Hospitals that cause harm and injury to women and babies during childbirth often resort to a “cover-up” of their mistakes, falsify medical records and deny bereaved parents answers, a damning report has found.
“Negligent” care has devastating emotional and psychological consequences for families, disputes between maternity staff have a “disastrous” impact on mothers, and ethnic minority and poorer women have worse outcomes because of racism and discrimination, Lady Amos said.
Recent rises in older motherhood and obese women having babies have also contributed to maternity care becoming more complicated, the ex-Labour cabinet minister added in a report the government commissioned amid mounting alarm about NHS childbirth services in England.
“The system is not working for women, babies and families, or for staff,” Amos concluded after spending months talking to hundreds of families and maternity staff.
“We have seen maternity and neonatal services trying to respond in difficult circumstances and dealing with competing pressures but too often failing to deliver the safe care that women, families and babies expect and deserve, at times with devastating consequences.”
NHS trusts continue to provide poor care because they are doing too little to improve its quality and safety as a result of not learning lessons from previous maternity scandals, she added.
“It is a source of continuing distress to families, and great frustration to staff, that the areas identified in previous reviews and investigations as requiring action do not seem to have been addressed or have only been partially addressed. This cycle must stop,” she said.
Lack of staff can affect every stage of a woman’s maternity care. It means mothers-to-be face long delays to be assessed by doctors, have a planned caesarean section or start their induced labour.
It also leads to them being unable to have a home birth because no midwives are available, or to attend antenatal appointments that are too brief to properly discuss their pregnancy.
Staff shortages and the relentless pressure on maternity units means mothers are sent home after giving birth without being properly assessed and then cannot get through when they phone to seek advice.
“It is unsurprising that women and families report a lack of basic care and support,” Amos said.
Her 35-page report excoriates NHS trusts for several failings. Amos accused trusts of compounding the trauma of families who have experienced errors or inadequate care by resorting to secrecy rather than telling them the truth about what happened.
“We heard from many families about feeling that there had been a ‘cover-up’ and defensiveness from NHS trusts, the resistance they faced from trusts when requesting their notes and instances of medical notes being amended or redacted,” the report states.
One woman told Amos how, three years after her daughter was born, the trust in question “handed my solicitors magical notes that reappeared out of nowhere after three years. Which we know are inaccurate because my mum was taking notes. It [the NHS] shouldn’t have this cloak and dagger over your notes.”
Amos is undertaking an independent investigation into maternity and neonatal services in England. During evidence sessions she has heard how trusts are:
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Banning families from being involved in investigations into the mistakes they encountered.
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Conducting inquiries into errors which families think are poor quality and do not properly reflect what occurred.
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Driving distressed families to instigate legal action as a way of getting at the truth after they were “denied openness and honesty in the aftermath of harm and bereavement”.
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Failing to treat families who have lost a baby with compassion.
Paul Whiteing, the chief executive of patient safety charity Action against Medical Accidents (AvMA), said: “The evidence that Baroness Amos has uncovered shows the shocking lengths that some staff are going to, such as hiding or falsifying medical records, in order to cover their tracks.
“This shows the scale of the challenge to improving maternity and neonatal services and care.”
He added: “Sadly, we too often hear similar accounts of secrecy and manipulation of medical records. This, along with other defensive behaviours we see from some hospitals, causes so much additional distress and trauma to a family already struggling with grief, pain or upset.”
Hospitals’ refusal to be transparent, and their withholding or falsification of medical records, is “troubling”, Amos said, because it “compounds the harm already suffered through trauma or bereavement” and stops them learning from safety lapses that should not be allowed to recur.
Wes Streeting, the health secretary, commissioned Amos’s inquiry last August after a series of maternity care scandals at NHS hospitals, including those in East Kent, Leeds, Morecambe Bay, Nottingham and Shropshire, and soaring costs of the NHS settling negligence lawsuits.
The Nottingham inquiry covers 2,500 cases of alleged poor care and is the biggest maternity inquiry in the NHS’s history. It is due to report in June. An inquiry into maternity care is Leeds is also under way.
Staff Amos spoke to told her how public scrutiny and criticism of NHS maternity services is now so intense that some midwives said they “hide their name badges or uniforms in public or lie about their jobs when meeting people outside of work”.
MP Layla Moran, who chairs the Commons health and social care committee, said: “It is heartbreaking to yet again hear the stories of families failed tragically by the system, but also of healthcare professionals who have faced vitriol for doing their jobs in difficult circumstances.”
Moran, a Liberal Democrat, urged ministers to instigate urgent, immediate improvements without waiting for Amos’s final report and recommendations, which are due in the next few months.
Helen Morgan, the Lib Dems’ health spokesperson, said: “From collapsing ceilings in maternity units to rising injuries and deaths, we have accepted the unacceptable for British women. How much more suffering will the government permit? How many more reports do they need before they act?
“Wes Streeting should apologise for the dismal failure to end this scandal after 18 months of Labour drift, which has left things little better than under the Conservatives.”
Streeting said: “Baroness Amos’s report lays bare the systematic, sustained and recurring failures in maternity and neonatal care across the country, which have left too many mothers, babies and families as victims of avoidable NHS tragedies.
“I want to thank the families who have bravely shared their harrowing stories, and express my deepest admiration for their strength in speaking out to try to ensure that others do not have to endure their trauma.”
He will soon launch and chair a new taskforce that will draw up an action plan to overhaul maternity care, based on the recommendations in Amos’s final report.
