Agenda item

To receive an update on the delivery of maternity services in the county, including an overview of current issues and media reports.

5.1 Members engaged an in-depth discussion on the delivery of Maternity Services for the County, including the responses to the Panorama television documentary ‘Midwives under Pressure’ broadcast by the BBC on 29 January 2024, and the focus on Cheltenham General Hospital in the reporting of national maternity challenges.

5.2 Contributing to the discussion/responding to questions were representatives from the Gloucestershire NHS Hospitals Foundation Trust.

Key information presented at the meeting included: -

5.3 The BBC Panorama documentary broadcast on Monday 29 January 2024, focused on maternity services provided by the Gloucestershire NHS Hospital Foundation Trust. The programme included details of three very tragic deaths of a mother and two babies in NHS Gloucestershire Hospitals, in addition to exploring the national and local challenges in recruitment and staffing. The documentary also focused on the impact on staff, where some staff felt unable to speak up about safety concerns or felt they had not been listened to, particularly in relation to the two baby deaths in 2019 and 2020.

5.4 NHS representatives stated that the maternity services in Gloucestershire were undergoing significant transformation and that, as a Trust, NHS Gloucestershire Hospitals FT was determined to learn from past experiences and address any issues where mistakes were made.

5.5 The cases highlighted by the BBC documentary occurred between 2019 to 2021. Each case was independently investigated. Members were reassured that, as a result of the investigations and subsequent Care Quality Commission’s (CQC) inspections, significant improvements had been made to the delivery of NHS Gloucestershire maternity services.

5.6 Acknowledging that the Panorama programme had been very distressing, it was noted that the Trust had apologised for its failings and the trauma experienced by those individuals who had suffered such tragic losses. It was also noted that the Trust had made extensive changes and improvements over the past 18 months as part of the wider journey of improvement currently underway.

5.7 Some of the key changes included: 

1)    A new and expanded senior leadership team.

2)    An increased number of midwives and doctors.

3)    Work with staff to focus on patient safety, learning and continuous improvement.

4)    Introduction of a new consultant midwife role to strengthen midwifery oversight of midwifery-led care.

5)    An ongoing recruitment and retention programme to reduce vacancies and turnover of staff.

6)    Introduction of a ‘Place of birth risk assessment’ to prevent delays in accessing urgent care, if required.

7)    Three daily safety briefings to review staffing, workload and labour inductions (ensuring concerns are addressed immediately).

8)    Revisions to the internal Freedom to Speak Up Service.

9)    A range of other support offered to staff, including wellbeing and psychological services and safety champions.

5.8 The changes are being driven by staff, working in conjunction with families and communities. It is hoped this will encourage everyone to speak out and ensure the best and safest care is provided.

5.9 In terms of staffing levels and investment in NHS Gloucestershire midwifery services, it was confirmed that, since April 2020, the Trust had invested an additional £1.8 million towards increasing maternity staffing, including obstetricians, consultants, administration support and the number of midwives working in the department. Concerns were raised about the negative impact the Panorama Documentary might have on recruitment to NHS Gloucestershire maternity services.

5.10 The vacancy rate for clinically delivering midwives in the Trust had reduced from 15% in the summer of 2023 to 7.85% December 2023. With continued focus on the recruitment and retention of midwives, it was hoped the vacancy rate would reduce even further to 5.3% by July 2024.

5.11 Claims by the BBC that the NHS Gloucestershire maternal death rate was twice the national average were refuted at the meeting. Members were informed that such claims were inaccurate and something that national experts in maternal and neonatal deaths at Oxford University (MBRRACE) and the Local Maternity and Neonatal System, had reviewed independently. From the reviews, it had been confirmed that data for Gloucestershire was in line with the national average and not significantly different from the UK rate.

5.12 In response to members questions, the Trust stated it was committed to learning from the tragic cases reported by the BBC documentary and would be engaging with the Maternity Improvement Advisor from NHS England and other system partners to commission an external working party, including clinicians, to look at the mortality issues in more depth and to form a more objective review.

5.13 Running parallel to this, was a Local Maternity and Neonatal System (LMNS) Review led by the new Chief Nursing Officer of the NHS Gloucestershire Integrated Care Board and Chair of the LMNS, Marie Crofts. The review to focus on key priorities, transformational work, and the action plans currently underway to ensure alignment with strategic priorities.

5.14 In February 2024, the Care Quality Commission (CQC) published results of its national maternity survey. The national survey highlights women's and families' views on all aspects of maternity care from the first time they see a clinician or midwife, through to the care provided at home in the weeks following the arrival of their baby. The survey took place in February 2023 and asked women about their experiences of care at three different stages of their care – antenatal care, labour and birth and postnatal care. 230 people who accessed maternity care at Gloucestershire Hospitals took part in the survey.

5.15 The Trust was rated particularly high in several areas. Areas where the Trust was rated less highly, however, included i) Being given appropriate information and advice on the risks associated with an induced labour, before being induced; and ii) Being provided with relevant information, support and advice about feeding their baby, both during pregnancy and after the birth of their baby. Full results of the survey are available on the CQC website.

5.16 Stroud Maternity Unit and Aveta Birthing Unit

5.17 On 31 January 2024, HOSC Chair and Vice Chair, Cllrs Andrew Gravells and David Drew, had met with Siobhan Baillie, MP for Stroud, Maria Caulfield, Under Secretary of State for Mental Health and Women’s Health, Carolyn Jenkinson from the CQC Inspectorate, Professor Mark Pietroni and Kevin McNamara from the Gloucestershire NHS Hospitals FT, and representatives from the Nursing and Midwifery Council (NMC) to discuss the ongoing temporary closure of postnatal beds at Stroud Maternity Unit (SMU), plus other related issues, (including the recruitment and retention of staff).

5.18 At the meeting, it was agreed that partnership working should continue to allow key stakeholders to optimise the delivery of safe and reliable maternity services for the women of Gloucestershire. Periodical updates to be provided, and meetings reconvened at appropriate intervals. The Trust said that it had welcomed the opportunity to meet with key partners to discuss the challenges being presented during the delivery of maternity services.

5.19 Committee Vice Chair, Cllr David Drew, also conveyed his appreciation of the opportunity to meet with the MP for Stroud, particularly on issues relating specifically to Stroud Maternity Hospital. Cllr Drew emphasised the importance of re-opening the Aveta Birth Unit at Cheltenham and reinstating the offer of providing post-natal beds at Stroud. The comments were noted, with assurances that both decisions would continue to be monitored.

5.20 Members were advised that, although good progress was being made in terms of recruitment, there was still more to do to ensure staffing levels were at a safe and satisfactory level to enable the reopening of post-natal beds in Stroud.

5.21 Referencing the temporary closure of the Aveta Birth Unit at Cheltenham General Hospital in 2022, the Trust confirmed that, from the centralising of services to Gloucestershire Royal, 99% of new births now received one-to-one care during labour. Every effort was being made to achieve the 100% ambition. The Trust continued to work closely with system partners on how maternity service provision could be re-opened safely at both Cheltenham and Stroud Hospitals.

The following comments and questions were raised at the meeting: -

5.22 Several members questioned why the Health, Overview and Scrutiny Committee had not been notified of the deaths involving a mother and 2 babies between 2019 and 2021. Newly appointed Chief Executive of the Gloucestershire NHS Hospitals Trust, Kevin McNamara, stated that the information, including the outcomes of Care Quality Commission (CQC) inspections, was public information and available on the NHS Gloucestershire Integrated Care Board website. It was acknowledged, however, that better communications were required going forward. Links to the NHS Gloucestershire and CQC website to be shared with the committee. Action by – Democratic Services

5.23 A member enquired about the actions taken in response to the 3 deaths that had been highlighted by the Panorama Television Programme and proposed that a full independent ‘external’ inquiry be arranged. Lisa Stephens, NHS Gloucestershire Director of Midwifery, confirmed that the deaths had been investigated by an external independent review body and that a significant piece of work had been undertaken in response to the outcomes of the investigations, including a review of risk assessments aligned to individual birthing options.

5.24 In addition, a full governance review, led by NHS England, had been implemented. Leadership and staff safety continued to be key priorities during the review.

5.25 To note the actions being taken and to monitor the progress of the actions plans produced in response to the findings of the external investigations/CQC inspections, members requested regular updates on the progress of the actions at future meetings. The CQC inspection report following the recent inspection of Stroud Maternity Hospital to be shared with the committee when available. Actions by – Gloucestershire NHS Hospitals FT

5.26 Committee Chair, Cllr Andrew Gravells, requested that a progress report on the progress of the respective action plans be considered at the next committee meeting on 21 May 2024 and that representatives from the independent review organisations be invited to the meeting to respond to questions. Action by – Gloucestershire NHS Hospitals FT

5.27 Cllr Gravells enquired if the NHS Hospitals FT had been invited to participate on the BBC Panorama Documentary, and if the BBC had responded to the correction of inaccurate claims that the Gloucestershire maternal death rate had been twice the national average. It was confirmed that the BBC had not invited the Trust to contribute to the programme, nor had it corrected the inaccurate claims. 

5.28 Acknowledging resistance from some members of the committee, Cllr Gravells proposed that a letter be sent to the BBC to express the committees’ concerns about decisions taken before the broadcasting of the Panorama Television Programme. Action by – Democratic Services  

5.19 Since the meeting, a letter has been sent to the BBC, seeking confirmation on whether an invitation to participate in the programme had been sent to the Gloucestershire NHS Hospitals FT. The letter questioned why this had not been considered a central component to ensuring a balanced discussion during the documentary. The letter also enquired if information referred to by the television programme had been authenticated by either the NHS Gloucestershire Integrated Care Board or the Gloucestershire NHS Hospitals FT.

5.20 Members requested a full update on the delivery of Maternity Services in Gloucestershire at the committee meeting on 21 May 2024.