Overstretched NHS maternity units put mothers and babies at risk

Women giving birth are being admitted to maternity wards short of doctors and midwives as well as basic medical facilities, a review concludes today. “Significant weaknesses” persist in maternity and neonatal services across England, putting mothers and babies at risk despite years of sustained criticism from watchdogs, the Healthcare Commission said. Medical errors and poor standards of care have contributed to the deaths of at least six women in England in recent years, inquests have found.

Consultants did not always spend enough time on wards and not all staff received adequate training on safety issues, the review of 150 NHS trusts found. The pressure on maternity and neonatal wards is such that newborn babies are being turned away from some units regularly as there are no cots available, it suggests. More than half — 56 per cent — of neonatal units closed their doors to newborns in the six-month period to March 2007, in some occasions for more than three months. The average length of closure was two weeks, meaning that vulnerable babies would be shuttled between hospitals until one was found to take them.

The birthrate in England has risen over a decade to nearly 670,000 a year in 2006, with new figures for 2007 expected to show a further increase today. However, choice over where and how women give birth remains limited because of staffing issues, the review concludes, despite government assurances that all women should receive one-to-one care from a dedicated named midwife by 2012.

Sir Ian Kennedy, chairman of the commission, said that the NHS had no excuses for poor maternity care and the death of women giving birth. “I don’t want to be at the wrong end of another investigation report describing the deaths of babies and mother,” he said. “I have been there too many times. There’s no reason we should see that any longer.” He called for an end to the “tribal allegiances” that set obstetricians against midwives and criticised the “staggering” absence of statistics on maternity services in 17 per cent of trusts. “How can they know what they are doing? This is not how a modern, 21st-century large enterprise should conduct itself,” he said.

In a review that surveyed more than 26,000 women and 5,000 staff, the commission examined all aspects of maternity care, from neonatal checks to the final contact with a midwife, usually ten days after a birth. While a majority of women were happy with their care, in some hospitals more than one baby was being born in each bed every day — raising fears that mothers were being hurried out of the labour suite after birth.

The median number of delivery beds per 1,000 births per year was 3.6, equivalent to each bed being used for 0.7 births per day, but some trusts have as few as two beds per 1,000 births per year, meaning that each was used for 1.4 births per day. “This seems excessive and there is clearly a need to increase the capacity of delivery beds in these units,” the report concludes. In addition, roughly half of trusts need to “examine their staffing levels urgently” to achieve more than 31 midwives and 6.6 obstetric doctors per 1,000 births or greater, it says.

About one in ten new mothers rated the care received before and during the birth as “poor” or “fair” but this rose to one in five when assessing the quality of postnatal care. There was also an inadequate number of bathrooms in delivery suites, with relatively few units (16.5 per cent) having as many as one bath per delivery room, and only half reported having one or more baths for every four delivery rooms. “Shower facilities are more common and more than a third of trusts (38 per cent) reported one shower per delivery room, with just over half of units reporting one shower or more for every two delivery rooms. “Ideally, all delivery rooms should have a bath or shower room en suite, but there is clearly a long way to go before this position is reached.”

The mortality rate among mothers, taken from pregnancy until six weeks after birth, has remained between 13 and 14 per 100,000 over the past six years. Researchers say that there are several reasons why the death rate has not declined, including a rising number of women choosing to have babies later in life, which increases the risk of complications. However, of the 295 deaths of new mothers between 2003-05, half were attributable in part to substandard care, according to the official Confidential Enquiry into Maternal and Child Health.

One of the Government’s key aims is to give every woman choice over where to have her baby, with more home births and deliveries in local units staffed by midwives, rather than consultants, expected as a result. “[But] in practice, the choice of types of maternity unit is currently very limited, because our review found that about two thirds of trusts (65 per cent) had only obstetric units,” the commission found. “The remaining trusts had combinations of obstetric and midwife-led units; either alongside the main unit, or midwife-led units in separate freestanding premises. A few trusts had all three kinds of unit. Two acute trusts had midwife-led units only.”

Ministers have promised $660 million extra funding for maternity services over the next three years and 4,000 more midwives by 2012. But the Royal College of Midwives said that these would equate to fewer full-time posts and that at least 5,000 were needed “as soon as possible”.

Sabaratnam Arulkumaran, president of the Royal College of Obstetricians and Gynaecologists, said that women who experienced complications or who required emergency attention would still need to see a specialist. At least 1,000 extra maternity consultants were needed, with at least 500 needing to be recruited “in the next two to three years”.

But the Conservatives gave warning of potential mergers or closures of maternity units across the country. Anne Milton, a Tory health spokeswoman, said: “Labour talk about more choice for pregnant women but the reality is that women now have less choice. It’s worrying that many more maternity units are set to be downgraded in the next few years and that so many neonatal units are set to shut.”

Norman Lamb, of the Liberal Democrats, added: “This unacceptable level of care must be addressed as a matter of priority. Staff shortages are putting midwives under an increasing amount of pressure and many women are not receiving good enough care.”

In the absence of formal standards, the review set performance benchmarks for maternity for the first time. In December it rated 22 per cent of maternity services as “fair performing” (32 trusts) and 21 per cent as “least well performing” (31 trusts). Twenty-six per cent of trusts were “best performing (38 trusts) and 32 per cent were “better performing” (47 trusts).

The review was prompted by concern over the quality and safety of maternity units in 2005 after Northwick Park Hospital in North London was put on special measures while the deaths of several women were investigated. Other investigations took place at New Cross Hospital in Wolverhampton and Ashford St Peters Hospital in Chertsey, Surrey.

A spokesman for the Department of Health said: “As part of the NHS review, each region has prioritised improving maternity services and will be developing plans to improve frontline midwifery care, develop leadership capacity and enhance quality of care.”

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Infection alert as dangerous superbugs hit South Australian public hospital

SUPERBUGS are on the rise at Royal Adelaide Hospital and some patients are carrying two different strains. Fifteen patients are now colonised with vancomycin-resistant enterococci, three times as many as there were in May. Four more patients have two different strains of antibiotic-resistant bugs, VRE as well as MRSA or golden staph. VRE has forced ward closures interstate, while golden staph kills about one person in five. SA Health confirmed the cases yesterday.

The other main metropolitan hospitals have no recorded cases of VRE, except the Queen Elizabeth Hospital, which has had one case. Communicable Disease Control Branch director Dr Ann Koehler said there were no ward closures in SA. "VRE and other bacteria such as MRSA are becoming more common causes of healthcare-associated infections in SA and other states across Australia," she said.

Dr Koehler said the department had infection control teams supporting hospital workers and patients, but emphasised visitors had a role to play in reducing infections. "We can't stress enough the importance of visitors to our hospitals to follow simple and effective hand hygiene steps to stop their spread," she said. SA Health has taken actions to control the infection spreading, such as:

DAILY meetings of a VRE response team, increased staff education and frequent communication with relevant staff.

ENHANCED cleaning in identified wards.

ENVIRONMENTAL monitoring and active surveillance of groups at risk of colonisation.

FOCUS on hand hygiene, and compliance with precautions such as single-use gloves and gowns.

VRE does not normally cause illness, so patients are said to be `colonised' rather than infected. It can be a risk to patients with compromised immune systems.

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