NHS maternity units continuing to ‘conceal’ and ‘disguise’ failings

But despite subsequent pledges and recommendations to improve safety standards on maternity units, both Dr Kirkup and Professor Ted Baker, chief inspector of hospitals at the Care Quality Commission (CQC), have said that certain services are continuing to put lives at risk as a result of inadequate health care.

The NHS has been warned that maternity units in England are attempting to “conceal” and “disguise” their failings, endangering the lives of women and their babies, with concern raised that “significant cultural issues” are prevalent throughout such services.

Dr Bill Kirkup, who chaired the inquiry into the Morecambe Bay scandal, told a parliamentary select committee on Tuesday that a number of units have failed to learn from the mistakes of the high-profile maternity crises that rocked the NHS over the past decade.

The warning came as MPs launched a new inquiry into the safety of maternity services in England. The Health and Social Care Committee is set to examine evidence relating to ongoing concerns at maternity services and explore what action is needed to establish a safer culture.

“I’m sure there is a spectrum of performance,” Dr Kirkup said. “There are some brilliant units, there are some good, not quite so good units – but generally speaking they are the ones that are learning and that are clearly improving in response to all the initiatives that there have been since the time of the Morecambe Bay investigation.

“My problem is that there are a few… that aren’t able to, or won’t, learn and improve.

“I’m sure there are all sorts of reasons, to do with clinical isolation and leadership and organisational culture. But I don’t think we’re very good at spotting a small number of units that are in serious difficulties and perhaps don’t even recognise it themselves.”

Dr Kirkup, whose 2015 report exposed a “lethal mix” of failings that led to the unnecessary deaths of one mother and 11 babies at Furness General Hospital in Cumbria, explained that at-risk maternity units were hiding their shortcomings.

“There are some units that actively conceal what they’re doing. When they get in sufficient trouble, their response is to stop communicating with the outside world and disguise the failings they’ve got,” he said.

“I think they do that with the intention that they can sort it out themselves before they have to tell anybody, but it’s quite difficult to get past that barrier I think when units get into that slippery slope.”

Professor Baker said under the CQC’s current ratings, 38 per cent of units in England require improvement for safety – a statistic which, he argued, reflects the “cultural issues” prevalent in many of the country’s maternity services.

“This is a significant number and larger than other specialities, and that is a reflection of the cultural issues in services nationally,” he told the health committee.

“Maternity services are improving, and it’s important to emphasise that, but my perception is that they’re not improving fast enough. They can improve faster. If you can compare to other countries in Europe, you can see we’re not improving as fast as we should.

“At the root of it all is the issue of culture.”

Pointing to a series of CQC inspections that were staged throughout 2017, Professor Baker said his team had identified problems in a “proportion of units” that mirrored the issues highlighted in the Morecambe Report.

“Those problems are of dysfunction, poor leadership, of poor culture, of parts of the services not working well together,” he said. “This is not just a few units, this is significant cultural issue across maternity services.”

Since the 2017 investigations, the CQC has identified eight maternity services that were “inadequate for safety” and nine units that were hampered by “major cultural issues”. Professor Baker said action was taken against all these services.

But he warned that these deep-seated issues could not be addressed “one service at time”, arguing that “this is a challenge for the whole system”. He said that the NHS, regulatory bodies and external organisations, such as the Royal Colleges, need to “work to work together to drive the cultural change we need to see to improve maternity services”.

Professor Baker pointed to three key areas that were central to the provision of safe and proper care: an “open and transparent” leadership culture that “recognises” and learns from errors in care; training into team dynamics and relations, to propagate a sense of cohesion and understanding between staff; and the involvement of mothers in their own care plans.

The NHS has set a “bold ambition”, as committee chairman Jeremy Hunt put it, of halving all birth safety incidents by 2025. However, he pointed to research from Sands, the stillbirth and neonatal death charity, which shows that 14 babies still die every day before, during or soon after birth.

In response, Professor Jacqueline Dunkley Bent, chief midwifery office for NHS England and NHS Improvement, said that maternity units were moving in the right direction.

“First of all the safety of pregnant women, their babies and their families has been and always be an absolute priority,” she said. “We are working really hard to make sure we achieve that ambition.”

She said that between 2010 and 2018, there had been a 21 per cent fall in the still birth rate, meaning that the NHS in England had reached its 2020 reduction target two years ahead of schedule. “This means, in terms of numbers, 2,900 fewer still births,” she said.

Data for 2019 showed a 25 per cent fall in this rate, Professor Dunkley Bent added. “But I recognise we still have a long way to go,” she said. “That’s illustration of the progress being made.”

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