Health: Maternity Care Provisions in East Kent

Statement

My Lords, with permission, I will now repeat in the form of a Statement the Answer given to an Urgent Question by my honourable friend the Minister for Mental Health earlier today. The Statement is as follows:

“Mr Speaker, I will be setting out the situation concerning East Kent Hospitals University NHS Foundation Trust in line with the Written Ministerial Statement that was laid in Parliament this morning. The fact that I took steps to inform Parliament of this matter reflects the importance I have placed on this issue.

Before I begin, I would like to express my deepest and most heartfelt sympathies for the patients and families who have been affected. I made a Statement on 28 January about concerns regarding maternity services in East Kent Hospitals University NHS Foundation Trust. I would now like to update the House based on the reports from the independent Healthcare Safety Investigation Branch, which I refer to as HSIB from now on, and the Care Quality Commission. I requested that both HSIB and the CQC report back to me within 14 days when I instructed them to go into East Kent Trust two weeks ago and they reported to me on Monday.

HSIB has already conducted a number of investigations at the trust as part of its national maternity investigation programme. These identified a number of safety concerns, including the availability of skilled staff, particularly out of hours; access to neonatal resuscitation equipment; the speed with which patient concerns are escalated up to senior clinicians and obstetricians; along with failings in leadership and governance. As requested, the CQC carried out an unannounced inspection of the trust’s maternity service between 22 January and 5 February 2020. It has written to the trust with an overview of its findings and a full inspection report will be published in due course. The CQC received additional information from the trust this week, following its request for further assurance on triage, day care and medical staffing, and is considering this information. It is important that everyone is aware that the CQC is in regular contact with the trust and will continue to be so for the foreseeable future.

From the findings provided to me by HSIB and the CQC it is clear that the challenges at East Kent point to a range of issues—including having the right staff with the right skills in the right place; effective multidisciplinary working; clear collaborative working between midwives and doctors; good communication; and effective leadership support—but it would be wrong to speculate that there is one single cause. NHS England and NHS Improvement are working very closely with the trust and have taken some immediate actions.

First, the regional medical director and regional chief nurse are providing support to the trust. The medical director will address concerns surrounding appropriate senior medical oversight. Secondly, the regional chief nurse is providing support to the director of nursing and the head of midwifery to prioritise and focus their local maternity improvement plans to address identified safety concerns. They will also review the effectiveness of clinical governance and executive leadership support, and this will include ensuring that the trust is taking the learning from all historical cases and disseminating that learning through the trust.

The chief midwifery officer, Jacqueline Dunkley-Bent, has sent an independent clinical support team to the trust to provide assurance that all measures possible are being taken. This expert team includes a director of midwifery services from an outstanding trust, two consultant obstetricians, a consultant paediatrician and a neonatologist. She has placed the very best at the heart of the trust—on the wards, at the bedside of patients—with fresh eyes to oversee the care presently being delivered. The independent team is working with trust staff to deliver immediate improvements to care and to put in place robust and comprehensive processes to support improvement in standards over the long term. I can offer reassurance that Jacqueline Dunkley-Bent personally visited the trust two weeks ago to assess changes being put in place and that improvements are moving at pace.

Jenny Hughes, chief midwife for the south-east region, is also working with the trust directly. NHS England and NHS Improvement regional and national teams will continue to work with the trust. The trust is taking the issues seriously, is working closely with NHS England and NHS Improvement, and has created and filled several specialist midwife posts. Safety huddles, where safety issues are regularly and frequently discussed, have been embedded on both sites to anticipate problems before they occur, and multidisciplinary teams are working collaboratively.

I would like to reiterate my condolences, particularly to Harry Richford’s family and all those affected. I also thank the honourable Member for North Thanet for raising this important issue. The Government are fully committed to reducing patient harm and improving the safety of maternity services.”

I thank the Minister for that detailed Statement, which this issue definitely warrants. Given the measures that have been taken by NHS England and all the parties concerned, why has this trust not yet been put into special measures and at what point will it be? I agree with the Minister about the issue of leadership and culture in this hospital trust. I was horrified, as I am sure other noble Lords would have been, by the chief executive of this trust saying on the BBC that there had been “only” six or seven avoidable deaths since 2011. Actually, that is not true, and I think she said it because she had not read the report produced in 2015. What worries me is that there has clearly been a serious failure of leadership and culture across the whole of this trust, and that statement from the chief executive seems to symbolise that failure. How will the measures that the Government and NHS England are taking address the very serious leadership issues in this trust?

As I said, there has been an unannounced CQC inspection; there is also further engagement with the CQC and we await the findings of its report, which will come forward in due course. In addition, specialist teams have been sent in to ensure that there is robust leadership so that ongoing care is assured and patients can be reassured on that point. NHS England has announced that it will commission an independent review into East Kent so that there is a belt-and-braces approach to ensure the highest possible standards of care there. We can be reassured that the issues raised by the noble Baroness will be addressed and that no stone will be left unturned.

I also thank the Minister for the detailed Statement, which is much appreciated, and echo the sentiments of sympathy and support to the parents of Harry Richford and the other children who have died or had their health severely impaired by the trust. It did not start just two years ago. In 2010 there was a review by NHS Eastern and Coastal Kent on maternity care; safety and quality were mentioned three times in the statement of that review. In 2012 the services were reconfigured despite many concerns of local people. In 2014 the trust was rated inadequate and put in special measures by the CQC—it left special measures in 2017. In 2015 there was an expert report by the Royal College of Obstetricians and Gynaecologists warning about many of the problems that emerged in the subsequent tragic deaths of Harry Richford and at least six other babies. And so on and so on.

The expert review said that action needed to be taken quickly. This report was not passed to the CQC. Why, given that the hospital was in special measures, was the report not handed to the CQC and why on earth was the hospital allowed to continue out of special measures after that when there were clearly still major problems? Following on from the comments of the noble Baroness, Lady Thornton, why did the chief exec and, I presume, the board not read, implement and monitor this expert review?

The noble Baroness raises an important question, which I am sure will be considered as part of NHS England’s independent review and the CQC’s questions around quality of leadership, but I will make a wider point for those who may be listening about the safety of maternity care in the UK. We are rightly focusing on the questions of East Kent, but, for those who may be considering giving birth at the moment, it is important to state that the NHS is one of the safest places in the world to give birth. Some 0.7% of births result in a stillbirth or neonatal birth. We have stated that our ambition is to halve this rate of stillbirths, neonatal and maternal deaths, and brain injuries by 2025. We have already achieved our ambition of a 20% reduction by 2020. A message of reassurance, alongside the firm actions we are taking to address the concerns raised by the noble Baroness, is appropriate and important.

My Lords, I echo the comments of the noble Baronesses, Lady Thornton and Lady Brinton, about the role of the chief executive. I watched the news last night and was horrified to hear her say that she had no knowledge of the review until 2018, yet that review was requested by the medical director of the trust in 2015. If she is unaware of what is happening in her own trust, serious questions need to be asked. In view of what the noble Baroness just said about maternity services, it is important that we send a very clear message to our midwives on the front line. They need to be supported and we need to send the message, not just to the ones in East Kent but to those throughout the UK, that they have our support.

My noble friend is, as ever, very wise on this. A key plank of the maternity safety strategy, launched in 2016, is a number of initiatives to improve not only clinical care but culture in maternity services. They have been designed to improve leadership and to ensure that in every trust there is a midwife, an obstetrician and a board-level maternity safety champion to spearhead improvement. It is critical that we ensure that this is delivered so that incidents such as this do not occur.

My Lords, there is no question but that our maternity services across the piece are under enormous pressure. We know that in 2017, somewhere between 30% and 40% of all babies born in the UK were born to foreign nationals. Will the Minister tell me, in broad terms, do foreign nationals, when they have babies in this country, make a financial contribution?

People are entitled to free NHS care if they are ordinarily resident in the UK. However, my noble friend’s wider point about the pressure on maternity services was absolutely right. That is why, in February 2018, the Government announced an additional 3,650 training places for midwives. I am pleased to say that the first 650 began their training in September 2019 to ease the pressure, and there will be 1,000 training places for each of the next three years. This should ease the pressure and address some of the concerns my noble friend raised.

My Lords, I draw the Minister’s attention to one of the first advocacy schemes for maternity care, which still operates in Tower Hamlets 35 or 38 years onwards. When I was working there, I dealt with a number of cases where there were complaints from parents. Will she commend the efforts of the parents, who persisted in taking their complaints so far up? Without their knowledge, persistence and dedication, we would not have come to this point where we are seriously questioning the competence of the staff.

We are obviously very grateful to all those brave enough to bring their stories forward in the midst of extreme tragedy and pain. We know that it is not easy and that within the culture of the NHS, it can sometimes be extremely hard to break through the barriers of not denial, but resistance. We should pay tribute to all those who have campaigned for maternity safety. In particular, I pay tribute to my right honourable friend Jeremy Hunt, who began a lot of the work to improve maternity services when he was Health Secretary, and to James Titcombe, who led a lot of the work relating to Morecambe Bay.

Does the Minister agree that the NHS is overregulated, with lots of overlapping responsibilities between different regulators? Does she agree that we need much greater clarity so that issues such as this, with devastating impacts on people’s lives, are dealt with much more quickly and picked up much sooner, rather than individuals having to make formal complaints?

My noble friend makes the core point that when an issue arises, there should not be conflict between patients, the NHS and clinicians; it should be possible to resolve the situation in a straightforward way, within a culture not of blame culture but of learning. That is at the core of setting up HSIB, but this culture should go all the way from the grass roots of the NHS up to the very top. That is absolutely a part of the patient safety agenda we are trying to instil.