People’s Assembly NHS march, central London 3rd February 2018. Photo by Steve Eason.

Maternity Care in Crisis

The number of cases of mother and baby deaths and injuries being investigated at NHS hospitals in Shropshire has risen dramatically. Shropshire Defend Our NHS has provided information to the Ockenden inquiry, which led to an increase in its scope. Information and analysis via Pete Gillard and Gill George.

At least 104 families have now come forward for their cases to be considered as part of an independent inquiry into maternity care at the Shrewsbury and Telford NHS Trust (SaTH) in Shropshire. The Ockenden Review was announced in April 2017 in response to 23 cases, but the number of cases in which “women, infants and new-born babies had died or suffered harm” to be included in the inquiry has kept climbing. The Care Quality Commission (CQC) has now issued an enforcement notice against SaTH over their appalling record in maternity services. The Health Service Journal reports that the numbers are still expected to increase even further.

“The alleged poor care includes the deaths of babies and mothers as well as stillbirths and new-borns being left with significant brain damage. The cases are believed to span more than two decades with some of the most recent deaths taking place in December last year when a mother and two babies died in separate incidents.” (HSJ)

The causes of the crisis are complex. We’re looking here at ‘systemic failure’ – at a maternity service that has failed to support local women and babies and failed to support the staff who care for them in multiple ways. Responsibility for that rests with the Senior Management Team at SaTH, and with the Head of Midwifery, who seems to have cheerfully gone along with every cost-cutting exercise.

A significant part of the problem is ‘culture’, in a broad sense. The culture for many years in this service has been one of denial. Babies have died avoidably, and parents have been fobbed off with empty reassurances that ‘it was just one of those things’. If you won’t acknowledge that a problem exists in the first place, you can’t begin to tackle it. There is no culture of learning. The phrase that comes back, frighteningly often, from bereaved parents is that there was a ‘cover-up’. There is no established culture of listening to women either. Some of the most heart-breaking cases are when women have known that something is wrong with their baby – and they have been ignored.

That strand of misogyny extends to the treatment of midwives, in a service where most obstetric consultants are men. One obstetric consultant boasted to an expectant mother that he didn’t talk to midwives. Another told councillors and the public in a recent meeting that giving birth in a midwife-led unit is no safer than giving birth in a supermarket. Safe maternity care depends on joined-up working: on a relationship of trust and communication between obstetricians and midwives. You can’t create that when the attitude from some (male) consultants is one of open contempt towards their (female) midwife colleagues.

Cost-cutting is – unsurprisingly – a big part of the problem. SaTH runs an Obstetric Unit at Telford. Obstetric Units cost a lot of money. The research says that for women with low risk pregnancies, it is actually safer to give birth in a midwife-led unit than it is to use the medicalised environment of an Obstetric Unit. But because it’s so expensive to run the Obstetric Unit, SaTH has tried to reduce the ‘unit cost’ of Obstetric Unit births by forcing women to give birth in that medicalised environment – even when they don’t want to and it places them at higher risk. Part of the cost-cutting has been to deny choice to women in rural areas by closing the rural midwife-led units in Bridgnorth, Ludlow and Oswestry. Why? It saves £1.5 million a year. Choice and control – fundamental in child-birth and strongly linked to safety – are secondary.

The cost-cutting extends to staffing. The number of midwives at the main Obstetric Unit in Telford was steadily reduced between 2015 and 2017, as the Trust’s financial crisis escalated. When new midwives were finally recruited last year, the Trust focused on employing newly qualified staff because they are cheaper. The number of beds on the Delivery Ward and the Postnatal Ward has been increasingly inadequate, as more and more women are funnelled through the Obstetric Unit conveyor belt. Women report being treated as ‘a number on a bed’. Midwives also report the terrible stress of trying to provide decent care when you haven’t got the resources to do it.

It’s a toxic mix. It creates an environment where women are less likely to be heard, where midwives don’t get the training and support and back-up they need – and where signs that something is going wrong and a baby is in distress are much more likely to be missed. The NHS is very good at finding scapegoats when people are harmed by inadequate care. The danger here is that individual midwives will become convenient targets. This would be utterly wrong. Responsibility for the tragedies in SaTH’s maternity service lies with SaTH’s Chief Executive Simon Wright – and he is the man who must be held accountable.

People’s Assembly NHS march, central London 3rd February 2018. Photo by Steve Eason.

Much of what is emerging now is only in the public domain because of the heroism of bereaved parents who have fought for the truth and for justice for their babies. The parents of Kate Stanton-Davies who died in 2009 had to fight for eight years to get an apology. The independent report into Kate’s death said the trust “abdicated its responsibility”. On 19th September, the Chief Executive of SaTH was being questioned by the Health Overview and Scrutiny Committee over maternity deaths. He and his Director of Nursing chose not to say that SaTH had just been issued with an enforcement order over unsafe maternity care by the CQC. It was only because a health activist from Shopshire Defend Our NHS raised it from the floor at the end of the meeting that the committee was made aware. The health bosses had conveniently made a quick exit. Still, after all these years, the culture of dishonesty remains.

The news from Shropshire comes in the same week as the launch of a report by Maternity Action on migrant women’s experiences of maternity care in the NHS (which is available in full here: What Price Safe Motherhood?). As Home Secretary, Theresa May introduced charges for NHS secondary care under the raft of ‘hostile environment’ policies intended to marginalise migrants in every corner of society. Those who were made ineligible for free NHS treatment are charged the full cost of their care, as well as an additional 50% punitive surcharge. The charges reduce the likelihood that migrant women receive essential care, due to financial inaccessibility and fears of being reported to the Home Office. The hostile environment policies also contribute to stress and anxiety, which in turn has a negative effect on pregnancy outcomes.

The Maternity Action report details the experiences of 16 women with a range of immigration statuses who were deemed ineligible for free NHS care, some mistakenly. Women have avoided care due to fears of being detained or deported, been charged thousands of pounds they are in no position to pay, and received constant coercive phone calls from debt repayment companies. The report concluded that “NHS charging regulations are unworkable, unjust and harmful to women, especially those who are destitute, living in poverty or unable to earn a living.” Back in July, the same group wrote an open letter to the Health Secretary, signed by hundreds of people (including health practitioners and prominent trade unionists), demanding an end to charges for maternity care. They were ignored.

These events are testament to the racist and misogynistic weaponisation of the NHS under Theresa May’s hostile environment, and to the harm which is callously allowed to continue in the context of austerity and marketisation. The Chief Executive of SaTH must resign. There must be justice for the Shropshire families whose lives have been irreversibly changed – and there must be a safe service for women and babies going forward. Every aspect of the hostile environment and all charges for healthcare must be abolished.