Although we do not ration health care officially, we in reality give full funding to birth and only partial funding to hospice care and death. (luckily, a short journey for most of us) The shortage of midwives has been predicted for years, and concentration into centres of excellence seems pragmatic when so many births are to first time and elderly mums, (and therefore high risk short journeys). Closure or downgrading of some units is inevitable, especially now that so many are threatening to leave their health service.. There is little choice when there is a shortage of both midwives and obstetricians, and when the litigation is increasing… Compounding the problem is the threat of increasing Nurse and Midwifery debt.. 40% of maternity units are inadequately staffed (and some are so old they need replacing), so longer journeys will be necessary in rural areas.
FOUR in 10 maternity units recently visited by inspectors were found to be at risk of providing poor care.
The chief inspector of hospitals this weekend criticised an “unacceptable” variation in the quality of NHS maternity services after regulators reported concerns about care given to mothers and babies in 33 of the 83 units they visited.
Maternity units have been troubled for years by staff shortages and questions about safety, but the 83 inspections conducted since April 2014 suggest a widespread need for urgent changes.
Professor Sir Mike Richards, chief inspector of hospitals, said: “A significant number of units are providing or are at risk of providing elements of poor care. Almost a third are rated as ‘requires improvement’ . . . and about 5% are inadequate where we have the most serious concerns. This wide variation in the quality of maternity and gynaecology care in England is unacceptable.
“A lack of staffing, poor learning from incidents and poor culture and leadership have all contributed to ratings of requires improvement or inadequate.”
At East Sussex Healthcare NHS Trust, the Care Quality Commission (CQC) found staffing on the labour ward often fell below planned levels, women in labour did not have one-to-one care and mistakes continued to occur in monitoring the baby’s heart rate. It also found management at the trust seemed to be in denial, despite an earlier investigation highlighting the concerns.
The CQC report, published last month, said: “There was a lack of acceptance of the serious nature of the concerns we identified by the leadership of the maternity services . . . There was not a learning culture and incidents were not reviewed in sufficient depth to enable lessons to be learned and disseminated.”
East Sussex trust said it had put many improvements in place since the inspection but “acknowledges that there is still more to do and is committed to working hard . . . to make the necessary improvements”.
Another CQC report last month into maternity services at Cambridge University Hospitals NHS Foundation Trust found “serious concerns regarding the safety arrangements”, problems with foetal heart rate monitoring and an “unsafe” environment in the birthing unit.
The maternity unit was closed 37 times in 2013-15, mainly due to a shortage of midwives. Cambridge University Hospitals Trust said: “Despite the CQC findings we provide safe and high quality maternity services.”
A third report published by the CQC last month into West Hertfordshire Hospitals NHS Trust said mothers and babies were at risk from frequent staff shortages. The trust said it had improved staffing levels and safety since the inspection.
Last week a coroner called for a national review of staffing at high risk deliveries after finding that a baby might have survived if a more senior doctor had been present. Dr Peter Dean, the coroner for Suffolk, is writing to Dame Sally Davies, the chief medical officer, to ask whether consultants should attend high-risk deliveries.
In January Bonnie Strachan died half an hour after her birth at Ipswich Hospital. She was delivered in the breech position, meaning her legs came out first. After a delay in delivering her head, she emerged in poor condition and could not be resuscitated.
The doctor undertaking the delivery had experienced only two breech deliveries independently and the on-call consultant was not asked to attend.
Bonnie’s mother, Emma Strachan, 29, from near Framlingham, Suffolk, said: “Our baby girl was taken from us and Percy’s little sister was taken from him. The whole situation has affected us all physically, emotionally and socially.”
Guy Forster, the Strachans’ lawyer and a partner at law firm Irwin Mitchell, said Bonnie’s parents had opted for a natural birth in the belief that an experienced obstetrician would be there. “Bonnie was such a big baby that, according to national guidelines, a breech delivery was never advisable.”
Nick Hulme, chief executive of the Ipswich Hospital NHS Trust, where maternity services were rated as good by the CQC, said: “We are extremely sorry baby Bonnie died and . . . have made changes to our practices.”