Wednesday, February 03, 2010

NHS "professionalism" again

Dad delivers own baby when nurse storms off

A FURIOUS father branded a British hospital a disgrace after he was forced to deliver his girlfriend's baby in a maternity ward because the midwife had stormed out. The Sun reported Thomas Howard, 33, frantically called for help when he realised that the birth was imminent, but nobody came to his aid.

By the time the midwife returned, Emily Baron had already given birth to their daughter Madeline.

Baron, who is now recovering at home with Madeline, said, "I was really worried about the bleeding. When Thomas asked if the midwife knew what was wrong and she said 'No', he asked her to find someone who did. "She then just stormed out and you could hear her stomping down the corridor. I think her attitude was unprofessional."

Thomas said his instinct kicked in when it became clear the baby was coming. He delivered the newborn, tapped her on the back to help her breathe, and was cleaning mucous from her mouth when the midwife finally returned. "I was in shock at what had happened but the nurse didn't say anything to me. She just carried on as if it was normal," Howard said.

The couple said they may file a formal complaint against Royal Blackburn Hospital in northern England.

A National Childbirth Trust spokesman said, "Being left alone in labour in hospital is unacceptable. As a civilised society, we must ensure this basic need of women is met. Having a midwife with you when you give birth is vital to ensure there are no complications."

Last month, the Nursing and Midwifery Council said the midwifery profession was "still playing catch up" after a report warned Britain's rising birth rate was leading to a shortage of staff.


Failing out-of-hours care almost killed British baby

In parts of the country one doctor is responsible for 300,000 people at night

It started with a bruise the size of a shrivelled raisin that slowly grew into a magenta plum. It was Sunday evening, our baby was sleepy as we lifted him out of the bath and I noticed the mark under his tummy button. But he’d been running round London Zoo with his brothers and sister and I thought he must have knocked himself as he raced from the gorillas to the flamingos.

I wasn’t concerned as he lay on the bed while the other children bounded around him. He didn’t even have a fever. But I rang the local surgery, which gave an emergency number. I left a message and put the other children to bed. By 9pm no one had replied, so I looked up NHS Direct. An “information handler” answered. When I explained the almost non-existent symptoms, she suggested that I could go to A&E if I was concerned. By now all four children were asleep in bed, and I felt that I was turning a bruise into a drama and was more worried that my 18-month-old would pick up a bug if we queued all night in hospital.

I finally rang a private GP’s surgery when I realised that he had a slight temperature. The doctor on call arrived on her moped in 20 minutes. She lifted our son out of bed, joked with him and asked him to show her his tummy. At that moment she stopped smiling and phoned the consultant paediatrician at the hospital.

“You both need to go to hospital just to be on the safe side,” she said. We drove through dark, empty streets, reassuring ourselves that our baby was still babbling. The consultant laughed when our son started playing with his stethoscope but then he lifted up his pyjama top and began issuing orders. We suggested that it might be a bruise but no one was listening as they inserted drips to pump drugs and fluids into his arms and legs, and started preparing him for a lumbar puncture, The nurse was told to wake him every 15 minutes to prevent him falling into a deep sleep. We finally realised that they thought he might have meningitis.

Our baby screamed, tied to the bed by his tubes, but every time he fell into a fitful sleep he had to be woken. By dawn he was receding into himself, the bruise was vast and pulsating, but he was fading away. The paediatrician with 40 years experience didn’t think it could be meningococcal disease, the surgeon arrived and suggested cutting away the bruise and cleaning out the infected area. It took eight hours to synchronise the anaesthetist’s and surgeon’s timetables. The surgeon was Lebanese, the anaesthetist German and the two nurses were from the Philippines. They were amazing in their dedication. It was only when the anaesthetist said in a mild German accent: “We are going to put your son down now. Do you want to kiss him goodbye,” that I cried.

We sat in the waiting room under the strip lights watching babies tottering past us, not thinking about our son’s first step or his first word until the nurse came back from theatre. As I cuddled my child, the surgeon told my husband that he thought that they had managed to clear the infection. His stomach had been mangled but he looked beautiful as he slept.

It is impossible to draw conclusions from one case, but as our son recuperated over the next two weeks, and we lived our lives in shifts by his side, parents, doctors, nurses and cleaners gave us their views. And I did learn lessons. No one should automatically think that a foreign doctor or nurse is second best. Ours were extraordinary. The hospital wasn’t particularly clean, but we could provide our own pillow cases and food.

Almost everyone in the hospital believed that the NHS out-of-hours service was defective. I kept thinking back to the Sunday night when we nearly left our son to sleep. And I still think about it when I read reports that in parts of the country a single doctor is responsible for more than 300,000 people out-of-hours.

Andy Burnham, the Health Secretary, has finally admitted that this may be “unacceptable” but it has been obvious for several years that Primary Care Trusts who were given responsibility for this in 2004 have, in many areas, failed to provide a safe service, as required by law.

GPs must take back control of their out-of-hours services. This is not because they are greedy professionals who only work from 8.30am to 6pm for average salaries of more than £106,000 a year, or even because one exhausted German locum caused a man’s death through an accidental drugs overdose. They should do it because the current system doesn’t work. A&E departments are overwhelmed because most evening inquiries are directed to them and the emergency services have to mop up much of the rest.

GPs used to act as gatekeepers night and day. Our private GP had seen four children that Sunday, two had colds, but one had croup and ours was the fourth. In our case personal contact was vital. GPs should know who is being sent to treat their patients if it isn’t them and should want to be informed if a patient is suddenly on the critical list.

The Confidential Inquiry into Maternal and Child Health, commissioned by the Department of Health each year, says that one in four child deaths in Britain could be prevented if a parent had realised the child was ill earlier or if a hospital had reacted more rapidly. GPs can help both patients and hospitals to make the right diagnosis whether it’s at 3am or 3pm. At the moment they are the missing link.


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