NHS failing mums and infants as deaths COVERED UP – bombshell report

National maternity inquiry hears shocking claim that deaths of babies due to poor NHS care are being covered up and wrongly recorded as stillbirths

View 2 Images

Deaths of babies due to poor NHS care are being covered up and wrongly recorded as stillbirths, it has been claimed.

A national maternity probe chaired by Baroness Valerie Amos has outlined why mums and babies are still needlessly dying during childbirth. The inquiry outlined six factors that are still leading to poor NHS care despite numerous earlier inquiries into maternity scandals at trusts in the last decade.

Baroness Amos’s team has met with over 400 affected people and received input from over 8,000 people including mums, their relatives as well as NHS staff. She said: “It is clear from the meetings and conversations I have had with hundreds of women, families and staff members across the country, that maternity and neonatal services in England are failing too many women, babies, families and staff.”

View 2 Images

READ MORE: Mums and babies dying during childbirth increases for the first time in a decade

Many families felt there had been a “cover up” and defensiveness from NHS trusts after something went wrong. Mums reported incidents where they believed their medical notes had been amended or redacted.

Mums felt the system incentivised the recording of deaths as stillbirths as this prevents the case from being investigated by a coroner. One said: “I’ve still never agreed he was stillborn. He was resuscitated for 30 minutes before we were told he had died. You don’t resuscitate a stillborn baby. But you register a baby as stillborn, you have no independent investigation. They’ve been able to hide behind it… his death isn’t in the public domain.”

Baroness Amos is chairing the independent National Maternity and Neonatal Investigation commissioned by Health Secretary Wes Streeting after several inquiries at different NHS trusts revealed similar failings. The former UN diplomat said the six factors were shortages of staff, lack of NHS capacity, poor work culture and leadership, discrimination, lack of accountability when things go wrong and crumbling NHS hospital buildings. Campaigners are now demanding action to stop more babies and mums dying.

The inquiry pointed to lack of NHS capacity and maternity workforce shortages which have built up over the last decade or so. Midwives warned vital antenatal appointments had to be too brief, mums faced waits for medical assessments. When babies were born some inductions and caesarean section procedures had to be delayed while home births had to be suspended.

Probes have been held into deaths caused by poor care at maternity units in Morecambe Bay, Shrewsbury and Telford and East Kent which led to 748 recommendations for improvements being made. The biggest maternity inquiry in the history of the NHS, examining around 2,500 cases in Nottingham, will report in June while another inquiry was recently announced into care at Leeds Teaching Hospitals NHS trust.

Baroness Amos brought much of this together in her interim findings on “emerging themes” from 12 trusts she has been looking at in detail.

Richard Kayser, medical negligence lawyer at law firm Irwin Mitchell, which represents hundreds of affected families, said: “This latest report tells us what we’ve known for years. Put simply, maternity services aren’t good enough, resulting in mums and babies being put at risk because of deep-rooted problems nationally.

“Over the past two decades we’ve seen several high-profile investigations and reports – stretching back to Morecambe Bay and Shrewsbury and Telford – make hundreds of recommendations, many of which haven’t been implemented. The nation’s maternity services are now at a crossroads in terms of whether the same issues continue to be highlighted or whether decisive action is actually taken to improve care for families in future.”

The inquiry heard of “dilapidated and outdated” facilities, cold delivery rooms and of leaking roofs. In one hospital staff had to put the weather report on labour handover notes because the room leaks so much that women in labour have to be moved when it rains.

The report said many rooms were not large enough to accommodate staff and equipment. It said: “In one visit, we were informed that when an instrumental vaginal delivery was required in the delivery room, the door had to be left open to provide enough space – with a screen placed outside of the room to protect families’ privacy. It is inconceivable that anyone would choose to give birth in such a manner.”

Women described listening to nearby babies crying whilst they are mourning their own baby, of having to receive care in a ward shared with women in active labour. Shame about delivering poor care on understaffed wards led to some midwives hiding their name badges or uniforms in public or lying about their jobs when meeting people outside of work. One said: “I feel embarrassed to say I am a midwife now.”

The inquiry heard accounts of Asian women being stereotyped as “princesses” – with the implication that they are overly demanding or unable to cope with pain. Black women reported being deemed as having “tough skin” and able to tolerate pain. Black women described experiences of “the angry or aggressive Black woman” stereotype when asking for help or pain relief.

The rates of deaths of mums and babies are twice as high for those living in the most deprived areas compared with women living in the wealthiest. Young parents described facing judgement and felt that their grief and trauma were minimised because of their age.

One parent who had lost twins at 17 shared: “He’d completely written me off… didn’t care that I’d lost twins.” Another, who had experienced multiple losses, recalled being told: “You’re young, you’ll be fine, just try again.”

The interim findings from the National Maternity and Neonatal Investigation come as Baroness Amos continues to draw up a series of national recommendations to improve maternity and neonatal services. However some families have said it does not have enough power and are demanding a full statutory public inquiry.

In her foreword to the interim report, Baroness Amos said: “I have been asked many times during the course of this investigation what makes it different to those investigations and reviews that have gone before. The answer is that this investigation is national in scope and takes a whole system view… I see it as my purpose to understand the context and identify the urgent systemic issues that must be addressed.”

Wes Streeting will chair a new National Maternity and Neonatal Taskforce in the New Year which will be responsible for implementing the recommendations.