Guest post: NHS watchdog - 'complain about poor maternity care, and we will listen'

[MumsnetGuestPosts]

A landmark decision has been made today in the quest to improve the safety of mothers and babies using maternity services.

Following complaints to the Ombudsman Service, the Nursing and Midwifery Council - the regulator which ensures that nurses and midwives provide high standards of care to patients - has voted to have direct responsibility and accountability for all activity regulating midwives.

This could change the way midwives have been governed for more than 100 years.

Under the current system, the people who supervise midwives have two inherently conflicting roles: they investigate serious incidents on behalf of the regulator (the NMC), whilst often being responsible for the development and support of these same midwives, who may also be their peers. As a result, the safety of mothers and babies may not always be at the heart of local investigations, and lessons from serious incidents involving midwives may not be learnt.

In one case we investigated, a mother died after birth, despite attempts to resuscitate her. Her son died the next day because he had been deprived of oxygen during labour. Two supervisors looked into the case. They reviewed the medical records and decided that there were no midwifery concerns which would warrant a more serious supervisory investigation by the NMC, despite the fact that there were several areas of poor midwifery practice.

We found that supervisors should have identified a number of failings, particularly as the mother had a high risk pregnancy – she had diabetes and was having her labour induced. The baby's heart should have been monitored at regular intervals using continuous fetal heart monitoring from the moment his mother arrived in the delivery suite, for example. The lack of an investigation meant that the father and his wife's family had not been able to grieve.

If the changes do make it into law, it will mean that investigations will be independent of the profession and involve lay people in the decisions – this will help ensure that investigations are independent, with patient safety at their heart. It will mean that poor treatment is identified and that relevant improvements are made, so that the same thing doesn't happen to someone else.

This new system would show that complaining can lead to change, as the NMC’s decision comes as a result of families making complaints to the Ombudsman Service. The actions of these families could improve the safety of mothers and babies in the future.

Our research shows that almost 4 out of 10 people who are unhappy with public services do not raise a complaint, because they do not believe it will make a difference. Complaining can make a difference. We would like to see more people have the confidence to complain about their NHS treatment when things go wrong, because when we see big and repeated mistakes in our casework we work with others to develop system-wide solutions that make services safer.

This is exactly what happened with midwifery care. Our report on midwifery regulation came about as a result of families’ complaints to us - we recommended the NMC should be in charge of all regulatory activity, and for midwifery supervision and regulation to be separated. Now, I urge the next government to take forward the legislative changes needed at the earliest opportunity, to allow this to happen.

Once these changes make it into law, we can all be more confident that lessons will be learnt which will improve the safety of mothers and babies.

[Jackieharris]

Does this apply across the uk?

[Pippidoeswhatshewants]

MNHQ, could you please change the title and clarify that this relates to others and babies?

I was getting all excited, but it doesn't apply to me

[Pippidoeswhatshewants]

others, yes, but more importantly mothers!

[feb]

IF the investigation is independent of the profession, who will the investigators be? And how will they be in a position to judge whether the practice was appropriate?

[LucySMumsnet]

Oo, we see what you mean, Pippidoeswhatshewants - thanks for pointing it out. We've altered

[Pico2]

Is this a first line of complaint or intended to be after complaints through PALS etc? Experiences of poor care are often not the fault of MW - there are many other HCP involved in maternity care and it can be the communication between various HCP that cause the problems.

[Izzy24]

The NMC already has lay persons involved in decision making.

And yes, as feb says, they are not in a position to judge whether practice is appropriate.

[Chilicosrenegade]

let me get this straight.

If one has a traumatic birth one is expected to be compos mentis enough for filling in forms, discussing it all in detail. Finding out who to contact. There was a six month limit.

Took me 6 mths to speak! I was so traumatised.

This is great from a procedural perspective. Still pretty shit from a victims.

[anothergenericname]

What Chili said - it is 3 years since my son's birth and I still dissolve into tears when trying to explain what happened, never mind experiencing other PTSD symptoms and fears. I have written and re-written a letter of complaint but still not got close enough to finishing it that I'm ready to send it to anyone.

[Soleurmange]

So sorry to read that another

I too have experienced PTSD symptoms related to a traumatic birth. Although I agree with the proposed actions outlined in the guest post, I agree that a number of HCP and a lack of communication certainly contributed to what went wrong for me. Therefore, what specifically concerns me relating to midwives is that I experienced continuously conflicting information from one midwife to the next. There did not seem to be a consensus, evidence-based view on a range of areas across a great number of midwives who provided me with care. I found this very confusing and concerning, at times even dangerous to mothers and babies.

[JaneAHersey]

The reality is that this Government have starved the NHS (Now NHS England business brand) of resources and have sold many services to private companies. This government have also legislated to that they no longer have a duty to provide health care so even if people complain who will rectify the situation. The Transatlantic Trade Agreement means that many more overseas private healthcare companies will be buying large swathes of the NHS.

These services do not need more regulation they need funding.

[frostjen]

Im 18 weeks pregnant with my first child and so far my experience with the hospital has left me with little confidence and more than worried about the months to come especially the birth. At first the hospital lost my referral from the doctors so after hearing nothing for three weeks i had to call the hospital and the doctors only to get the referral sent over again myself. When i eventually got my scan i had to have bloods taken also, not a problem and was early for my 16:30 appointment. After having my rushed scan and paying £3 for my blurry picture i queued to have my bloods taken and was ignored by the staff. Once the nurse eventually had the needle in my arm for the third painful attempt at getting blood from me, another lady rushed into the room to wave what i assume was a copy of my appointment letter to question me in an accusatory manner why had i been given a 16:30 appointment and who gave it to me... I simply replied (with needle still in arm) i don't know, i don't work here, before the wonan tutted at ne and rushed out of the room. The nurse then explained the department was meant to have closed at 17:00 and as it was now 17:20 she was now on overtime and not being paid for it; very professional! I left bruised and feeling guilty for showing up.

At my next scan i was told i shouldnt have been booked in as i had another coming up and the scan technician repeatedly told my partner and Ithat he would do it but we would have to wait as it was a freebie on the NHS; understanderbly as taxpayers who work full time this was quite insulting and the technicians contemptuous attitude left my partner angry and me upset.

To make matters worse after having a trainee midwife spend over an hour asking questions on my first antenatal appointment at the beginning of December (whilst the midwife made phonecalls at her desk),i just recently found out last week on my second antenatal visit that ive had ecoli and a bladder infection for well over a month, however no one bothered to let me know as they lost my notes!! So I was given a copy of my 'book' amd told to fillin what i can, when i asked the midwife what my original weight or Edd was she told me it isnt necessary and topd me to book an appointment for 9 weeks time at my local centre. The appointment was in the late afternoon, Friday and lasted 15 minutes. I had to wait until Monday morning to get an emergency appointment with my doctors for that afternoon to get a prescription for antibiotics.

To say im dreading the birth is an understatement, and my go to gor support is google as the hospital just makes me nervous now.

Good times.