator of health and social care in England comments that:
Enduring problems included a defensive culture, dysfunctional teams and poor quality investigations without learning taking place.
The report published earlier this week focuses on the following matters:
Lack of Staff
It was concluded that lack of staff is the main reason maternity care can prove unsafe. There was much commentary on how this can be improved. There is no doubt that appropriate staffing levels are a prerequisite for ensuring safety. MPs say that maternity units are short of 1,932 midwives and 496 senior doctors. In a recent survey, 80% of midwives told the Royal College of Midwives that they believed there were too few staff to ensure safe care.
The Department of Health and Social Care have committed to fund the Royal College of Obstetricians and Gynaecologists to develop a tool that trusts can use to calculate workforce requirements, it is hoped to be in place by autumn 2021.
Family involvement in investigations
Much scrutiny has fallen to the way the trusts handle incidents involving poor maternity services. The Morecambe Bay Investigation found that the response by the trust to maternity incidents was ‘grossly deficient’ and that there had been a ‘repeated failure to investigate and properly learn lessons’. The first Ockden Report reviewing maternity care at the Shrewsbury and Telford Hospital NHS Trust echoed similar concerns, describing investigations as ‘cursory’ and failing to identify underlying issues in maternity care with the evidence of blame instead being ‘shifted to errors’.
Professor Ted Baker, Chief Inspector of Hospitals, Care Quality Commission commented:
We have to accept the fact that humans are fallible, and that the professional response is to investigate thoroughly, openly and honestly to learn from that to try and prevent a similar mistake being made by others.
Involving families in a sensitive and compassionate way is a crucial part of the investigation process to consider how and why things went wrong. Too often, this is not done in a meaningful way. Families are not consulted and listened to, rather, the investigation is rushed and completed as a tick box exercise.
Families should be confident that their voices are heard, mistakes are acknowledged and lessons have been learnt. It is important that they are provided with appropriate, timely and compassionate support that they deserve to help them move forward.
Disparity in healthcare
It is extremely concerning to note references in the report to the persistent health inequalities experienced by women and babies from disadvantaged groups, resulting in poorer outcomes. An ongoing inquiry into racism in the health system was launched in February after researchers found that black women are four times more likely to die in childbirth in the UK.
Clea Harmer, chief executive of the stillbirth and neonatal death charity ‘Sands’ commented:
Babies should not be a higher risk of death simply because of their parents.
The report urges the government to introduce a target with a clear timeframe to address the disparity in relation to inequalities in maternal and neonatal outcomes. We await the outcome of the report considering inequalities in healthcare and hope that considerable steps are taken to investigate this fully.
It is hoped that Parliament will continue to investigate and analyse the safety and quality of maternity services provided by NHS England. The consequences of such avoidable failings are devastating for all involved and we hope that the trusts respond and react accordingly.
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