Ockenden Report

Baroness Finlay of Llandaff Excerpts

Wednesday 30th March 2022 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for her points. I will take this opportunity to elaborate a bit on multidisciplinary training in the maternity workforce. Some £26.5 million of the £95 million invested in maternity services last year will allow training aimed at how multidisciplinary teams work together. There is a new core curriculum for professionals working in maternity and neonatal services—this is being developed by the maternity transformation programme, in partnership with professional organisations, clinicians and service users, to address variations in safety training and competence assurance across England. A single core curriculum will enable the workforce to bring a consistent set of updated safety skills and continue to learn. It is important that we have collaboration and close working relationships between midwives and obstetricians because that obviously benefits the mothers and babies within their collective care. The noble Baroness has already said that this has to be mother-centred and patient-centred.

I also thank my noble friend for highlighting the fact that the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists have been clear that the professions must work together collaboratively. We expect all maternity services to act on the recommendations.

We also have to make sure that staff feel able to and confident about speaking up, as my noble friend said. The Government have taken this issue seriously. In response to a recommendation from Sir Robert Francis’s Freedom to Speak Up review, we established the independent national guardian, to help drive positive cultural change across the NHS and, in addition, to provide support to a network of local freedom speak-up guardians. We will have to see how that works, what can be done better and how we can improve it. Putting in one measure will not solve all these problems. There is no silver bullet, but one of the reasons to put this in at local level is to see where it works and where it does not, and what we can learn from that.

[Baroness Finlay of Llandaff (CB)]

My Lords, I also thank the Minister for the very sensitive way in which he has dealt with this Statement and, like others, commend those parents who have fought for years to be heard. I also commend Donna Ockenden for an outstanding report that makes really harrowing reading.

To follow up on the question asked by the noble Baroness, Lady Bottomley, about training, it has struck me for many years that the competition between midwives and obstetricians is extremely damaging. It was there when I was a medical student and it has not changed. The bullying culture on the wards has I think been almost endemic and right across the system. I hope that the colleges will look at training jointly from day one, not just after qualification, because that team building needs to happen very early. The way the midwifery tutors and the obstetric tutors deal with their trainees must be integrated from day one and then follow on into continuous professional learning. So my first request is that that message goes back very clearly to the schools of midwifery and to the obstetric training courses.

My second point relates to the CQC, which has done a great deal to raise the quality of care across the NHS and is often to be admired. However, it is worrying that it took so long for it to realise that there was a problem. That would suggest that, internally, its benchmarking of what was normal was at a level that is actually unacceptable. I hope the Minister will be able to go back to the CQC and that the CQC itself will be supported to radically rethink the way that it looks at maternity services. I hope that it will be prepared to have some extremely difficult inspections, consultations and conversations with staff in some units that were previously thought to be doing well, but where it might discover that there is bullying and, particularly, this closed-ranks culture that was so evident in the way people responded to the report. But, overall, I think we are all grateful for the openness of this report and the openness with which the Minister has brought it to our notice.

[Lord Kamall (Con)]

I begin by thanking the noble Baroness, Lady Finlay, not only for her questions today but for the advice she has given me over a number of months since I started in this post. I have learned so much from the noble Baroness, especially from her courage to speak about her own professional experiences and admit where there are issues that need to be addressed. I am very grateful for that.

I completely take the point about working together from day one because, if you do that, you embed that culture of collaboration from day one, rather than just training people and then saying, “Oh, by the way, don’t forget to work collaboratively”. I think that has to be bred into the system and it is something we have to understand.

The other principle, which all noble Lords discussed in debates on the Bill, is the concept of a safe space. In an ideal world, we would find out who was responsible and they would be held to account, but what is really important is that we learn from that and the system learns from its failures. We have to encourage the ability to have a safe space where people feel confident about speaking up. We saw incidents where people felt bullied into not speaking up or where they withdrew their statements. If we can get this through the SHA and throughout the culture of the new HSSIB, this would be a really important first step. I thank noble Lords who, during the debate, pushed for the removal of certain bodies in order to make sure people felt comfortable coming forward.

On the CQC, there are real questions about the inspections in 2014 and 2016 and why it did not recognise safety concerns at the trust. Subsequently, the CQC did recognise the issues and place the trust in special measures. There was some progress made by the trust following this, and there were two subsequent visits. As a regulator, the CQC holds providers to account and makes clear where improvements must be made, but I think it recognises that there are lessons to be learned. There are lessons to be learned not only in government but across the health and care sector. It is important that we look systemically at how we work together and address some of those concerns.