Around the same time as the Health and Social Care Committee (HSCC) was publishing its report into the safety of maternity services, the Department for Health and Social Care (DHSC) announced an extra £2.45m to help improve maternity safety. Given what is at stake, this relatively modest sum will have to be deployed carefully if it is to restore public confidence following a series of widely publicised failings in maternity units over the last decade or so.
The Royal College of Obstetricians and Gynaecologists (RCOG), the principal recipient of the funds, will be working with the Royal College of Midwives and Cambridge University to help identify early warning signs that babies are in distress, and a workforce planning tool for maternity units to ensure they have the right staffing levels in place.
History keeps repeating itself
Over the last decade or so, there have been too many avoidable neonatal and maternal deaths across the NHS. Last year the CQC prosecuted the East Kent Hospitals University NHS Foundation Trust for the avoidable death of a baby following a caesarean section. In April 2021 the Trust pleaded guilty and was fined £700,000. The prosecution was the culmination of years of failings in the maternity unit, problems that were known about and investigated but not addressed until the parents of the baby who died campaigned for justice. This was similar to the Morecombe Bay Trust where it was only the tenacity of parents wanting answers that uncovered the years of neglect and poor care that had contributed to neonatal deaths and injuries.
The 2020 Ockenden Report into Shrewsbury and Telford NHS Trust’s maternity unit revealed a catalogue of sub-standard care being delivered; and, more recently the coroner examining the death of a baby (again during a caesarean section) at Nottingham University Hospitals NHS Trust (NUH) noted that it was "a clear and obvious case of neglect". NUH is already the focus of an ongoing, independent review into the death and serious injury of babies.
The catalogue of failings recorded in the wake of all these tragedies - poor culture, inadequate training, poor communication, insufficient staffing levels, a failure to involve parents, and a failure to embed the principle of patient safety – seem fated to recur time after time in spite of an oft-repeated commitment to improve.
Is £2.45m enough?
A recurring theme in all the blogs that I have written on shortcomings in maternity care is inadequate staffing levels. Without enough doctors, nurses and auxiliary staff, morale is repeatedly eroded by overwork, tiredness and stress. Corners are cut, patient safety jettisoned and patients and parents ignored. The HSCC report, recognising that properly staffed maternity units are critical to creating a functioning patient safety ethos, put the cost of employing enough staff at £250m - £300m. Although a fifth of this extra £2.45m will be used to develop a workforce planning tool to help units plan their staffing requirements, lack of funds to employ, or deploy, additional personnel – even if they are available - has the potential to derail the whole initiative. To put this extra funding into context, it is worth noting that compensation for a baby who is brain damaged during birth can be at least £10m – or four times the amount allocated.
Nonetheless, the investment of £2m to develop a best practice approach to monitoring the health of babies during labour in order to spot when they are in distress is certainly to be welcomed as is the intention to roll out lessons learned nationally. Lack of experience and inadequate training in the use of foetal heart monitors, a critical tool in labour management, was highlighted as an issue almost a decade ago and yet it continues to be an ongoing problem. But, as we have seen with so many NHS initiatives, warm words and good intentions rarely seem to morph into wholesale improvement.
Although this extra cash will be helpful, whether or not it changes anything in the long run remains to be seen. The vast majority of maternity units in the UK are safe but it only takes one dysfunctional unit to cast a shadow over the rest by undermining public confidence in the whole system. Properly staffed units would be a start: with enough pairs of hands to ensure that staff are not working to the limit, trusts can start to address other areas of concern such a blame culture which, it is widely acknowledged, stops people from being honest and open about mistakes and then learning from them.
If you have any concerns about medical negligence or the standard of maternity care you have received at any hospital, I would be happy to chat through the options open to you.