Maternity Services

Baroness Hodge of Barking Excerpts

Wednesday 22nd June 2011 Commons Chamber

[Margaret Hodge (Barking) (Lab)]

I am most grateful to you, Mr Speaker, for enabling us to debate the maternity services on which people in my constituency and neighbouring constituencies depend. On behalf of those people, I hope that the Minister will feel able to respond positively to the proposals that I wish to make, which I know are supported by neighbouring MPs.

Let me preface my remarks by saying that I know there are many dedicated and committed individuals working in the NHS in Barking, Dagenham, Havering and Redbridge who give their all to the maternity services in the borough. I fully acknowledge and warmly thank them for what they do. However, my overriding responsibility and duty is to all the women in the area who want to be certain that when they have their babies, there will be a bed for them, and enough experienced and appropriately qualified midwives looking after them, and that the care they receive during their pregnancy and birth will be of a consistently high quality, giving mothers the support they need and ensuring that we can all be confident that the pregnancy and birth will be safe for both mother and baby.

That is not a lot to ask and expect, but shockingly, it is not delivered and guaranteed at present to all mothers dependent on our hospital trust. Barking, Havering and Redbridge University Hospitals NHS Trust has one of the highest birth rates in the country, with just under 10,000 babies born in trust facilities last year. In my constituency, the birth rate went up by more than a third between 2002 and 2010. Across all the communities served by the trust, the number of births has been growing year on year by 500 additional births, and everybody believes that this trend will persist for the foreseeable future. However, a report from the Care Quality Commission this March expressed major concerns about the quality of care at one of the trust hospitals—Queen’s hospital in Romford—which is a huge indictment of the service and a dreadful worry for families who are having their babies.

The CQC found that maternity services at Queen’s were failing to meet essential standards of care, and that the trust was not taking all proper steps to ensure the safety of women in the maternity unit. Inspectors stated that services were so understaffed that mothers and babies were at risk. They found that too many staff did not have the right skills and that the appropriate equipment was sometimes missing. Inspectors reported mothers in labour being left alone for long periods without the pain relief that they needed. They also found significant delays in patients going to theatre and said that babies were being born in what they termed “inappropriate locations”. Inspectors expressed concerns about respecting and involving mothers in their own care, and found that the trust did not give bereaved mothers proper facilities in a separate room, away from other new mothers who had had their babies safely.

Sadly, the CQC confirmed what all of us already knew—we knew it from the fact that more women die while under the care of the trust than elsewhere. Four women have died in BHRT maternity units in the past 12 months, with five dying in the past 18 months. Maternal deaths there are five times greater than the national average. The trust has paid out £15 million in compensation in the past five years on claims against the obstetric services. That is one of the biggest compensation bills across the whole of the NHS. Those statistics are heart-rending. What should be moments of joy for mothers and their families become experiences filled with fear and pain—and, at their worst, loss and grief. As local MPs, we are told of far too many cases of people having to put up with terrible care, particularly at Queen’s hospital.

One of my constituents gave birth at Queen’s in July last year. She was kept waiting for hours in reception when she was already in labour, with other patients waiting in the same area. She was told that staff were too busy to give her an epidural. The same staff then failed to give her an episiotomy, and she suffered second degree tears and had to have 20 stitches in her vagina. Yet she had to wait for three hours to be stitched because, the hospital told us,

“not all midwives have had the required training to perform this procedure.”

Another constituent went to Queen’s when she was two weeks overdue. She had been having contractions for over a week and was losing weight. But, instead of inducing her there and then, the hospital sent her away. Shortly afterwards, she gave birth to a stillborn baby. A third constituent was supposed to have a home birth. The midwives arrived late, and without enough pain relief or oxygen. After an hour, she was in such agony that she had to go to Queen’s where she had to have an emergency caesarean. The trust later accepted that she had not been properly examined while she was in labour at home.

There have also been some high-profile cases recently of women who have tragically lost their lives at Queen’s because the care that they received was so lacking. Sareena Ali and her unborn baby died after staff failed to identify that she had a ruptured womb which triggered a heart attack and a major organ failure. She had not been checked for two hours, despite her husband begging staff to check whether anything was wrong because she was in consistent agony. She had an emergency caesarean —on the antenatal ward in front of other women in labour—but the baby was stillborn. Staff tried to resuscitate Sareena with a disconnected mask; it was her sister-in-law who spotted this. Sareena died five days later—a death that could have been avoided.

Earlier this month, Violet Stephens went to Queen’s at 31 weeks pregnant with dreadful gastric pain and high blood pressure. After four days in hospital, she was eventually diagnosed with a life-threatening complication called HELLP syndrome. She had an emergency caesarean and, although the baby was delivered healthily, she died. Violet had had similar symptoms during her previous pregnancies, but the system failed her and her case is currently under investigation. In August last year, Saira Choudhri was sent home from Queen’s even though she was having contractions every two minutes. She was found blood-soaked and in agony by two nurses in the car park. Thankfully, her baby survived.

This litany of tragic instances of unacceptably poor care has to stop, and the Minister and her Secretary of State must take responsibility for improving our maternity services. In part, the problem lies with shortages of staff, and shortages of properly qualified and experienced staff. The new chief executive is recruiting midwives from abroad and I welcome that, but we have been here before, and the trust has to find ways of retaining as well as recruiting good midwives over the longer term.

Mothers talk about the lack of respect for them as patients and the failure to involve them in decisions about their care. Most women see a different community midwife at every appointment. All of that suggests a deeply worrying cultural problem among the midwifery staff who work for the trust. When Sareena Ali died, there was a full complement of staff on duty and there was no unexpected pressure on them. They blatantly failed to do their job and to take proper care of her. There appears to be a poor working culture, with midwives not co-operating effectively together as a team and with individuals not accepting their proper personal responsibility. All too often, they seem literally not to care.

Furthermore, the trust’s complaints procedure is not working. Individuals complain, but the trust’s response is all too often incomprehensible and it seems never to learn the lessons from past mistakes. Saira Choudhri, the woman who was almost forced to give birth in a car park, complained to the trust about the attitude of staff and the care that she received. Her complaint was brushed off with a technical response that completely failed to address the real issue, and nothing seems to have changed. If the trust had an open, rigorous and patient-focused complaints protocol and acted on those complaints in order to improve care, some of those tragedies might have been avoided. If it had listened and learned from what patients were telling it, other women might not have had to go through similar ordeals and Sareena Ali might now be at home with her husband and baby. There is going to be a full inquest into the death of Sareena Ali, which I trust will help to ensure that nothing like this ever happens again.

All the local MPs believe that the health authority’s determination to close the maternity service at King George hospital is complete madness. Birth rates in the area are rising and the quality of care at Queen’s is simply unacceptable. What on earth do the bureaucrats think they are up to? The Government’s health reforms are supposed to put the patients’ interests at the heart of what is done, but that is not the case in Barking and Dagenham. Decisions appear to be driven by money, not patients, and by consultants’ convenience, not women’s interests. Queen’s hospital simply cannot cope and things will only get worse if the King George goes.

Local GPs in my area are also strongly opposed to the proposal, and across north-east London, tens of thousands of my and my colleagues’ constituents have signed a petition against it. This is not a bit of MP nimbyism. It is a common-sense conclusion, with the support of a cross-party group of MPs, based on a proper understanding of what local people should be entitled to from our national health service.

I know the decision on the King George hospital has been referred to the independent review panel, but I would urge the Minister to ask the Secretary of State to exercise his power to halt the proposed closure. The Department, NHS London and the trust need to sort out the quality and the finances, not shut the door for patients by killing off the hospital.

Worse still, we campaigned for years—ever since I became the MP more than 16 years ago—to get new health services, including maternity services, built on the old Barking hospital site, which was closed in the 1980s. My constituents want high-quality maternity services close to home, with babies born in Barking again.

We finally won that battle and now we have a brand-new, state-of-the-art maternity unit on the site literally standing empty while Queen’s hospital continues to fail. I have been told today that no babies will be born in Barking hospital until March 2012. That is an outrageous scandal. It was supposed to open last year and the building has been ready for months. I ask the Minister to confirm in her reply that she will investigate the reasons why this unit has not opened and instruct her officials to get it open and working as soon as possible.

Lastly, but most crucially, I ask the Minister to establish a full, independent and impartial inquiry into maternity services at Queen’s. We have had enough, and we want somebody with extensive experience in their profession to be appointed by the Secretary of State to establish what is wrong and to prescribe action to put it right. I sincerely say to the Minister that I have now concluded that nothing less will do.

Perhaps the Minister will listen to the words of some women who have been through the experience of having a baby at Queen’s. One woman said:

“All of my friends that have had their babies at Queen’s have all received such poor treatment that it’s really made them think twice whether to have any more children.”

Another said:

“I struggle to see how closing a maternity unit that is better performing in favour of one that is in effect under notice to improve can be the right decision for local people.”

A third woman said:

“If I have another baby I flat refuse to go to Queens.”

I ask the Minister to listen to those women, to act to support their best interests and to protect mothers and babies in our corner of north-east London by delivering a safe, patient-focused service in which we can all have confidence.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

I congratulate the right hon. Member for Barking (Margaret Hodge) on securing the debate, and thank her for bringing this important issue to wider attention. Her message came across loud and clear. She has campaigned vigorously in support of her local health services for many years, both on the Government and Opposition Benches, and Members are to be congratulated on their vigilance in doing exactly what they were elected to do.

It is never good enough for patients anywhere to experience poor-quality health care, and it is clear that the problems at Queen’s maternity unit must be fixed now, so that the people of north-east London can regain trust in their maternity units. Regaining such trust is never an easy business. When mothers go to a maternity unit to give birth, they implicitly trust that they will receive the best-quality care. That is a vital part of maternity services, and it means that mothers can feel comfortable and safe with midwives, wards and hospitals. The shocking deaths at Queen’s maternity unit have put that relationship and that trust at risk, and I know that local concern is running extremely high. I offer my heartfelt sympathy to the families involved. To lose someone at what was expected to be a time of celebration is especially traumatic, and no words that I can say today will console those families. However, I believe that the message has been conveyed by the right hon. Member for Barking, the hon. Member for Ilford South (Mike Gapes) and my hon. Friend the Member for Ilford North (Mr Scott).

I understand that two investigations of maternal deaths are taking place at the unit; I hope Members will understand that I cannot comment on them at this stage. I know that the Care Quality Commission found that maternity services at the trust were failing to meet essential standards of quality and safety, but, although that was partly due to unsuitable staffing levels, they are not the only issue.

Unfortunately we cannot turn the clock back, but what we can do is ensure that decisive action is taken immediately to improve the position and ensure that the Queen’s maternity unit performs as it should have all along. In response to the CQC’s report, the trust has drawn up an urgent action plan and is taking steps to improve its maternity services. I understand that it has recruited an extra 60 midwives, and that a further 60 are shortlisted for interview. I also understand that it has revised the training programme for all midwives, created a new triage system enabling all women in labour to be seen by an experienced midwife within 15 minutes of arriving at the unit—the right hon. Lady particularly mentioned waiting times—and introduced a telephone triage system so that women can get advice even before they leave home. That is a start, although it is a start from a very low base. Although all those facilities should have been in place already, it is good that they are there now.

I have met Averil Dongworth, the new chief executive of the trust. She has assured me that everyone at the hospital—particularly the midwives and the support staff in the unit—is determined to improve standards and rebuild confidence. That may sound hollow to the Members who are present, who have probably heard it before, but Averil Dongworth struck me as an impressive woman with a steely determination to turn things around. She has also promised to keep in touch with and meet the local Members of Parliament regularly. I think it important for them to feel that, on behalf of their constituents, they are monitoring the position regularly and frequently. I have asked Averil Dongworth to keep me up to date. The position is very simple: nothing but the best will do for anyone who is seen in the NHS.

I also understand that NHS London, the local strategic health authority, is taking action to improve clinical leadership. It is important for that leadership to be in place, because its absence is often the reason why things go wrong, particularly midwifery in this instance. I understand that the authority has asked a senior obstetrician and an experienced midwife to spend time working in the team.

The right hon. Lady mentioned the health for north-east London review, which includes proposals to change the way in which Barking, Havering and Redbridge University Hospitals NHS Trust delivers maternity care. As Members have mentioned, under those proposals King George hospital would continue to provide antenatal and postnatal care, but would no longer provide maternity services during delivery. Maternity services would be consolidated at Queen’s with a new midwife-led unit that could deliver more than 2,500 babies a year. I understand that the unit is empty. The situation is extremely disappointing, but the proposals have been referred to my right hon. Friend the Secretary of State for Health, and the independent reconfiguration panel will advise him within the month, no later than 22 July. I know that Members look forward to hearing the decision, but obviously I cannot prejudge it.

The financial payouts in litigation that the right hon. Lady mentioned really pale into insignificance when compared with the human cost. There is not just the human cost when things go tragically and irreversibly wrong, but the poor experience that women have had, which is a very bad start to their new family life. Nothing can compensate for any of those things. She mentioned Sareena Ali and the unresponsive nature of the trust in relation to complaints. That has to change and I sincerely hope that Averil Dongworth will turn that around so that local people can start what will be a very long and slow journey to building that trust.

The right hon. Lady also mentioned that the problem is not just about recruiting staff but keeping them. That is the real challenge. When local people have lost faith in a local NHS organisation, the recruitment of staff becomes increasingly difficult. Keeping up morale is very important, which is why I think it is an important step in that journey for the chief executive to keep in touch with local MPs.

The right hon. Lady rightly said that this should be about the care of women and their babies and families, and not about other people’s convenience. My hon. Friend the Member for Ilford North reiterated many of the same points and I am always impressed when there is cross-party support on issues such as this. This place does not always have a good reputation but at times like this our reputation should soar because that cross-party working is extremely important to get things done. The hon. Member for Ilford South also spoke about the cross-party support and referred to the culture and institutional problems, the issues that are so very difficult to dig into and turn around. I sincerely hope that we can start to do that.

The Government are doing all we can to stamp out instances of sub-standard care. As I have said, nothing but the best will do for anyone. New standards of care are being developed for antenatal services and the management and care of women in labour, as well as for delivery and post-natal care. We are also keeping up the record number of midwives entering training—nearly 2,500 this year and 2,500 next year. I want to see the potential of the whole maternity team being realised. There are new technologies out there and new techniques improve care and deliver value for money while improving the experiences of women, their babies and the wider family. We will continue to work with the Royal College of Midwives to make sure that we have an appropriately resourced but also skilled maternity work force with the leadership they need. Of course, that will be of scant consolation to many of the families involved, but sadly I cannot turn the clock back.

[Margaret Hodge]

I am grateful for the Minister’s remarks, but in the last couple of minutes available, may I ask her to comment on two other specific issues? First, I think that we need an independent inquiry. I recognise all that has been done, but will she respond to that point? Secondly, will she respond to my point about the Barking hospital site where we have a brand-new, state-of-the-art maternity unit that is being kept closed?

[Anne Milton]

I thank the right hon. Lady for making those points, but I honestly do not know that an inquiry is the right way forward. The tragedy of this is that we know what some of the problems are and there has been a failure to turn them around. Certainly, an empty building and a midwife-led unit that could deal with 2,500 deliveries a year for women of low risk would be an important development, but I do not want to prejudge the Secretary of State’s decision on that. I hope that the right hon. Lady, her constituents and the families involved will at least take some heart from the fact that steps are going to be taken to prevent any of this from ever happening again. I will make sure that those efforts remain at the top of the trust’s agenda. I can assure her, my hon. Friend the Member for Ilford North and the hon. Member for Ilford South that I will take a personal interest in this and make sure that we monitor progress towards giving local people what they deserve—the very best from their local NHS.

Question put and agreed to.