NEW ARRIVAL: Andy Burnham is about to find maternity services in a dire state

This comes hard on the heels of the latest report by senior midwife Donna Ockenden into the Nottingham services which found systemic failures in clinical safety over many years, a toxic and bullying workplace culture, and a persistent refusal to listen to vulnerable families.

In just one unit over 13 years, 444 women and 76 babies suffered serious and “potentially avoidable” outcomes, including death, due to substandard treatment which was at times cruel. Amos went into less detail but identified serious failings at 12 other trusts.

The overriding message from the two grim reports is that the culture of cover-up of appalling care is alive and kicking in the NHS, just 25 years after the Bristol public inquiry made 198 recommendations to end it.

Another inquiry?
Many independent maternity inquiries spanning the last 20 years have reported or are in progress, but parents who have suffered catastrophic harm are campaigning for a public inquiry to span this entire period and compel people at all levels of the NHS and Department of Health and Social Care to account for their failures.

However, it could be that the inquiries themselves, and the political and media weaponisation of them, have made staff even more defensive and even more likely to bury bad care.

In maternity services, mistakes can have catastrophic consequences for parents and staff. No one wants to be sued, professionally censured or have their head on a spike in the media.

Ockenden particularly has shown that the worse the care is, the more likely it is to be covered up from ward to board, and inspectors and regulators have failed to uncover it in a timely way, despite parents shouting from the rooftops.

A public inquiry would buy Burnham time, but would it fix anything, or would it just make obstetrics and midwifery even less attractive career choices?

Caesarean demand
Unsafe practices, such as an obsession with “natural birth”, highlighted by Ockenden but sidelined by Amos, can deny women life-saving interventions such as caesarean sections when they need them. This clearly has to be challenged.

But even when everyone agrees a caesarean section is needed, many units lack the structural capacity to cope with increased demand.

Caesarean section rates exceed 50 percent in some units, with no expansion of theatre capacity, so there is a daily game of risk roulette to decide who goes next, with limited theatre space to try to accommodate both planned and emergency sections.

The paradox of progress
Ironically, obstetric “advances” and concerns of mothers triggered by the recommendations of maternity inquiries may be making the service less safe because of system overload.

Professor Steve Thornton and his obstetrician colleagues observed in the British Medical Journal that induction of labour now exceeds 30 percent as a result of increased monitoring triggering more concerns.

He noted that as regulators and media reports often suggest earlier intervention may have prevented harm, “This leads to defensive practice. There is no consideration of associated harm or maternal experience. Women may spend days undergoing cervical priming, with artificial rupture of membranes then delayed owing to capacity constraints. Requests for caesarean section follow, only to encounter limited theatre availability. The system generates demand it cannot meet.”

The future
Until maternity units are redesigned with enough capacity and staff to cope with the massive rise in caesarean sections triggered by maternal demand, fetal monitoring and higher-risk births in older, larger mothers, then more “avoidable harm” will be unavoidable.

Experienced senior midwives and obstetricians will continue to retire as soon as possible, leaving many units woefully short of experienced staff. There are already serious shortages of obstetricians, with high levels of burnout. And although more midwives are being trained and birth rates are falling, many newly qualified midwives can’t get work due to a lack of funding.

Not just yet
Every sensible NHS inquiry promises “a just culture” which recognises that while individuals must be held accountable for reckless or deliberate misconduct, most errors occur within flawed, overloaded and fast-moving systems.

In such a culture, staff own up to errors knowing that instead of demanding “Who is to blame?” and “Can we cover this up?”, their employer thanks them and asks: “Why did this happen?” and “How do we prevent it from happening again?”

Investigations happen quickly and independently. Politicians listen and provide the resources to minimise harm. Those who have suffered harm are fully included and swiftly compensated without having to litigate.

Burnham knows all this, having witnessed the Mid Staffs scandal as health secretary. But can he deliver it?

With Bio-Waste Spreader: “With Andy Burnham all but certain to become prime minister, there is much speculation about what changes in farm policy and levels of capital taxation farmers can expect to pay under a Burnham-led government. So far, he has outlined his intention to devolve power and policy-making from Westminster, but it has to be assumed this is unlikely to include agriculture…”

With Dr B Ching: “Passengers inured to the shortcomings of the new trains operated by East Midlands Railway (EMR) won’t be surprised that investigators of last month’s crash are probing why one of those trains ‘unexpectedly’ stopped. The collision, near Bedford, happened because a train failed to halt at the red signal behind a new Hitachi train which had stopped. The driver of the rear train was killed and 162 people were injured. A secondary concern is that the new train halted because of a fault with its Automatic Warning System (AWS)…”

With Lady Liberty: “‘I forgot to get napkins so I just wiped my hand on the American flag behind me,’ posted a student organiser called Darializa Avila Chevalier on Twitter back in the heady days of 2019. Chevalier also shared thoughts on Sheryl Crow’s song Soak Up the Sun (‘bootstrap capitalist propaganda’), Marx and Lenin (‘white dudes’) and the Democratic establishment (‘Fuck Kamala Harris’). Chevalier is now the Democratic candidate for New York’s 13th Congressional District…”

With Remote Controller: “Streaming means viewers mostly watch when they choose, but big live events still depend on strict grid timings: royal weddings and funerals start at 11am; general election coverage 10pm. So Mexico v England in the World Cup last 16 was a scheduling nightmare. Initially due to kick off at 1am on Monday, it was rumoured to shift to 7pm on Sunday due to severe weather warnings. Restored to the original slot, it was threatened with a later start due to storms…”

With Old Sparky: “Grid operator Neso now faces summer challenges that exercise it almost as much as in winter (Eye 1674), but it still underestimated the demand for air conditioning in the June heatwave. So it had to supplement its plans from whatever source was available ‘at the margin’ in the electricity market. This demonstrated that there is absolutely no reason to think that importing electricity via subsea ‘interconnector’ cables – energy secretary Ed Miliband’s favoured alternative marginal source – is any less costly or volatile than gas...”

With Lunchtime O’Boulez: “The Royal Opera House was in gala mode in May for the unveiling of new stage curtains that dazzled with the gold cyphers of King Charles III (replacing those of Elizabeth II) and are jaw-droppingly expensive – the precise cost is undisclosed but thought to be in excess of £1m. The audience may have seen cause for celebration but there was much less delight backstage, where rumours were circulating that the House was in such deep financial trouble it might soon be curtains for a fair few staff.…”

Letter from Tshwane
From Our Own Correspondent: “South Africans adore a good courtroom drama – every day here an epic battle plays out before some judge or other. There’s the president’s potential impeachment; a commission of inquiry into police and intelligence services corruption; assassination attempts on commission witnesses (some successful and some not); and crime boss ‘Cat’ Matlala, on trial for murder and corruption, who has just turned state witness and threatens to throw his security service associates under the bus…”

With Gold Digger: “How will Nigel Farage use his latest bung, the £270,000 paid to him last month by Direct Bullion for acting as the gold trader’s ‘brand ambassador’ for 12 hours? Perhaps to pep up the beleaguered finances of another company founded by the gold company’s owner, Paul Withers, to which the Reform UK leader has also put his name: Stack BTC. When Farage first became a shareholder in the ‘Bitcoin treasury’ company…”

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