A report has been published setting out steps which need to be taken in order to improve the safety of maternity services in England after a series of shocking failures were uncovered at NHS Trusts.
On 6 July 2021, Parliament published its “Safety of Maternity Services in England” report. The report is the result of an inquiry in which a range of issues were considered relating to the safety of maternity services in England. The inquiry was commenced after a concerning number of shocking failures were uncovered at NHS Trusts, initially in relation to the Morecambe Bay NHS Foundation Trust and later at Shrewsbury and Telford Hospital NHS Trust and the East Kent Hospitals University NHS Foundation Trust. The report highlights improvements that need to be made in order to improve the safety of maternity services in England.
Staffing and Training
The report concludes that staffing levels across maternity services “requires improvement”. It notes that currently 8 out of 10 midwives report that there are not sufficient members of staff on a shift to provide a safe service and it is recommended that approximately 496 additional obstetricians and 1932 more midwives are required to address the current staff shortfall. Another concern raised is the lack of a sufficient tool for measuring safe levels of staffing, although the Royal College of Obstetricians and Gynaecologists (RCOG) are currently developing this tool, after a large injection of funding (£2.5m) was announced earlier this week, and aim to have it in place by autumn 2021.
Training levels are also scrutinised in the report, with the implementation of training being described as “variable” across England. Whilst training is available, there are “inconsistent levels of uptake of the training specified by the Maternity Incentive Scheme”; this is often due to staffing and rota constraints.
The report makes specific recommendations which should enable maternity services to increase the take up of maternity training.
Denise Stephens, a Partner in the Thames Valley Clinical Negligence team, who specialises in managing claims relating to cerebral palsy and other birth injuries commented as follows:
“We welcome the recommendations in relation to increased staffing and increasing the uptake of training. More skilled obstetricians and midwives can only lead to a reduction in the risks to expectant mothers and babies”.
Patient Safety Incidents and Personalised Care
The report goes on to identify that maternity investigations fail to involve the impacted families in a compassionate manner and families are not confident that their stories are being heard nor that the lessons learnt from the care they have received are being implemented.
The report has rated personalised care as inadequate, with women not being provided clear information regarding safety risks and likelihood of interventions.
An area particular area of concern was the evidence of mothers who said that they were made to feel like a “failure” for having a Caesarean section. It was found that one of the failings at both Morcombe Bay and Shrewsbury and Telford was the ideology that a “normal birth” should be achieved at any cost, rather than, more appropriately, the birth being a “safe birth”, with the report urging the end of the phrasing “normal birth” for vaginal delivery as this is an unhelpful and potentially damaging term. The report also expresses concern that maternity units appear to have been penalised for high Caesarean section rates and recommends an immediate end to the use of total Caesarean section percentages as a metric for maternity services.
Denise Stephens, further commented:
“It is very disappointing to see how many families feel that they are not being listened to. Their experiences can provide valuable insight into the improvement of patient care and appropriate listening is likely to result in fewer negative outcomes. I welcome the objective of a greater focus on both knowledge sharing and patient experience and the report’s recommendations, if implemented, should lead to a reduction in both maternal and baby deaths.
Many patients will benefit form more personalised care plan and earlier, frank discussion that their original birth plan may no longer be the best option for a safe outcome. I hope that the implementation of the report’s recommendations will lead to a reduction in children suffering from severe brain damage as a result of birth injury”.