‘An aircraft would not take off without the correct crew, but maternity services do this every day’
Major reforms to the way maternity care is provided to women in England is being forced through by NHS bosses, with maternity unit staff put under pressure and safety concerns dismissed, according to the team investigating the largest maternity scandal in NHS history.
In a damning critique of NHS Engeland’s approach to its new “continuity of carer” model, the Shrewsbury and Telford inquiry team said the model had been introduced without enough midwives in place meaning the safety of women and babies was at risk.
Under continuity of carer (CoC), expectant mothers are provided with a named community midwife throughout their pregnancy and who attends the birth.
But critics say the rollout has created a two-tier system with women in hospital facing long delays because the wards lack enough staff.
In April, a senior doctor at the Worcestershire Royal Hospital was censored after raising the alarm over the changes, which she said were leaving wards dangerously understaffed.
Die Royal College of Midwives (RCM) vertel Die Onafhanklike “there simply aren’t enough midwives for it to be embedded safely”.
The Shrewsbury inquiry team argued a dogma of the CoC model has taken hold within senior levels at NHS England, with bosses reluctant to hear concerns about the problems it is causing on the frontline.
In a six-page dossier submitted to MPs on the health committee and seen by Die Onafhanklike, the team investigating the 1,862 cases of poor maternity care at the Shrewsbury NHS trust, said they had received concerns from across the country.
They warned: “The maternity review team believe that CoC is being used as the panacea for improving maternity care provision, maternity care outcomes and women’s birth experiences.
“A change of this magnitude must come with the staffing resources to facilitate it and the ears to hear when safety concerns are raised. Our concerns are focussed on an ambition which has been rolled out with the expectation to implement with what appears to be limited thought given to the impact on the workforce providing the service.”
The team, led by expert midwife Donna Ockenden, added they had heard examples of senior midwives in trusts trying to escalate their concerns to regional chief midwives, but were shot down and labelled as obstructive to the “national maternity vision”.
They said heads of maternity services had told them they had been “heavily criticised” for trying to implement the changes by their trust boards too because of the costs adding: “The heads of maternity services have then subsequently been criticised by their regional CoC leads for not meeting the ambition and percentage targets.
“In order to meet the targets, CoC for many trusts has evolved into a tick box exercise with examples of inequalities in the care given to women. When this has been raised as a safety concern by those responsible for leading maternity services they have been described as being obstructive to change.”
They added: “Every single day we are aware of labour wards that are insufficiently staffed. This is now often accepted as the norm and this lends itself to increasing numbers of patient safety incidents. An aircraft would not take off without the correct crew, but maternity services do this every day.”
They said it was their “unanimous view that we need to refocus on the maternity system’s national ambition of aiming to achieve a year on year reduction in both maternal and neonatal morbidity which means providing safe maternity care across the continuum.”
The Shrewsbury inquiry team includes midwives, obstetricians and neonatologists from 20 different NHS trusts across England.
Their concerns have been echoed by the RCM, which said it had received multiple reports from maternity units of changes being made without enough staff, with little consultation and with managers unable to challenged “top-down targets”.
Gill Walton. chief executive at the RCM said: “While the RCM wholeheartedly supports the concept of midwifery continuity of carer, we cannot currently support the implementation because there simply aren’t enough midwives for it to be embedded safely.
“RCM members across the UK are consistently telling us that attempting to deliver that type of care was putting dangerous stress and strain on the safety of services. We have shared this insight consistently with NHS England and also in writing to England’s chief midwifery officer, Jacqueline Dunkley-Bent.”
She said the changes could not be done “on a shoestring” when there was already a shortage of 2,000 midwives.
“We want continuity of carer to work – we know that the evidence shows that it’s better for women and babies – but imposing it without the proper foundations is setting it up to fail.”
NHS England wants 75 per cent of women from ethnic minority and deprived communities to be covered by the CoC model by 2024, with a majority of all women under the model this year. The rollout began with a target of 20 per cent of women in 2019.
It has given maternity services an extra £96m this year, including £47m to recruit an extra 1,000 midwives. Health Education England (HEE) has pledged to train an extra 3,650 student midwives by 2023.
Die Onafhanklike asked NHS England for a response to the claim its senior leaders were shooting down safety concerns, but it did not respond specifically to that question.
In a statement a spokesperson said: “The evidence is clear – having the same carer before, during and after pregnancy reduces the chances of losing a baby and increases women’s sense of trust in the care they receive, and these better health outcomes for mother and child are why the NHS is determined to ensure more women benefit.
“The NHS has made £96m available to trusts following the findings in the Ockenden Review – most of which will go towards expanding capacity – while our planning guidance provides trusts with clear information on how to improve maternity care for mothers and their babies, including the requirement to have appropriate staffing levels in place before continuity of care is implemented.”