The Pennine Acute Hospitals NHS Trust – Review of Maternity Services
On November 22nd, 2016, the Pennine Acute Hospitals (PAH) Trust released a report titled ‘Review of Maternity Service’ to the Manchester Evening News following a four month freedom of information battle.
The report highlights various issues associated with the current status of maternity services at Royal Oldham Hospital (ROH) and North Manchester General Hospital (NMGH) . These include; reduced staffing numbers; poor attitude of staff; and high incident rates of severe perineal trauma.
Reduced Staffing Numbers
The reduction in staffing numbers at PAH has resulted in fragmented care, lack of clear management and an inability to escalate high risk pregnancies accordingly. Staffing shortages have led to a heavy reliance on locum medical staff creating a consultant workforce which lacks specific skills and competencies. Inadequacies in specialist areas appears to have been a running theme in the make-up of PAH’s maternity workforce for a number of years having dangerous and damaging consequences for women.
The review draws on one particular incident to demonstrate this. Following surgery, a new mother was taken back to theatre three times as medical staff repeatedly failed to reach a satisfactory resolution or make the correct diagnosis of faecal peritonitis. As a result, the woman remained in hospital for several months and now lives with a colostomy. This is a severe case of medical negligence and extremely traumatic for the woman affected.
In order to address these issues and prevent incidents of medical negligence like this happening again, there is a desperate need for a workforce with specialist skills, as well as clear leadership to ensure consistent, effective and clinically sound decision-making.
Poor attitude of staff
The attitude of PAH maternity staff is perhaps the most worrying issue to come to light in this report. The review describes an embedded culture of not responding to the needs of vulnerable women, as well as low rates of incident reporting. A rigid-mind set and a reluctance to learn from previous incidents exacerbate these issues and lead to repeated failings. A pertinent example of this is when a mother died of a catastrophic haemorrhage after her symptoms were put down to mental health issues. The review describes nursing staff as concentrating on the woman’s “bizarre behaviour” rather than understanding its cause and is another severe example of how medical negligence can have catastrophic consequences.
Capacity issues at Royal Oldham Hospital have forced maternity staff to divert women away to NMGH due to lack of beds. The report states that this poses an unacceptable risk to pregnant women and does not allow them to give birth in the safest place. The women who attend NMGH come from an environment of significant social variance and deprivation, the associated complexities such as physical, psychological and emotional co-morbidities make this a particularly salient issue.
The lengthy amount of time new mothers stay in hospital further heightens capacity issues. The review lists various explanations for an increased length of stay which includes; case mix; system error; and administrative error. Regardless of the exact reasoning, there is no doubt that this proves costly, impacts on capacity and flow, and disrupts the lives of new families.
The maternity services review identified that ROH and NMGH are both above national average for reporting severe perineal trauma (third and fourth degree tears). The injuries associated with severe perineal trauma include post-partum pain, haemorrhage, infection, and incontinence. These pose both short and long term health consequences to women, some of which can be life changing. Whilst the review of maternity services does not explicitly make a causal link, it is plausible that the shortage of specialised staff and inadequate management of wards have caused an increase in the number of severe perineal traumas suffered. Moreover, as a consequence, the length of time new mothers spend in hospital is lengthened.
Complaints and Claims
In consideration of the various issues the maternity services review raises, it is no surprise that there is a high rate of complaints and medical negligence claims made against the Pennine Acute Hospitals NHS Trust. The report explains that neither the number of complaints have altered significantly over the past three years, nor have the themes on which the complaints are based. This not only reflects the entrenched attitude of staff whereby the same mistakes are repeated, but also the inadequacies which continue to characterise the workforce due to the reliance on locum staff and newly qualified midwives.
The Pennine Acute Hospitals NHS Trust published this review of the maternity services in June 2016; it highlights a number of serious issues which have led to unjust and distressing consequences for mothers and their babies. The key recommendations for the future include replacing generic consultants with those with more specific and focused skills, partnered with consistent and effective leadership, as well as correctly identifying and escalating high risk pregnancies. Now the report is in the public domain, it remains to be seen how the trust will move forward from this and take urgent action to make long overdue improvements to their services.