Only radical ideas will cut maternity tragedies – It will take more than just extra money to lower our scandalous rates of neonatal mortality

Jenni Russell in the Times reports May 11th 2017: Only radical ideas will cut maternity tragedies – It will take more than just extra money to lower our scandalous rates of neonatal mortality

nadequate, inefficient care on maternity wards is leaving babies disabled or dead, some mothers in pain or with long-lasting injuries, and one in six of them not feeling cared for or respected at an intensely vulnerable time. Other European countries have much better results. Our infant mortality rate is 50 per cent higher than Finland’s. The huge variations in deaths or serious incidents across England show that there’s nothing inevitable about these grim figures. Some tragedies and agonies are unavoidable but too many of ours are the result of errors.

This week a BBC investigation found that maternity units in England were making at least 1,400 mistakes a week. Bad as that sounds, it is an underestimate. England’s medical inspectorate, the Care Quality Commission, lists more than 128,000 reported safety incidents in maternity services in 2014-15, which amounts to around 2,500 every week. Even that’s unlikely to be the real total. The CQC says that some hospital trusts are reporting such low levels of serious incidents that their figures are statistically improbable.

That matters because if errors aren’t even being acknowledged then the systems that allow them to happen have no hope of being changed. No one doubts the deep desire of most staff to do their jobs well, but notes are being lost or muddled, painkilling injections given too late or in the wrong place, women are being left in labour for too long or induced too early and babies’ signs of distress aren’t being recognised in time. Of every 1,000 births, 11 incidents result in moderate harm, severe harm or death.

Everyone makes mistakes and no institution will ever be flawless, but on maternity units the consequence of a few minutes of carelessness can ruin lives for ever.

One of my friends was pregnant with her third child when contractions began in her seventh month. At the hospital an irritated midwife told her the unit was full, she was imagining it, and sent her away.

A few hours later, with her husband on the other side of the world on business and the contractions getting sharper, she took a taxi to the hospital and was sent away again. The third time she returned the exasperated midwives decided she was troublesome and put her in a room on her own without supervision. She had to ring frantically to get their attention when her very premature baby began to be born. Because no one was monitoring her, her baby was starved of oxygen. It was only a few months later that she was told, carelessly, that her baby had cerebral palsy, was probably severely brain damaged and would never walk.

I doubt that my friend’s tragedy even figured in any hospital statistics; the gap between birth and diagnosis was too great. She didn’t sue, although she had to give up work to spend eight hours a day for years giving remedial therapy to her daughter, who struggles to read and is paralysed from the waist down. Any event like this saddens and constrains much more than one life. My friend’s other children have had to grow up with a mother who is inevitably preoccupied by her most needy child, and with the knowledge that when their parents die the responsibility for their sister will pass to them.

The government knows it has a problem. Two years ago the health secretary set a target of halving neonatal deaths by 2030. Its own inspectors report that only 2 per cent of maternity units are rated outstanding for safety and only half are good. The question is why disasters happen and what we can do to make them rarer.

The midwives’ union argues forcefully that one of the principal reasons is the lack of midwives on wards. Mothers consistently report that they wanted more care than harassed staff could provide; a third didn’t get the attention they needed. Midwives argue that on the international standard of one midwife for every 29.5 births England should employ 3,500 more midwives than its current full-time equivalent of almost 22,000.

Image result for maternal death cartoon

There is a logic to the midwives’ argument, both in terms of care and expense. Birth-injury claims against the NHS are so costly that they amounted to half the total, more than £3 billion, from 2000-10. Around 40 per cent will fail, some will be reduced, but if only half the claims are met that comes to £150 million a year — much the same as the cost of the extra midwives.

Changing the way maternity services work, not just expanding them, may be a smarter, cheaper solution. The government’s national maternity review, which reported last year, concluded that radical changes including teamwork, learning and more low-risk births at home would cut both costs and mistakes.

Midwives spent a lot of time on paperwork but much of it was useless; it should be cut out. Units could follow a lead from Birmingham, which created maternity support workers to assist at home births instead of a second midwife. Hampshire installed a 24-hour midwife call line at its ambulance service — in a year it diverted 18,000 calls from labour units and the 999 service, and cut unnecessary ambulance trips. Creating a rapid-resolution payout system like the one Sweden operates for injuries would avoid the courts, let institutions learn fast from their mistakes, and reduce costs, harm and deaths.

The key to better care is not more money for more of the same, but imagination and innovation from those working on the frontline, targeted spending and openness to new ideas. The lives and happiness of thousands of mothers and babies rest on it.

Image result for maternal death cartoon


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About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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