Maternity Services in the NHS - At breaking point or already broken? - Written by Andrea Ribchester-Hodgson

The Shrewsbury and Telford NHS Trust hit the news on 30/03/2022 when the final findings of the investigation into maternity services by Donna Ockenden were released.

Following complaints made over several years by patients and the families of those who had died it was finally determined that there were serious issues at the Trust which needed to be investigated but even the full extent of what had occurred was not appreciated. The investigation looked at nearly 1600 incidents over a 19 year period The final numbers have however shocked and appalled the nation.

Donna Ockenden is a senior midwife who was tasked with examining maternity practices at the Shrewsbury and Telford NHS Trust (SaTH) over a 20 year period.

She found that: -

• Babies' deaths were often not investigated
• Grieving parents were not listened to.
• Failures in care were repeated
• Some mothers were even blamed for their own deaths.

The report determined that 201 babies could have survived had the Trust provided better care. There were also 29 cases where babies suffered severe brain injuries, 65 incidents of cerebral palsy and the deaths of 9 mothers.

Further to the release of the report West Mercia Police have now stated that they are investigating around 600 cases of maternity care and exploring with medical experts and prosecutors whether there was evidence to support a criminal case against the trust or any individuals involved.

This is not the first NHS Trust scandal in the provision of maternity services, however. Previously the University Hospitals of Morecambe Bay NHS Foundation Trust, underwent investigation leading to the Kirkup report in March 2015 which found evidence of “substandard” clinical competence, “deficient” skills and knowledge and “extremely poor” working relationships between staff groups such as midwives, paediatricians and obstetricians. The report determined that 11 babies and a mother died avoidably between 2004 and 2012.

In 2021 the Morecambe Bay Trust was again told to make urgent improvements following an unannounced inspection prompted by whistle-blowers. The Care Quality Commission found that the improvements achieved since the original scandal erupted nearly a decade before had not been sustained, saying the unit “has deteriorated, affecting patients and staff”.

Only one day after the Ockenden report was released on 30/03/2022, there were further reports involving concerns in two other maternity services.

Nottingham University Hospitals (NUH) NHS Trust was reinspected in March 2022 having already been rated as 'inadequate' last year. A warning notice was then issued to the Trust by the CQC on 21/03/2022. The notice is issued when care "falls below what is legally required" and was stated to relate to care within triage services and monitoring once admitted.

Maternity services at the trust are already the subject of a review following criticism linked to baby deaths. The local clinical commissioning group (CCG) and NHS England is leading the review, which was announced last year following investigation into 46 babies suffering brain damage and 19 stillbirths in Nottingham between 2010 and 2020. The review team said the number of families taking part in the review had increased from 84 on 9 March to 387 on 22 March 2022.

Whilst in the Midwifery Led Unit in the Lagan Valley Hospital in Northern Ireland, the relevant Trust has "temporarily paused births". The trust said it was taking this action because of "concerns that have been raised about a very small number of cases who have birthed in the unit". The Trust confirmed the cases are under review and they are engaging with the families involved.

This is taking place against a background of staffing problems with the RCM having warned of a staffing crisis in October 2021 following an exodus of midwives from the profession due to understaffing and fears they cannot provide safe care to women in the current system.

A report published by NHS Digital in July 2021 revealed the number of NHS midwives working in England in May had fallen by almost 300 in just two months, the fastest fall for these two months for any of the years listed in the NHS report, which goes back to 20 years say the RCM.

One midwife was quoted as stating; “I feel that the maternity system is completely broken. In the unit I work in from the labour ward to antenatal and postnatal ward and community services, it’s broken and following a breakdown of a full-scale attempt at a midwifery continuity model”

Against the background of horror stories currently in the press it must be difficult for anyone who is pregnant or currently trying to have a baby to fully trust the service they are being provided by the NHS, markedly affecting what is supposed to be such a happy time. This can also only impact badly on those NHS staff who are providing good care and further cause such staff to be demoralised and leave the profession, adding to the current maternity staffing crisis.

It is difficult to see how the current crisis will be addressed and horrifyingly it is likely in the current circumstances that we will continue to see further instances of failings in maternity care being uncovered.

Clear Law has extensive experience of dealing with birth injury claims at a high level and solicitors at the firm are more than happy to discuss concerns anyone may have regarding the care that has been provided to them or their family.