Maternity units need thousands more doctors and midwives to be safe

The numbers of doctors working in maternity services in England will need to be increased by a fifth to make wards safer for mothers and babies, it has emerged.

NHS England has written to hospitals demanding urgent action to improve the safety of mothers and babies in the wake of the damning report last week into poor care at the Shrewsbury and Telford Hospital Trust.

Dr Eddie Morris, president of the Royal College of Obstetricians and Gynaecologists told MPs on the Commons health select committee that adopting all the recommendations could mean a 20 per cent increasing in the numbers of obstetricians working in maternity.

He also warned of existing gaps in rotas for junior doctors: “We know that every single unit in the country has gaps in the rota of the junior doctors and the senior trainees who are delivering service, which I think shows that we do have a significant problem around staffing those rotas.

“When we look at consultant obstetricians, we don't know yet exactly how many more staff we need but if we're going to expand the work that consultants do along the lines of [Donna Ockenden’s] recommendations, we may well need an expansion in our consultant workforce of somewhere around 20 per cent. Now that would need training and would need considerable efforts to encourage more doctors into the speciality.”

The Royal College of Midwives has also emphasised it believes the NHS in England is short of at least 3,000 midwives.

Dr Morris added: “If units are under pressure and understaffed then the teams don't get time to train properly. And that's one of the areas where we feel that steadily over the years that loss of team identity and the ability of a team to work together, has been lost.”

In a letter sent on Monday night from NHS England’s chief nurse Ruth May, its medical director Steve Powis and chief operating officer Amanda Pritchard, hospitals were given until next week to confirm they had adopted 12 essential safety actions.

The letter said: “Despite considerable progress having been made in improving maternity safety, there continues to be too much variation in experience and outcomes for women and their families.”

It said the report into poor care at Shrewsbury and Telford Hospital Trust must be used to “redouble efforts to bring forward lasting improvements in our maternity services.”

It added that all NHS trust boards should review the Ockenden report and check that their systems are effective and that the board is “assured that poor care and avoidable deaths with no visibility or learning cannot happen in your own organisation.”

Among the steps trusts have been told to take are to bring in consultant led labour ward rounds twice a day including night shifts, seven days a week. All women with a complex pregnancy must also have a named consultant lead.

NHS England has said a non-executive director must be designated to oversee maternity services and trust boards should review all maternity serious incidents.

Trusts must also make sure they have ways of getting patient feedback, and that staff are able to train together as teams with any training money ringfenced.

Mothers must be risk assessed at every contact with the service and this must be regularly reviewed and include a discussion about the choice of place of birth and associated risks.

A report by the independent investigation into Shrewsbury and Telford Hospital Trust last week concluding a poor culture that denied women choice and which promoted a ‘normal birth’ led to women experience traumatic deliveries and poor care.

More than dozen women died giving birth at the trust between 2000 and 2019 along with dozens of babies and children left severely brain damaged.

The report also criticised a lack of kindness and compassion towards mothers by staff and a failure to properly investigate serious incidents that meant mistakes in care and systemic failings were not identified meaning errors were repeated time and again over many years.

A final full report considering more than 1,860 cases is expected to be published next year.