The crisis in NHS maternity wards

Killing babies through being too busy is accepted as normal and many mothers are treated worse than farm animals



When my daughter was born, I did not think she was alive. She came out of her mother with a chest striped blue and purple, and failed to move. She lay motionless on the mat in the delivery room and the blue disappeared, rapidly replaced by more purple. Then the purple darkened and contracted as fast as the pupil of an eye. Now, at the ripe old age of ten seconds, my baby was white as a sheet with dark blotches. And still not moving.

My wife Rachel had tapped me on the shoulder barely two hours before. We were in bed. The clock radio blinked 1.30. In the dark, she had told me: "I think I'm in labour." It was all more rapid than I could ever have imagined. Zooming down dark London backstreets, I thought the baby was about to be born in the footwell of our car. And by the time we reached the nearest maternity unit, the poor child was trying to get a glimpse of the corridor. We were shown to a room. Midwife and baby emerged simultaneously.

Now, looking at my daughter lying there on the blue plastic mat, I remember two things clearly: assuming something terrible might have gone wrong, but deciding not to panic unless the staff did. I looked to the midwife for reassurance. "Show me your notes," she said - not shouting, but urgent all the same. "Hold up your wife's notes." I was grabbing at the file. "Last-but-one page." Everything had happened so fast, she had not been able even to glance them over. "Are you Rhesus Negative?" she asked Rachel. "I don't know, don't think so," my wife replied. I was still staring at the little scrap on the floor. Baby motionless; midwife worried.

Then a miracle happened. Our NHS angel, the midwife, took a towel and rubbed the lifeless baby to get the circulation flowing, and suddenly the white and the purple disappeared and the skin shone with glorious red, like a farmer's cheeks on harvest day. Then she started bawling her eyes out - the noise might have tried our patience in the weeks since, but that morning it was as welcome as wedding bells.

The midwife, a sparky fortysomething whom I shall not embarrass by naming, had been about to go off shift when we arrived. She had stayed on from a sense of duty, thank goodness, and congratulated us heartily. "Blimey, I thought she was a goner," I confessed over the sound of my newborn screaming. "I even thought you thought she was." "My rule," said the midwife, "is never panic in the first minute."

I wrote my anxiety down to new-father nerves and inexperience. But had I known what I now know - thanks to working on Panorama's undercover investigation of other maternity units - I might have approached the day of my daughter's birth with rather more trepidation. We sent a reporter, Hayley Cutts, to work as an unpaid volunteer in maternity wards at hospitals in Barnet and Manchester. Some of the footage she came back with was truly frightening.

In one excerpt, filmed in January at Barnet Hospital, Hayley watched as a midwife was called away to a crisis elsewhere. That left an astonishing 24 women in the care of just two qualified midwives and one student. Picture the scene. As Hayley's camera whirrs, concealed in her blouse, the phone goes. It's a call from the delivery suite, where mothers actually give birth. They're saying they're full - they have to send a patient over to the maternity ward.

Hayley passes the news on to her more experienced colleagues. "There's a woman coming over in two minutes." "For what?" asks one. Hayley explains, "She's from the delivery suite." "She's here and there's no beds," murmurs a midwife ruefully. When, seconds later, the labouring woman appears, your first impression is of a terrible misjudgment: how can a woman so deep into labour be sent packing from the unit where she is supposed to be having her baby? The nearest midwife tells her to sit in the corridor.

The scene is awkward enough watching it on tape - it must have been a dozen times worse for the mother-to-be herself, labouring on a hard plastic chair in full view of janitors and any passing visitor. When Hayley points out to the midwife in charge that the woman is crying, she replies: "Tell her to get a life." We showed the tape to Mavis Kirkham, professor of midwifery at Sheffield Hallam University, who was shocked. "I think that's really tragic, that poor woman in strong labour in a public corridor," she said. "These are Third World conditions. No farmer would let an animal they valued labour with that degree of stress and anxiety in a tense public place."

After 50 minutes in the corridor, the woman was eventually taken to a bay in the ward, but when she got there, there was no bed for her. So she had to wait again on a plastic chair. The hospital authorities later informed us the staff's 'mistake' was not to have shifted the woman to another hospital. But the nearest alternative maternity unit was six miles away, and the poor woman was about to give birth.

I wish I could say that the overload on the ward was a one-off. But often the wards at Barnet are so choc-a-bloc they have to close temporarily. It happened eight times in the four weeks Hayley was there. When she asked a midwife why the doors were shut to new arrivals, she got the reply: 'We're dangerous at that stage. It gets to the point we've got so many women and not enough staff to look after them that we could miss things.' If that is not a warning sign to expectant mothers, what is?

At one point the Barnet staff are caught in conversation about how things won't change unless something terrible happens. 'I tell you what it's going to take,' one midwife says, 'a baby dying.' Another disagrees, saying it 'needs a mother' to die. The exchange happens casually, across an admissions desk. It is all the more shocking for that. 'We've killed off babies before now, deaths you can push under the carpet,' says a midwife on our tape. 'To kill a baby is cheap, but to damage a baby is more expensive. To kill the mother - that will actually give us the results we need, but God help the poor midwife involved in that.'

The chief executive of Barnet And Chase Farm Hospital Trust, Averil Dongworth, was suitably appalled by this conversation on her premises. But when she blamed the midwives I wondered if she had missed the point: staff shortages, missing equipment and rota chaos are surely not their fault.

So what has the Government promised? In 2004, there was a pledge that every woman in full-blown labour should have access to 'a designated midwife 100 per cent of the time'. And only last month, Health Secretary Patricia Hewitt promised every mother would have the right to opt for a home birth, overseen by a midwife. Yet the Royal College Of Midwives says the system is 3,000 midwives short and one-third of maternity units had their budgets cut last year.

All of this while Britain's birth-rate goes up. Small wonder that a report from Oxford University into maternity care in Britain found that two-thirds of mothers said they felt they had been abandoned too soon after giving birth.

If only the scenes we'd witnessed at Barnet Hospital were an exception. But they were not. North, south, east and west we found all manner of horror stories about the pressure on maternity services. I went to see Ben Harman and Katie McKay at their swish terrace home in Battersea - young, professionals with loving families and lots of friends. Eight months ago, when her labour began, Katie was told by Chelsea & Westminster Hospital that their maternity unit was too busy to take them at present and she should 'have another bath' while her labour progressed. So she did. This was her first child; why argue with the experts? After the bath she rang back - the unit was still full and there was no space at any other hospital. 'I freaked out,' Katie told me. Still they told her to hang on. After two hours Ben drove her to Chelsea & Westminster, but still the staff were too busy for her. 'It was only after my waters had broken, one hour and ten minutes after I'd actually been on the ward that I was given my first internal examination,' she told me.

The baby was lying the wrong way round, in the breech position, and in distress. Instead of an emergency caesarean they tried to deliver the baby normally. She was starved of oxygen and baby Ella died five days later. 'From our point of view,' Katie said, 'It was just too many red lights. If you go through one red light you might get away with it. If you go through five you're going to have an accident. 'The first red light we went through was when the position of the baby wasn't picked up, the second red light was the hospital being closed to admissions, the third red light, not being examined for an hour-and-a-half. Unfortunately, for us it resulted in our baby's death.'

This was the wisest single thing anybody told us in the course of filming. How terrible that Katie had to find it out through her own personal tragedy. Sitting in their front room, I leafed through their photograph album. Picture after picture showed Ella being hugged, so cherished by her mum and dad in those five short days of life. Her parents found the explanation that midwives weren't available to provide better care because of a "change of shift" was little short of an insult.

Our reporter, Hayley, also did work experience at St Mary's hospital in Manchester, inside the city's biggest maternity unit. Secretly recording there for weeks, she kept hearing stories from stressed-out midwives and mums who said the care they received was unsatisfactory. Hayley was at the bedside of Lili, who was 16 days overdue but had not been induced because of a lack of beds in the delivery unit. Finally, staff did induce her. But then they turfed her out of the delivery ward because they said they needed the room for someone else. With no access to any pain relief beyond gas and air, she begged to be examined. When it turned out she was in the late stages of labour, Lili was rushed to delivery to have her baby. Then, in one of the film's most chaotic scenes, Hayley is sent to fetch a CTG, the monitor which picks up a baby's heartbeat when pressed to the mother's stomach.

From ward to ward she goes. Here is a sample of the exchanges: Hayley: "Hiya, I was wondering if we could borrow a CTG monitor." Staff member: "Oh - er - that'll be a matter of finding one." Staff member two: "I doubt it. The place is full." Ward clerk: "I can't actually find one anywhere, love." Hayley: "Really? Do you know when one will be available or not?" Staff member: "I couldn't say, no. Unless they might have one over there. Have you tried over on MDU, maybe." Hayley: "OK, I'll go and ask - thanks." And the reply from the next unit when she asks if they've got a precious CTG? "We haven't. They're all in use." Such scenes would be comic if they were happening anywhere but in a hospital.

And when Hayley - who is totally upfront about her lack of training - is asked to monitor a baby's heartbeat by a midwife too busy to do it herself, you realise just how disturbing the problems on Britain's maternity wards have become. It brought me back to those chaotic moments in December when our Anna was born - which was, after all, a normal if somewhat rapid delivery. In those precious moments you realise a life is in the balance; and the whole future of your family. You don't want to leave the hospital counting yourself lucky that a midwife turned up for the birth.

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An Australian government denies its hospitals are in crisis

The Queensland Government has denied the state's health system is in crisis despite finding that four unregistered foreign-trained interns were undertaking the work of doctors at Cairns Base Hospital. The scandal comes two years after Indian-trained surgeon Jayant Patel was blamed for contributing to the deaths of 17 people at Bundaberg hospital, which led to a radical shake-up of the health system.

Queensland chief medical officer Jeanette Young filed a report to the Government yesterday which said that not only had four overseas-trained interns been doing the work of doctors at Cairns Base Hospital earlier this year, but two medical supervisors had allowed them to do such work even though they knew the four were not registered doctors. Two of the four interns have been dismissed and one is in the process of being dismissed. Another has been registered and is now practising as a doctor at the hospital.

Two medical supervisors at Cairns Base Hospital, acting executive director of medical services Wayne McDonald and deputy medical superintendent Ric Streatfield, face an ongoing examination of their actions by Queensland Health's Ethical Standards Unit as well as the Queensland Medical Board, which is responsible for the registration of doctors in the state. The investigations will look at not only their actions in allowing the interns to perform the work of doctors but also reports they gave to Queensland Health that indicated the interns were being supervised and had no direct contact with patients. The initial reports to the Government were that the four had always been under supervision but Health Minister Stephen Robertson sent Dr Young to Cairns to investigate patients' files.

Dr McDonald has already resigned from Queensland Health, but the medical board has the power to ban him from practising medicine in Queensland. Dr Streatfield could face a range of disciplinary actions, including being sacked.

Mr Robertson and Dr Young yesterday denied that the incident showed a system-wide problem in Queensland Health, and said the problem had come about because the hospital did not follow guidelines. "This is not a system in crisis; this is a system under pressure," Mr Robertson said. "This is not Bundaberg; the circumstances are quite different." Mr Robertson said that, although the Government had outlined clearly what guidelines needed to be followed, that had not happened in this case. "The guidelines are very clear: you don't employ doctors that are not registered by the medical board," Mr Robertson said. "I also want to stress this was a mistake made by one local hospital; it is not a whole-of-system flaw."

Three of the interns are Alex Burgansky, who did much of his secondary schooling in Ukraine and is under investigation, and Lulu Meng and Juan He, both from China, who have been sacked. The fourth, who is now a practising doctor, has not been identified. Cairns Base Hospital takes 18 interns most years, but with a shortage of doctors in regional Queensland, the intake was increased to 24 interns this year. All 24 places were filled with graduates from Australia, but when four dropped out, the hospital was forced to look overseas for replacements.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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