Half of maternity units putting mothers and babies at risk

A story in today’s Mail makes for grim reading.

The paper has analysed inspection reports of the maternity services in 150 hospital trusts. Of those, the

Care Quality Commission (CQC) rated the safety aspect of 65 of those as “requiring improvement” and of 13 as “inadequate”. (The Mail’s report focuses on the safety ratings – the figures for the overall ratings are slightly different, with only eight rated inadequate.)

At those 13 hospitals, women and their babies are receiving poor care that may be putting their lives at risk.

Here’s an excerpt from the CQC’s report on the Addenbrookes maternity unit, carried out in September 2015:

“We found serious concerns regarding the safety arrangements in the maternity services which were not replicated in the gynaecology service. These related to the environment, equipment, lack of recording of risk assessments and substantial midwife shortages. There were continued thematic incidents reported, relating to fetal heart rate (FHR) monitoring, with limited evidence of changes in practice to improve safety. We found that the suitability, safety and maintenance of many types of equipment throughout maternity services were unsuitable.”

It goes on, alarmingly:

“In the birthing unit, the environment was also found to be unsafe owing to poor ventilation whereby high Nitrous Oxide (gas and air) levels exceeded the safe “Work Exposure Level” (WEL) which the trust had known about since 2013. In maternity, numerous and essential patient risk assessments including venous thromboembolism (VTE) and early warning score (EWS) assessments were not being completed. Staff raised concerns to us that the maternity record system was potentially unsafe due to a combination of electronic and paper records being in use and being used inconsistently.”

Most of these problems could be put right with proper staffing: the NHS urgently needs more midwives and obstetricians. But we also need to look at the cultural attitudes towards safety in the NHS. There is no good reason for not acting on the poor ventilation at Addenbrooke’s, or for the failure, reported by the CQC, to log incidents correctly at Wexham Park Hospital: “Incidents were not always being reported and there were accusations of improper downgrading of their severity alongside suggestions of defensive practice.”

The recent Cumberlege Review made important recommendations on safety. But this has happened before (not least in the RCOG’s Safer Childbirth report in 2007), and nothing has changed. At Morecambe Bay, 11 babies, and one mother, died unnecessarily over a nine-year period. Judging from the evidence of the CQC, we may be seeing yet more tragedies like Morecambe Bay.

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