A brief snapshot of how maternity services in the West Midlands are faring in the wake of the CQC’s ongoing national maternity inspection programme, reveals a mixed picture. Of those in Birmingham, Coventry and Warwickshire that have been inspected to date, three require improvement, two are rated good, and one (Birmingham Heartlands Hospital) has been rated inadequate. Another (the George Eliot) is currently being inspected. The CQC’s England-wide inspection programme started last summer (July 2022) with the intention of giving maternity units an objective assessment of what they were doing well and where they needed to improve while highlighting the challenges they are facing. As I noted in my blog last month, maternity is the one area of the health service where there is no shortage of analysis of its successes and failures.
A merry-go-round of recommendations
A brief look at the Royal College of Obstetricians and Gynaecologists' website reveals a raft of reports, reviews, inquiries and surveys produced by a range of bodies and committees in the past five years where the same themes relating to the care of mothers and babies resurface time after time. Poor communication; lack of resources; inadequate staffing levels; low staff morale; ineffective leadership; and poor behaviour between members of staff, including a lack of collaboration between doctors and midwives, the list feels endless. It’s hardly surprising that the East Kent Report declined to make specific recommendations: Dr Kirkup stated that “NHS trusts already have many recommendations and action plans resulting from previous initiatives and investigations, and we have no desire to add to their burden with further detailed recommendations that would inevitably repeat those made previously, or conflict with them, or both. We take those previous recommendations and the resulting policy initiatives as a given.”
Good hospitals lead by example and practice
So far, so depressing. But there is a glimmer of hope in an ocean of criticism. Take the hospitals in the West Midlands region I’ve referred to above. Although Heartlands has had the book thrown at it, the maternity unit at University Hospitals Coventry & Warwickshire has, by contrast, been rated good, with its leadership labelled outstanding (the first Trust to receive the accolade). The CQC noted that the Trust “provided very good care to women, birthing people and their babies, that was led by extremely committed, visible, approachable and effective leaders who prioritised safety and engaged well with staff, women and families.”
It seems to me that if you have hospitals (relatively) close to each other where one has more successful outcomes in one area of practice than the others, there is an obvious learning opportunity whether through secondment, mentoring, best practice training, a buddy system, or other initiative. I appreciate that hospitals want to retain their autonomy and their identity – and some of the issues uncovered at Heartlands are a result of its absorption into of the University Hospitals Birmingham Trust which has negatively affected staff and management morale – but common sense should prevail with resources and best practice pooled for everyone’s benefit.
Inspection reveals common themes
In February, the CQC issued an interim news report, identifying the key themes that had emerged to date. For those with the task of forming national action plans to help hospital maternity units tackle the challenges uncovered by the inspection programme, the good news is that its findings revealed nothing particularly new or surprising. Improving communication, both with patients and between staff, providing personalised care, improving culture, training, leadership, and staffing were common threads – and have been repeatedly identified elsewhere as areas for focus by endless reports and policy recommendations.
Staffing is the NHS’s Achilles heel
Extra funding, of course, will help but as the Heartlands inspection showed, simple actions such as following a surgical checklist correctly requires care and concentration, not money. Nonetheless overworked and undervalued staff will always be a healthcare provider’s Achilles heel. Until there is a coherent plan and funding in place to train enough doctors, nurses, and midwives to resource our healthcare system properly, the service will continue to rely on a patchwork of locums, agency staff and overseas recruitment to shore up the NHS.
Of course, as every medical negligence lawyer knows only too well, giving birth in this country is safe but when it goes wrong, it can go very, very wrong with a potentially catastrophic outcome for babies and their families. The CQC inspection has already identified plenty of good practice among the maternity units visited. The challenge is ensuring that this is mirrored in units lagging behind.
Having acted on behalf of families affected by their treatment in various maternity units, I would be happy to chat through the options open to you if you have any concerns about the standard of maternity care you have received.