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Jeremy Hunt calls for maternity safety enquiry
Former Health Secretary, Jeremy Hunt, has called for an independent enquiry into maternity safety in the NHS. According to The Independent, he is calling for a probe into why poor care and cover-ups are being repeated at different hospitals to find out why mistakes are repeating themselves. He is quoted as voicing concerns about whether the safety of mothers and babies is being compromised by a mistaken obsession with ‘normal births’ leading to delays in performing caesarean sections.
Remarkably, Britain’s longest serving former Health Secretary is quoted as saying that he feels liberated since leaving government and intends to criticise the government when he believes they are not delivering on their commitments. In this case, however, his amply justified criticism of the NHS’s inability to learn from previous mistakes and previous independent enquiries into those mistakes, and its repeated, unacceptable failings in maternity safety, reflect promises that were made, and not delivered, under his leadership.
Could it be that, in his new role as Chair of the Health and Social Care Select Committee, Jeremy Hunt can finally make a difference to NHS maternity care? His call for yet another investigation into NHS maternity safety finally suggests some recognition of the real issues threatening NHS maternity safety: a mistaken obsession with ‘normal births’; delayed caesarean sections; covering up rather than learning from mistakes. The problem is that we have heard it all before.
The right method of delivery for you – no such thing as a ‘normal birth’
In 2017, I wrote about the dangers of the Royal College of Midwives’ (RCM) Normal Birth Campaign to promote what they called ‘normal births’. RCM announced in August 2017 that they were discontinuing their campaign. The move was part of a ‘Better Births’ initiative to improve maternity care for all women, including those with medical complications for whom an unassisted vaginal birth might not be appropriate.
The damage done by a ‘growing move amongst midwives to promote normal childbirth at any cost’ had been revealed during the 2015 Morecambe Bay Investigation. This obsession with ‘normal births’ combined with other ‘lethal’ deficiencies, including poor working relationships between doctors and midwives, resulted in the avoidable deaths of babies and mothers at Furness General Hospital’s “dysfunctional” maternity unit. The Nursing and Midwifery Council (NMC) investigated the midwives who were at the heart of the problem but, as Secretary of State for Health, Jeremy Hunt then ordered an investigation into the NMC’s poor handling of those complaints.
In 2020, the ’normal birth’ obsession to which Jeremy Hunt refers still threatens the safety of women and babies in NHS maternity units. Any preference for unassisted vaginal delivery must be reviewed with the mother and necessary action taken to protect the mother and baby’s safety when risks or complications arise during the labour and delivery. Other methods of delivery, such as forceps, Ventouse (suction) or caesarean section may be the only way of avoiding catastrophic harm.
Maternal and infant safety following detection of abnormalities in the baby’s heart-rate, cord compression, uterine rupture, abruption and other obstetric emergencies need midwives to be open- minded and act quickly. They must be willing and able to seek help urgently from maternity care doctors (obstetricians) and support decisions for intervention by assisted delivery or caesarean section when these are needed to perform a safe delivery. The midwife’s swift action in recognising potential problems and calling for medical help can be the difference between a healthy baby and devastating injury or death.
Delay in delivery
In 2017, I wrote about NHS Resolution’s five-year review of cerebral palsy claims, Five Years of Cerebral Palsy Claims: A thematic review of NHS Resolution Data.
This was a review of 50 maternity incidents which had led to successful cerebral palsy compensation claims. In each of these the NHS had admitted liability. In each case a baby had suffered catastrophic brain injury.
The review revealed repeated and increasingly common themes in the maternity care failings. These included errors in fetal heart monitoring, including misinterpretation of CTG traces, failure to electronically monitor women at high risk or who become high risk during labour, use of false reassurance or wait-and-see approaches to uninterpretable traces. Failings in teamwork resulted in lack of escalation of urgent or emergency situations. Untrained or inexperienced doctors were left to handle vaginal breech births with no immediate access to help from more experienced consultant colleagues. Each of these errors led to delay in the delivery of a baby who suffered brain damage which would have been avoided without the negligent delay.
Learn from mistakes by investigating properly
In addition to mistakes in care, the five-year review criticised the way individual NHS organisations and the NHS as a whole reacts after mistakes are made in maternity care. It criticised poor quality local (NHS Trust level) investigations for failing to involve (or in some cases failing to inform) parents of the injured children in the investigation. It found that investigations focussed on blaming individuals whilst failing to address organisational or system-wide causes for errors, which meant that nothing would change as a result of the investigation.
The report highlighted that its findings echoed those of previous investigations, including Morecambe Bay and Each Baby Counts, and reflected that little appeared to have changed. I questioned at the time whether, given the findings of this and other reports, the NHS was willing to face up to its mistakes and take responsibility for bringing about change. The lessons were available. Did it really want to learn?
Since then, initiatives to remove maternity safety investigation from local NHS organisations to HSIB, (along with an unsuccessful attempt to block parents from these investigations altogether via safe space investigations at HSSIB) have been roundly criticised, not least by the Parliamentary Joint Committee. Most recently, the NHS’s defence team, NHS Resolution, is facing calls from patients’ lawyers’ group, APIL, to answer criticisms about its own efforts to block parents’ access to independent legal advice after their babies have been brain injured by maternity mistakes.
Does the NHS want to learn?
Former Health Secretary, Jeremy Hunt, seems to have his doubts. The evidence from countless enquiries, investigations and reviews certainly supports his misgivings. We can only hope that the recent shocking revelations of the number of families harmed by maternity safety incidents at Shrewsbury and Telford, and at East Kent act as a catalyst for meaningful action to be taken within the NHS to raise standards of maternity care and put an end to the harm.
Compensation for mothers and babies injured by maternity mistakes
For over 30 years Boyes Turner have helped countless babies and their families recover substantial compensation for cerebral palsy and severe neurological injury following maternity and neonatal negligence. We understand the causes of these injuries and are highly skilled in recognising where midwifery, obstetric, and neonatal care mistakes have been made and obtaining top level compensation for our clients.
Our nationally recognised expertise in these claims enables us to obtain faster NHS admissions of liability and larger interim payments sooner, meaning that we can quickly make a real difference to our client families’ lives. The help that we can give our clients includes money to pay for care, adapted accommodation, essential equipment and therapies, assistive technology and special education and recovering a lifetime of lost earnings. In most cases our client’s compensation for care is paid in a way that guarantees it will last throughout their life, bringing valuable peace of mind to their family.
In cases involving negligent maternal death, our bereaved families find that compensation provides valuable help with difficult adjustments, including child care and domestic help and replacement of lost earnings, at what is a very difficult time.
If you are caring for a child with brain injury or have suffered serious injury as a result of medical negligence, and would like to find out more about how compensation can help, contact us by email on email@example.com.
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DR PETER DEAR