Staffing crisis, delays and cancellations – Manchester midwives have been warning of ‘failures’ to mums and babies for years
[ad_1]
Maternity care in Manchester has been hit with damning reports, rating it ‘inadequate’ as three hospitals have been warned to make urgent improvements to keep mothers and babies safe.
Patients have been left at risk because of delays and cancellations to planned Caesareans or surgical births, and inductions of labour – which kickstart childbirth, according to inspectors from the Care Quality Commission (CQC). Any delays or missed opportunities to stop harm can cause serious complications and make it more likely that mothers and their babies will need interventions that make recovery harder.
The findings have caused a wave of shock among many patients who say they chose maternity services at the maternity units in Saint Mary’s Hospital, Wythenshawe Hospital and North Manchester General Hospital because they believed it to give excellent care. Saint Mary’s hospital chiefs, which provide the service given at each of the three units, have spoken of their ‘disappointment’ at the results, insisting they immediately began a ‘focused programme of improvements’, monitored closely by the watchdog which condemned the services after a series of inspections in March.
But, these reports cannot come as a surprise for many staff inside the NHS, particularly those working within midwifery and obstetrics. Underpinning each of these reports is the common thread of short staffing – and people within the field have been warning about those very same dangers for years.
Try MEN Premium for FREE by clicking here for no ads, fun puzzles and brilliant new features
Maternity care in Manchester is suffering from not having enough midwives and doctors, and in turn, not having the right mix of senior and junior staff on daily and nightly rotas to cope with demand. That comes from the reports issued on Friday, July 28.
However, it’s also the warning sounded by one Greater Manchester midwife to the Manchester Evening News in late 2021. Standing in St Peter’s Square protesting a ‘maternity crisis in the UK’, her words about maternity care in general now read as prophetic: “The shortage of midwives has a snowball effect on the whole of maternity care. We cannot uphold these working conditions anymore. It’s a massive public health matter and it is serious.
“If you’re a community midwife, you could be responsible for a caseload of 140 women, that’s 140 you have to keep track of during their pregnancies – organising their appointments, chasing blood test results, making sure they’re staying healthy.
“We’re supposed to be one-to-one with patients during labour, but we might be looking after two in labour or a woman who has just given birth and one who is in labour.
“On the postnatal wards, it can be 12 women and their 12 babies per midwife. And they almost always have risk factors. It’s not safe.”
National maternity scandals
More recently, the issue of safe staffing has surfaced as part of last year’s Ockenden report – a review into maternity care that found a string of “repeated failures” spanning a period of 20 years – including hundreds of cases where there was avoidable harm. As a result of these failures, babies died or were left seriously disabled owing to catastrophic mistakes at the Shrewsbury and Telford Hospital NHS Trust.
Staffing gaps were also a feature of the independent review into East Kent maternity services, published last year, finding that up to 45 baby deaths might have been avoided at the trust if they had received appropriate care.
It found “a pattern of recurring harm” that was visible from 2009 to 2020, and which could have been acknowledged and rectified at any time over that period. The Department of Health and Social Care acknowledged that staffing levels could contribute to issues in services and said it had expanded midwifery, obstetrics and gynaecology training places.
In the wake of sweeping maternity reviews, the CQC has been carrying out a nationwide ‘maternity inspection programme’, and nearly half of the 45 hospitals inspected so far have been rated as substandard.
Still, while these problems are not unique to the borough of Manchester, Greater Manchester, or even the north west – they have been known for a long time.
Warnings from the north – for years
A few months after that 2021 protest, during the height of the Omicron Covid-19 wave in February 2022, we spoke to one junior doctor working in obstetrics who was fairly sure safe staffing ratios were being breached in early January, despite – and he was one of several medics to use the phrase at the time – being constantly ‘guilt tripped’ to work and plug the gaps.
One student midwife, in a different hospital, said she had been frequently working in situations during Covid that she wasn’t qualified to handle, as students were brought in to fill in for absences. She had repeatedly worked on a postnatal ward where only one qualified midwife was on duty, when the recommended number of midwives on that particular ward was five.
“I’ve been in situations where I’ve been left in emergency situations totally on my own as a student,” said the student. On one occasion in recent weeks she had been left dealing with a bleeding mother without supervision, unable to find anyone to provide advice, she revealed. “Which, again, shouldn’t be happening, but it’s due to staffing. And it’s not that they don’t want to support you, there just physically aren’t enough people there,” she said.
“Women are coming into my clinic. I’m asking them how the baby’s movement is and they say ‘it’s fine now, but last weekend, it wasn’t moving a lot’,” explained another qualified midwife at the time. “I ask if they called triage and they say ‘I called and called and I couldn’t get through’. Actually, there are going to be times when that baby isn’t OK. It’s that bad that [staff] aren’t picking up the phone on the 24/7 urgent line.”
The Omicron wave was characterised by high levels of staff sickness absence, stretching limited resources even further. But months on, more stories echo the same problems.
In April 2022, we looked at how short staffing was listed as failing amid the devastating death of a baby at the Royal Oldham Hospital. The hospital admitted failings including, not communicating effectively during a period of reduced staffing and pressure; multiple physical checks were not being carried out when they should have been; and a ‘failure to, adequately or at all’, monitor mother and baby’s wellbeing – including the baby’s heart rate during labour.
Back in March 2023, we reported how staff shortages have led to ‘frequent closures’ of the Royal Bolton Hospital’s birthing centre, midwifery-led unit and postnatal wards, leaving patients with fewer options for their births, according to another CQC inspection.
New inspections, same problems
The CQC’s latest reports released on Friday about the three hospitals have raised eerily similar issues about lack of senior staff, delays and telephone services.
At Saint Mary’s Hospital specifically, inspectors said: “Women and birthing people could not always access timely telephone advice and support. The service did not have a system in place to monitor unanswered calls or signpost women and birthing people.
“The triage telephone helpline was often engaged and there was no system in place to indicate length of wait, signpost or take a message from women and birthing people. We asked senior staff about monitoring calls that were not answered, they told us they did not monitor call drop off rates.”
At all three hospitals inspected, the CQC found: “The service did not always have enough staff with the right qualifications, skills, training and experience to keep women safe from avoidable harm and to provide the right care and treatment. Staffing levels did not always match the planned numbers putting the safety of women and birthing people and babies at risk.”
Of the staff involved in the service, ‘managers could not be assured of their competence’ at each of the hospitals. Making matters more difficult, each site faces the criticism that ‘not all staff completed training in key skills, they were not up-to-date with required mandatory training’. That training was ‘often cancelled due to midwifery staff shortages’, reads the North Manchester General Hospital findings.
At Saint Mary’s, the CQC said staffing concerns were commonplace: “Staff and managers we spoke with told us they had concerns regarding safe levels of staffing. Some staff on the postnatal ward stated they regularly did not have the number of staff which were planned to be on the ward, and this was common with maternity support worker staffing.
“Staff told us they were concerned about having the right skill mix of staff on wards due to the number of newly qualified staff on each shift. Some staff told us they felt low staffing numbers impacted on being able to deliver the level of care they wanted to give.”
Doctors of a good skill mix were also reported to have been in short supply at Saint Mary’s. “This could lead to delays to women and birthing people being medically reviewed by an appropriately trained decision maker,” reads the report. “The service told us the main reason for women and birthing people leaving maternity triage before care or treatment was complete was the length of time to wait to see a doctor after being seen by a midwife.”
Both Wythenshawe and Saint Mary’s had problems with delays to treatment and pain relief due to a lack of medical or anaesthetic staff.
These problems have a significant knock-on effect. The CQC said: “Staff did not always assess, monitor nor manage risks to women, birthing people and babies. Opportunities to prevent or minimise harm were missed as the service did not operate effective and timely triage processes.
“Women and birthing people could not always access the service when they needed it. There were delays in women and birthing people accessing elective Caesarean sections and induction of labour.
“Risks and action plans were not always followed up or addressed in a timely way.”
At Saint Mary’s Hospital, from December 2022 to the end of February 2023, more than half (64 out of 124) of patients were postponed from the planned day of an elective Caesarean list, where they had chosen to give birth that way and there was no immediate risk to the baby.
The wait for admission ranged from 0.5 to 3.9 days, although delays reduced to 19 per cent in May 2023 after the inspectors had issued an urgent warning to the unit to improve.
Recruitment drive – but is it ‘robbing Peter to pay Paul’?
Nationally, there have been years of demands to improve maternity staffing. England faces a shortfall of around 2,500 full-time midwives, a shortage that has existed for over a decade.
The latest annual figures also show that there were 10,000 more births across England between 2020 and 2021. It also comes with increasing demands on services driven by women requiring more complex care and support, the Royal College of Midwives has said.
The independent chair of the Ockenden report, Donna Ockenden, made 27 recommendations, including that the government increase the annual budget for maternity services to £200m-£350m. There have also been Women and Equalities Committee to set a target and strategy to end racial disparities in maternal deaths.
A committee report previously found maternal deaths are four times higher in black women compared to their white counterparts, and “significant disparities” also exist for women of Asian and mixed ethnicity.
But the government has rejected the increase in the annual budget following Ms Ockenden’s recommendations, and the committee’s calls.
Dr Suzanne Tyler, Executive Director, Trade Union, at the Royal College of Midwives, said: “Report after report have made a direct connection between staffing levels and safety, yet the midwife shortage is worsening and we still have no NHS workforce plan to address it. Staff are desperate to plug the gaps, and they are doing, but they are at the limits of their endurance.
“The chancellor has previously agreed with us about the lack of staff and need for investment in maternity services. Now is the time to put his hand in the treasury pocket and give maternity services the funding that is so desperately needed; for the sake of women using them and the staff caring for them.”
But, this month, the government has said it is taking action nationally ‘to improve safety for mothers and their babies within the NHS to ensure maternity and neonatal care everywhere is of the highest standard’, especially following the discoveries made in East Kent.
Minister for Women’s Health, Maria Caulfield, has announced she will now personally chair a new group overseeing maternity services nationwide.
The maternity and neonatal care national oversight group will bring together key people from the NHS and other organisations. ‘It will look across work being carried out by a range of programmes set up to improve maternity and neonatal care, including the implementation of the East Kent and other recommendations, to ensure they are joined up and effective’, said a Department of Health and Social Care statement.
Minister for Women’s Health Maria Caulfield said: “This government will continue investing in the maternity workforce and working with the NHS to raise standards.”
The government says it has ‘taken steps to improve the quality of care for mothers and babies within the NHS, including £165 million of additional investment a year to improve maternity and neonatal services’.
Despite the Royal College of Midwives’ misgivings about workforce planning, the government said the NHS ‘recently published the first ever long term workforce plan, backed by over £2.4 billion in government funding to deliver the biggest training expansion in NHS history to help meet the challenges of a growing and ageing population by recruiting and retaining hundreds of thousands more staff over the next 15 years’.
A spokesperson added: “The government also continues to build on the maternity transformation programme, and continues to work closely with NHS England to implement the three-year delivery plan for maternity and neonatal services that was published in March 2023.
“This plan looks to guide services towards safer and more personalised care for women, babies and families.”
Locally, Manchester University NHS Foundation Trust, which operates Saint Mary’s Hospital, has heavily focused on staffing in its response to Friday’s CQC reports. Bosses say changes include ‘reducing waiting times in triage, investing in staff to increase the number of operating lists available, providing additional staff in key areas of the service, increasing numbers of senior doctors available during peak times, and launching a wide-reaching campaign to recruit more midwives’.
Professor Cheryl Lenney, Chief Nurse for Manchester University NHS Foundation Trust, which is responsible for St Mary’s, said: “Although the CQC report highlighted several areas of good practice across our maternity services, we were naturally disappointed with the overall rating.
“The inspection took place in March 2023, and we took immediate action on the initial feedback we received by embarking on a focused programme of improvements. These have included reducing waiting times in triage, investing in staff to increase the number of operating lists available, providing additional staff in key areas of the service, increasing numbers of senior doctors available during peak times, and launching a wide-reaching campaign to recruit more midwives.
“We have confidence in our ability to improve maternity services for women and their families, and our teams have made good progress. In line with NHS England’s three-year ‘maternity and neonatal improvement plan’ we can and will do more.
“We are committed to continuously improving our services, not only meeting the expectations of those who use our services but exceeding them.”
Among the improvements, the hospitals are making changes to the triage system where patients receive their initial assessments. “Continuous and sustained improvement has been seen in response to telephone calls, ‘time to initial midwifery triage’ and ‘time to medical review’ [where a patient is seen by a doctor], and work is ongoing to achieve further improvements,” said a spokesperson for MFT.
The trust has also assured that there is now increased midwifery staffing and increased senior medical presence on all three midwifery triage units. As of May 1, there is now ‘additional capacity’ for mothers choosing to have a Caesarean section, which require theatre space and skilled surgical teams, and there has been a reduction in delays.
“The trust has approved long term substantial investment and recruitment to increase the number of obstetric consultants, obstetric anaesthetic sessions, theatre team support, midwifery staffing and consumables,” said the spokesperson. “By increasing the Caesarean section capacity, more Caesarean sections are done when scheduled (fewer postponements).
“Additionally, the pressure on labour ward capacity has been relieved resulting in significant reductions in delays for women who are being induced.”
So far, the trust says it has 137 midwives – including 10 experienced midwives and 127 newly qualified midwives – and six doctors joining in the coming months. Investment for consultants and junior doctors is also underway, says the trust.
“We had 660 midwives before starting the improvement plan in March 2023 – each month, we’d see roughly 10 midwives either retire or get new jobs. In May and June, that number had been cut in half,” added MFT.
“Saint Mary’s staff support and care for approximately 8,500 babies at [the main Saint Mary’s Hospital in] Oxford Road, 4,900 babies at Wythenshawe and 3,600 at North Manchester each year, totalling around 17,000 births.
“A new recruitment campaign is being launched to attract both experienced and newly qualified midwives. There has been a reduction in leavers during May and June 2023.”
Guideline staffing ratios – the number of nurses or midwives per patient on a given ward – are not set in stone but vary from specialism to specialism, trust to trust. But repeated crises, including the Mid Staffs scandal of more than 15 years ago and the contemporary findings across England, have shown the critical nature of getting it right.
However, challenges might remain even with this plan. As one Greater Manchester midwife warned the M.E.N. back in 2021: “A lot of trusts say ‘we have recruited 10 midwives in the last month’ – but it’s robbing Peter to pay Paul.
“There’s no new midwives, they’re just taking staff from a different trust. Every September, when we have newly qualified midwives, a lot of them leave the profession before qualifying, and many leave within the first year.
“There are so many job adverts at every single trust, but the grass isn’t greener. We can go 12 plus hours without eating some days. We are working overtime, all the time, without getting paid.”
[ad_2]
Source link
