No end in sight for strain on England’s maternity services

maternity_services 1Closures, budget and training cuts, and reduced services will continue to put mothers and babies at risk in maternity units across the UK in 2016.

Towards the end of last year the Royal College of Midwives (RCM) highlighted the intense pressure on maternity services following the insight provided by a survey of UK senior midwives (Heads of Midwifery).

The RCM said that maternity units face unprecedented challenges as a high birth-rate, increasingly complex births, and an acute shortage of midwives threatens the quality of NHS services.

With staff pushed to their limits in busy maternity wards and no relief in sight through extra funding, training and staff, mistakes are inevitable. The Times reported in June 2015 that the annual bill for NHS negligence in pregnancy had reached £1 billion after more than 1,300 babies died 2014.

The results of the RCM survey, published at the beginning of the winter, suggest that the situation is not going to get any better in 2016. According to the survey over two-fifths of England’s maternity units had to close temporarily during the last year because they could not cope with demand (32.8% in 2014 and 41.5% in 2015). Units closed their doors on average on 6.6 occasions in 2014 and 4.8 times in 2015.

More than a quarter of senior midwives (29.5% in 2014 and 29.6% in 2015) said that they did not have enough midwives to cope with the amount of work. It is estimated that the country is short of 2,600 full-time midwives. A tenth of the senior midwives surveyed (10.9% in 2014 and 11.0% 2015) reported that they had to cut services as funding and staffing shortages bite. This included cutting specialist midwives, parent classes, bereavement support and breast feeding help.

Senior midwives said that the most common type of staff redeployment was from the community and postnatal service to the labour and delivery suites.  This restricts choice and impacts on the quality of care women and their new-borns receive. Worryingly the lack of adequate postnatal services makes spotting infection in the mother or baby, or maternal mental health issues, less likely. This can have potentially devastating consequences.

shutterstock_149926550 smlMany senior midwives responding to the 2015 survey were worried about how well they were able to do their job given the demands of the role. Nearly a third (31.2%) disagreed or strongly disagreed with the statement ‘I am able to do my job to a standard I am personally happy with’ and nearly two-thirds (62.3%) disagreed or strongly disagreed with the statement ‘I am able to meet all the conflicting demands on my time at work’.

It is also a concern that two-fifths (21.9% in 2014 and 20.3% in 2015) of senior midwives had to reduce staff training.  Training and continuing professional development are critical to the delivery of safe and high quality care.

Cathy Warwick, RCM Chief Executive, said: “All of this shows a system that is creaking at the seams and only able to deliver high quality care through the efforts and dedication of its staff.

“When services are operating at or beyond their capacity, safety is compromised and mistakes can, and almost certainly will be made, through no fault of the dedicated staff delivering the service.”

Susan Liver, Clinical Negligence specialist and a partner at Birchall Blackburn Law, says: “The UK is still one of the safest places to give birth but maternity services have never been under such intense pressure, which puts doctors, midwives and managers under great strain. Such conditions will lead to errors and ultimately it will be the mothers and babies who have to live with the consequences.

“We’ve worked on many cases for families who have complained that too few midwives have had to care for too many women and babies. Complications have arisen and symptoms have been missed or not dealt with quickly. The results can be serious birth or maternal injuries.”

There have been some high profile investigations into maternity and neonatal services, including the Morecambe Bay Investigation that was set up to examine the standard of care in the maternity and neonatal service at University Hospitals of Morecambe Bay NHS Foundation Trust, between 1 January 2004 and 30 June 2013.

The Investigation was established in September 2013 by the Secretary of State for Health after concerns were raised by families following a number of tragic deaths and serious incidents during that time. The report was published in March 2015, which acknowledged that staff shortages and a culture that prevented people from speaking out about poor care played a key role in often catastrophic errors and omissions.

Jackie Smith, Chief Executive and Registrar of the Nursing and Midwifery Council, said: “What happened to the families at Morecambe Bay was awful and we have a duty, when things go wrong, to act swiftly.

“[The] report makes very significant recommendations which we will consider carefully. Every midwife and nurse has a responsibility to speak up when things go wrong and the work we are doing with the GMC on the Duty of Candour will reinforce that duty to speak up.”

What should be life’s happiest moment can be the most painful if maternity services fail a mother and baby. The consequences can last a lifetime and a family will need practical, emotional and financial support. They will also need help getting answers and making sure it does not happy to anyone else.

Should you or a member of your family feel that the NHS maternity service has failed in its duty of care, please contact our specialist clinical negligence team. We are here to help secure compensation that can pay for specialist rehabilitation, changes to the home and car, purchasing aids and equipment, care and assistance, covering loss of earnings and paying for private medical treatment.

We will always handle your case sympathetically.

Further reading:

The Royal College of Midwives, ‘Maternity services overworked, understaffed and struggling to cope shows senior midwives survey’

Morecambe Bay Investigation Report – March 2015