Ockenden Review of Maternity Care: Shrewsbury and Telford

Jim Shannon Excerpts

Wednesday 15th January 2020 Commons Chamber

[Lucy Allan]

My right hon. Friend makes an important point—I was going to come to it in my speech, so I will bring it in now. The Morecambe Bay inquiry was led by Dr Bill Kirkup, who said of the recent findings at Shrewsbury and Telford Hospital NHS Trust that

“two clinical organisational failures are not two one offs”,

and that that points to an “underlying systemic problem” that may exist in other hospitals. My right hon. Friend is right to make that point, and I thank him for his kind comments.

The interim findings in the Ockenden review were not published, and I understand that the hospital trust has not been told about them. The families were certainly not told about them, and neither were MPs. There has been no statement to the House, and we do not know what action is being taken to ensure the safety of women and babies at Shrewsbury and Telford Hospital NHS Trust.

[Jim Shannon (Strangford) (DUP)]

I am an avid watcher of that Sunday night programme, “Call the Midwife”—I am not sure whether you watch it, Mr Speaker—where everything seems to work out at the end of the day. The hon. Lady is outlining something that does not work out at the end of the day. She mentioned families. Does she agree that the care of mother and baby must be a priority, and that more support for mothers who have had several children must be considered, to ensure that they are coping and not expected simply to carry on because they already know what to expect? Every life is precious and adds more pressures to families, particularly mothers.

[Lucy Allan]

I very much appreciate the hon. Gentleman’s intervention. As always, he makes an excellent point, and I am grateful to him for his many interventions in many debates I have secured.

I am concerned that the NHS can choose to sit on this information, and that Ministers can say, “Well, we don’t comment on leaks”. This is about the safety of women and babies, and the adequacy of the maternity care they receive in our hospitals today. Women were repeatedly told that their case was a one-off tragedy, that there will always be risks to childbirth, and that such risks cannot be completely mitigated. Failings seem somehow to have been normalised, and at the time many women accepted that, rather than question or challenge the care they received. People trust the medical profession, which is why openness and transparency are so crucial.

When people raised concerns they were dismissed as being difficult—no one listened. There was a “we know best” attitude, and complaints about poor practice were treated as women making a fuss about a perfectly natural event that occasionally would have a negative outcome. As Health Secretary, my right hon. Friend spoke about “never events”, and I suggest that those must include an avoidable death. A baby dying in childbirth should therefore be a “never event”, yet it seems that that is not the way the deaths in this case were treated—they were treated as something that could be a result of childbirth. The trust even boasted of having the lowest number of caesarean deliveries in the country, so there seems to have been an unwillingness to intervene when there were complications in a delivery. In my view, an intervention during a difficult birth must be a good thing: that is what the clinicians and medical professionals are there to do. I am concerned about the way this trust appears to have treated women and about its attitude towards women, which seems to have been dismissive. And that is something we have seen from the top.

What adds insult to injury in this particular case is that the trust commissioned a report in 2013 that appeared to find that all was well. We now know, because of the leaked report, that that was in fact a whitewash. The trust was exonerated by what was a perfunctory bare minimum desk-top review. This allowed poor practice to continue unchecked. If it had been identified at the time, the more recent cases of malpractice, which are still coming forward and include death and injury, could have been avoided. We still do not know how many women and babies have been affected, but we do know that £50 million in compensation has been paid out already. However, with hundreds more women coming forward, the cases in which a financial settlement has already been reached are clearly the tip of the iceberg.

The question we have to ask, and must go on asking, is whether that poor care, and the normalisation and denial of it, is a systemic problem within the complex bureaucracy that is the NHS.