Broken Forms
of Health Care

An independent report has highlighted a huge variation in the quality of maternity care across England.

Trusts in London came out particularly badly, something that Sam Brown experienced firsthand when she gave birth to her first child.

She had been due to go into the midwife unit at her local hospital in East London but when she went into labour, staff shortages meant she ended up on the main labour ward.

She was then left to her own devices.

Feeling the need to push, Sam sent her fiancé, Adam, to fetch a midwife.

"I will never forget this. She said: 'You're in a dream world girl, it's your first child, it's going to be hours'.

"They didn't talk to me like I was a real person, the fact I wanted help was a real inconvenience to them."

A passing cleaner had to tell her how to use the gas and air and the entire hospital was "filthy", she says.

After about 40 minutes of being left in agony and "absolutely terrified", Adam called for another midwife who had just come on shift.

It was then discovered the baby's heart rate had started to drop and the consultant was called ...

BBC NEWS 25 January 2008

The Liberal Democrats have uncovered figures revealing how much the workload of midwives has increased in the last six years, with midwives in some areas having to deal with up to 25% more births each since 2001.

Figures from Parliamentary Questions show the number of births per midwife across England has increased:

England overall: 6.5%
East Midlands: 25%
South Central: 19%
North East: 16%
South West: 15%
Yorkshire and the Humber: 10%
West Midlands: 10%
North West: 8%

Commenting, Liberal Democrat Shadow Health Secretary, Norman Lamb said:

"These figures show that our maternity services are under huge strain around the country.

"There simply aren’t enough midwives to deliver on the Government’s promises of one-to-one maternity care.

"With the birth rate rising and many midwives set to retire over the next decade, the situation will only get worse. A chronic shortage of midwives could also force the closure of small childbirth centres across the country.

"The Government needs to stop burying its head in the sand and launch a national review of capacity in maternity services."

Lib-Dems 09 January 2008

Scores of premature babies may be dying unnecessarily across England because the NHS mismanaged a reform of neonatal units in 2003, parliament's spending watchdog reveals today.

Health ministers provided £73m over three years to link up hospital neonatal units in 23 regional networks that could provide specialist services to save premature and low birth weight babies.

But the National Audit Office finds that the Department of Health did not issue instructions for the units to be adequately staffed. As a result the service was overstretched. Its specialist nursing workforce was nearly 10% below strength.

There were not enough cots to respond to every emergency and there was a lack of specialist 24-hour transport to move babies and mothers to other hospitals.

Jacqui Smith, when health minister in 2003, said she agreed with recommendations from the British Association for Perinatal Medicine for minimum staffing ratios. But the government did not order NHS trusts to implement them.

The NAO says there was "confusion" over whether staffing ratios were mandatory, making it difficult for unit managers to convince NHS trusts they needed more staff.

Half the 180 units providing neonatal services did not meet the approved ratio for high dependency care of one nurse to two babies. And only 24% met the intensive care ratio of one nurse to one baby. ...

The Guardian 19 December 2007

Thousands of women are left alone during and shortly after labour, leaving them feeling vulnerable and potentially at risk, a survey shows.

A Healthcare Commission poll of 26,000 women found one in four had felt worried when left alone by medics.

Midwives said the findings raised concerns as one-to-one care was key to spotting problems that may arise.

The poll also identified significant variations in care among 148 NHS trusts across England. ...

Louise Silverton, of the Royal College of Midwives, said: "It is a serious concern that too many women are left alone during labour, leaving them feeling worried and vulnerable.

"The main way to solve these problems is simply to improve midwife numbers.

"Without this the government's targets will just be broken promises, and we have seen this too often in the past." ...

BBC NEWS 27 November 2007

... the price paid by the NHS for deliveries going catastrophically wrong has risen 59 per cent to £259m – enough to fund the consultants and midwives needed to save thousands of babies and mothers from harm.

The dangers of childbirth in the modern health service are highlighted today by figures showing that £665m has been paid out over the past three years to settle medical negligence claims where obstetric deliveries have gone catastrophically wrong.

The size of the payout – enough to hire 1,000 extra consultants – reflects the enormous and growing burden of medical negligence on the health service, which is diverting scarce resources from patient care. ...

Last year, for the first time, the NHS Litigation Authority ranked maternity units in a league table according to their level of risk, based on a new standard for maternity care. Out of 154 maternity units in England, 18 are currently ranked Level 3 (the safest) and 54 are ranked Level 1 (least safe), with the remainder ranked Level 2. ...

The Independent 08 October 2007

The Health Secretary has approved plans to close “vital” hospital services, which will cost lives, an MP has said.

A long-running review of NHS services in Greater Manchester and Cheshire ended yesterday with Alan Johnson’s endorsement of an independent panel’s recommendation to close maternity units at Fairfield in Bury, Rochdale Infirmary, Trafford and Salford Hope. Salford will also lose its neonatal intensive-care unit.

The Independent Reconfiguration Panel has also backed plans to down-grade Rochdale’s accident and emergency unit and end emergency surgery at Fairfield Hospital.

The changes are expected to happen within five years and are likely to mean more home births and deliveries in units staffed by midwives. ...

Sunday Times 26 August 2007

No doubt Alan "postman pat", will not make his constituents suffer the same indignity. Will he sleep at night when the first deaths occur in direct response to these cuts?

roger, york

Up to 1,000 babies that are born dead each year could be saved if doctors and midwives were better trained to spot vital warning signs, according to one of the UK's leading experts on stillbirths. Health experts say the numbers of stillbirths in the UK are alarmingly high – 10 times the level of cot deaths – and most are unexplained.

New research to be presented at an international conference in Birmingham next week will hear that "sub-optimal care" is a key factor in many of the deaths. In many cases, midwives are having to deal with too many births.

The conference will hear important new evidence of a vital link between foetal growth restriction and stillbirths that can provide doctors with an early warning system that could save countless lives and spare families the loss of a child.

Almost 4,000 babies were stillborn in Britain last year according to the latest government figures. Despite falling since the 1960s, the rate of stillbirths has remained stubbornly unchanged for more than a decade ...

The Independent 23 September 2007

Just months after the IoS highlighted the crisis facing Britain's maternity services, a row has broken out over the Government's decision to axe bursaries for trainee midwives at a time when the profession is desperately short of staff.

Dame Karlene Davis, general secretary of the Royal College of Midwives (RCM), said: "The Government's decision to scrap bursaries for trainee midwives and further limit job opportunities after they qualify, while leaving them to deal with chronic shortages across the country, multiple closures of maternity units and a rising birth rate, smacks of hypocrisy." ...

The Independent 23 September 2007

The health secretary, Alan Johnson, yesterday chose the eve of a bank holiday weekend to announce the closure of a series of maternity units across the Greater Manchester area.

Among the units to be axed is the one at Hope hospital, which is in the Salford constituency of Mr Johnson's cabinet colleague, the communities secretary, Hazel Blears. Its threatened closure last year prompted Ms Blears to break with the government and join a picket line in protest. However, the group which advised Mr Johnson recommended that Ms Blears's constituency should still have a stand-alone midwifery unit. ...

The Guardian 25 August 2007

A government plan to cut senior staff in paediatric wards and neonatal units and replace them with trainee doctors will put infants at risk, doctors and patient groups have warned.

Under the Government's controversial Modernising Medical Careers (MMC) programme, senior staff on some paediatric wards will be replaced by trainee doctors from August.

The move is part of a government plan to reform training for NHS doctors. Patricia Hewitt, the Secretary of State for Health, said recently that this was needed "not just for junior doctors themselves, the workhorses of the NHS working quite outrageously long hours, but also for the sake of patients".

Busy paediatric wards have up to seven specialist paediatric senior house officers (SHOs) - doctors with up to four years' experience. Most could be replaced under MMC.

In future, trainee doctors with one or two years' experience will spend four months in paediatrics before moving on to another specialism, and would not necessarily have any interest in that area of medicine.

The move has alarming implications for the 45,000 babies born prematurely each year. Babies born at 23 weeks have a 17 per cent chance of survival and require expert medical support, while half of all babies born before 30 weeks suffer from apnea, which causes them to stop breathing. ...

The Independent 17 June 2007

Extra workers drafted in to help hard-pressed midwives could actually be putting mothers and babies at more risk, a report has claimed. Maternity support staff are supposed to free up midwives' time by helping with paperwork and non-clinical duties.

However, Kings College London found some trusts in England try to use them to care for pregnant women, even though they are not sufficiently trained. Experts stressed support staff should never replace midwives or doctors. ...

BBC NEWS 29 May 2007

Maternity Support Staff, or maternity care assistants, were first introduced into the NHS in 2005 in response to growing concerns over staffing on maternity wards. ...

The new role was brought in to ease midwife workload by taking some of their duties. While this varied from hospital to hospital, this could mean anything from clerical work and answering the telephone, to helping out in ante-natal clinics by helping to run parentcraft classes and accompanying midwives on community visits. ...

BBC NEWS 29 May 2007

The Royal College of Midwives says the shortage of staff and facilities on labour wards has reached "crisis" point. The Royal College of Obstetricians has warned of a lack of skilled obstetricians and a looming recruitment crisis as the number of UK medical graduates choosing obstetrics has halved in a decade. On Wednesday, MPs demanded urgent action to address the problem in a Commons debate. A BBC Panorama programme broadcast this week, filmed undercover in two hospitals in north London and Manchester, claimed wards were buckling under the midwife shortage. ...

The Department of Health says that there are 2,084 more midwives working in the NHS since 1997 (to 2006) and there has been a 44 per cent increase in students training to be midwives. The Royal College of Midwives says that though numbers rose in the earlier part of this period, they fell by 375 between 2004 and 2006. A poll of 102 out of 216 department heads found that two-thirds said their units were understaffed and one in five said they had lost staff in the past year.

The college complains that while other parts of the NHS have seen huge increases in staff and resources over the past decade, midwifery has not benefited to the same extent. The proportion of the NHS workforce represented by midwives dropped from 2.1 per cent in 1997 to 1.7 per cent inn 2005.

Doctors claim that only one midwife in three is working at any time, as more choose to work part-time for agencies, which supply staff to the NHS to cover holidays, sickness and unsocial hours. A midwife working long hours could potentially earn up to £80,000 a year at agency rates compared with £24,000 to £26,000 for the NHS. ...

The birth rate is going up. There were almost 50,000 extra births in England in 2005 compared with 2001, a 9 per cent increase in five years from 564,871 to 614,237. ...

The Independent 04 May 2007

Women may no longer be entitled to one-to-one care from a midwife during labour, after a shift in Government policy set to be announced this week.

The Royal College of Midwives says any plans to go back on earlier pledges by allowing hospitals to use cheaper and less-skilled maternity support workers will increase the risks for women and babies.

Several recent reports have suggested that standards of maternity provision are falling as NHS trusts battle huge deficits, and more women are encouraged to have their babies at home. One report by the Conservatives suggested that around one in six of England's 282 maternity units could be shut down.

In its 2005 manifesto Labour promised that by 2009 all women would be cared for by a midwife throughout the pregnancy, and receive continuous care during the delivery. But "Maternity Matters", the strategy to be announced by Patricia Hewitt, the Health Secretary, this week, is ex-pected to suggest that some women could give birth without the care of a midwife.

Ivan Lewis, the health minister, said "a skilled professional" - either a midwife or a maternity support worker - would be present throughout every birth. "What matters is that the woman feels she is well cared for," he said. ...

Telegraph.co.uk 02 April 2007

'I am horrified by the scale of the crisis in our maternity services. Choice has been rendered meaningless by midwife shortages .... There are beacons of hope, but I am convinced things will get worse before they get better. And that will be reflected not just in statistics, but in human tragedy."

This was my doom-laden conclusion to The Truth About Childbirth, a documentary I researched and presented for Channel 4 in the winter of 2004. A far cry from my habitual Sukie Sunbeam brand of blitheness. "Are you sure you want to set out such an apocalyptic vision?" asked one of the commissioning executives. It was as if he hadn't watched the rushes.

The programme explained that all childbirth professionals agree that the most important factor in labour was one-to-one continuous care - this came from midwives, obstetricians, the National Childbirth Trust and natural birth gurus. In other words, mothers should be attended throughout by a devoted birth professional - ideally, a trained midwife. In reality most maternity units were woefully understaffed and it was commonplace to hear of midwives running between four women in labour. The Royal College of Midwives said forlornly (and still does) that at least 10,000 extra practitioners are needed to bring the maternity services up to scratch. ...

The Independent 25 March 2007

The lives and health of thousands of women on maternity wards are being put at risk every year, with many suffering permanent physical and mental scars.

According to a study by the National Patient Safety Agency (NPSA) ... 18,000 mothers have been physically injured as a direct result of being in maternity care. This figure includes 246 cases where pregnant patients died and another 1,000 where women suffered "serious harm", including from perforated bowels during surgery. This means that in some cases women have needed a temporary colostomy.

The findings are based on the NPSA's study of 60,000 maternity care blunders that occurred between November 2003 and June 2006. Even the 10,000 injuries rated as "low harm" in the NPSA report, including perforated bowels repaired during birth, would be considered traumatic by most people.

The patient safety watchdog claims that the majority of women receive "high-quality maternity care" from the NHS. But experts insist that these complications and, in many cases, avoidable deaths of women during childbirth are a growing phenomenon. They blame them on a lack of qualified medical staff, including midwives and obstetricians, and the rise in the number of cases of Caesarean sections.

Professor Jason Gardosi, a senior obstetrician, said the problems with maternity care in the UK were "endemic", that the injury and death figures were "the tip of the iceberg" and that substandard medical care was not being detected because of a lack of proper monitoring.

04 March 2007

There has been a rise of 21 per cent in deaths of pregnant women in the care of NHS maternity services. Deaths over the past three years now total 391, up one fifth on the comparable period, and 17,000 women have suffered physical harm while on labour wards. ...

Experts are warning that 10,000 more midwives are needed to prevent a further rise in blunders and deaths. They say there is also a shortage of trained obstetricians, desperately needed now that doctors perform more Caesarean sections, largely because of staff shortages. More than one in five births in Britain are by Caesarean section, a figure significantly higher than World Health Organisation guideline of 15 per cent.

The NHS Institute for Innovation and Improvement, set up to improve healthcare for patients, said that about two-thirds of maternity units either have too few staff or have an "inappropriate" balance of skills.

Professor Jason Gardosi from the NHS's Perinatal Institute, which aims to reduce deaths in childbirth, warned that failings in British maternity care were "severe and endemic" and that substandard medical care was going undetected because of a lack of proper monitoring.

He told The Independent on Sunday: "Staff are doing their best within the confines they are given but in many instances, mothers and babies survive only because they are lucky. You would not allow an aeroplane to fly without a full crew, but midwives have to make do without a full staff. It is little wonder we see so many avoidable deaths." ...

The Independent 04 March 2007

Some English hospitals should be stripped of doctor-led maternity care and specialist children's services, a government adviser says.

Dr Sheila Shribman, the children and maternity tsar, calls for regional super-centres instead.

Hospitals that lose maternity units may get midwife-led services and more support for home births will be provided to give women greater choice.

Dr Shribman said the move would improve care, not damage it as critics say.

Some have argued that hospital cuts are being driven by NHS deficits - the health service finished last year over £500 million in the red.

But Dr Shribman said EU restrictions on working hours meant specialist services could not be safely provided in every local hospital. ...

BBC NEWS 06 February 2007