Have maternity services at the Royal Free Hampstead improved?

[umf]

This thread is a spin-off from this discussion about north London maternity hospitals.

A lot of mumsnetters have been critical of the Royal Free. I don't think the RF's problems are unique or the worst in London. But it has had a bad reputation for several years and women report the same repeated concerns.

Personally I had a ghastly experience of antenatal and postnatal 'care' there in 2006. It was comforting to me to discover on mumsnet that I wasn't the only person who felt so miserable about the place.

A RF consultant (SympatheticConsultant) contributed to the old thread, saying that staffing levels and organisation had lately improved, and hoping that positive comments would start appearing.

Perhaps the RF now has a user feedback mechanism so that they take on board the comments of the women who birth there. But just in case they don't (!) how about we do it here?

What do recent and current users think? Is the RF getting better?

What improvements do you feel most urgently need to be made? What's going well there?

My friend - who gave birth at RF in 2006 (as did I - had hellish experience, she had an ok one) gave birth at the RF 3 months ago. She found the RF ok BUT the new computer system was rubbish - she went in concerned about lack of movement to the day assessment unit, was told to go for a scan, got down to the scanning area and was told no they didnt have anything on their system and basically had someone in radiology yelling at her to sort it out - not really what you expect when you're worried about things. To be fair to them, the midwives in day assessment did sort things out eventually - after 2 hours! When she did go in to give birth in active labour (again concerned due to lack of movement - she had a problematic first pregnancy) the midwives kept trying to send her home telling her it was ages to go - and were still trying to send her home half an hour before she gave birth. So in summary, from what my friend tells me, no its not significantly better from 2006 - still pretty chaotic and some pretty disinterested midwives there. Though my doula at my DS2's birth 5 months ago does tell me that the RF are worried about their reputation and consulting with local doulas about improving matters so at least some one there cares.

Hi umf,

Re. "However, I can't see how maternity services there could have been made even adequate without replacing most of the staff and completely refiguring the management"

This is exactly what has happened over the last 12 months. A new midwifery management team has been brought in and many of the "older members" of staff who were 'a recognised problem' have retired or been sacked (where concerns have been raised and not rectified)! Unfortunately within the NHS as a whole dealing or removing staff with attitude issues towards clients and other staff is not always an easy process to undertake. But I do believe that most of the problem areas within our unit have now been dealt with.

We have now doubled the number of dedicated Obstetricians working within the Unit over the last 12 months. Miss Alison Wright is running a post-natal debrief clinic for mums that have had difficult experiences and would benefit from an opportunity to talk through events afterwards. She is also heavily involved with the MSLC.
Five of us new Consultants started last year and it has been a difficult struggle for us to start reversing some of the negative perceptions the unit has developed over the preceding years. We are doing are best and there is a very different feeling about the unit now.

We are actively working to bring about an atmosphere within the unit, that we exist to serve and meet the needs of our users. Within the last 6 months we have been targetting all the staff groups to go through REACT training courses (User Awareness courses)to ensure they recognise the central needs of the user within our service provision.

The computer system was unfortunately forced upon us by higher powers and we are unlikely to be able to get rid of it. We have been placed in a "guinea pig" role where we are a testing ground for the system before the system is rolled out across most of the other London Trusts. This has not helped us, but I think we are now aware of the deficiencies of the system and together with the programmers are and have identified workarounds for the major issues.

Our current service drive is to ensure 90% of all referrals are booked by 12 weeks! We are aiming to get all mothers an appointment within 2 weeks of being referred and have stream-lined our appointment system accordingly. The new system went live this month and I would hope all mothers booked with us will see immediate and visible improvements.

Another longer term and more difficult goal is to ensure all women are seen in the ANC within 30 minutes! This is a problem I recognise that most Obstetric units struggle with.

We are all aware of the historical problems and the new team are actively dealing with them.

I am very keen to hear user experiences on all aspects of the service but would be very keen to hear experiences of current users or those who have been through the unit within the last 6 months. I'm especially keen to hear direct user experiences (positive and negative) relating to the following areas:

• Day Assessment Unit
• Triage and Delivery Suite
• The Birth Centre
• 5 South Antenatal and Postnatal ward

Unfortunately what has happened before I had no control over but I am now in a position to sanction actions to bring about changes in how we as a service function when deficiencies are flagged up!

We now really do want to meet and indeed exceed the expectations of our parents!

I can't comment on any of your post sympathetic consultant - except to say I heart Alison Wright. Sigh.

my friend was the some time ago and the computer didn't discharge her or the baby.
So she got no post natal care at home afterwards and was unable to register the baby's birth....
as a firs time mu she didn't realsie midwives would come to your house and check you etc.

total shambles and very scarey too

Sypathetic Consultant

In answer to some of the things you were interested in...

I had my baby at the Royal Free 10 months ago.
Triage - Lovely midwife, very nice, friendly made me feel relaxed.
Wasn't far enough along to go to the birth centre so was put on the ante natal ward where i was pretty much ignored, i was doing ok so was fine with this at the begining.
The problem for me was when things progressed i was in full on labour in a room with 3 other women and their partners and they wouldn't move me to the birth centre becuase they were changing shifts. No privacy, i had to labour in public and it was humiliating and awful and i feel possibly affected my outcome.

On birth centre, fine care. Too much of a haze to remember really. I had gone into panic mode thinking i would give birth on the antenatal ward so didn't get off to a good start.

Not coping, requested an epidural which i got straight away, very good, i had read stories of waiting ages but by the time i had been moved to the labour ward it was ready for me.

I had an emergency C section in the end, which was managed well and thetre staff were excellent. In the recovery afterwards they were also nice.

My biggest criticism of the whole experience was the post natal care.
The midwifes were cold and heartless, they never came to check on me. One walked out on me when i was in the middle of a scentence requesting pain relief, they told me off for my baby making too much noise in the night and they insisted she was starving and needed formula. I had been in labour for 2 days and was recovering from a serious PPH and wasn't in a postion to argue. They never once offered me pain relief, i had to ask for it.
I discharged myself in the end. I don't see the point in staying in hospital when you aren't actually being cared for.

In a nutshell, during the labour itself i was treated very well but the whole experience was runied on the post natal unit. It is for this reason that i wouldn't go back. I am pregnant again and have no idea where to go!

Hope it helps.

SympatheticConsultant:

Good to hear that substantive changes are being made.

I'm particularly interested in the "post-natal debrief clinic for mums that have had difficult experiences and would benefit from an opportunity to talk through events afterwards".

How are such patients identified? Or can anyone refer themselves? How are new mothers informed of the service? What are the clinic's specific aims?

stickybean:

Your post-natal ward experience sounds distressingly like mine 2.5 years ago. What an awful way to start motherhood. Hope this thread can be constructive and a little bit cathartic. Like lots of women (it seems from reading other posts) I was too distressed and too overwhelmed to complain at the time. And also figured that the problems were both obvious and well-known.

Hi Stickybean,
That is sad to hear. But I would be keen to know who amongst our staff treated you in such an unnacceptable manner. I know it may be difficult for you, but I would encourage you even now to consider writing a letter of complaint. At least that way we can investigate. If there was professional misconduct or such shocking staff attitudes I would rather they were addressed with the individual(s) concerned and if not rectified with a warning and staff retraining then we now actively move towards having such members of staff removed from their posts. A small number of staff have been removed over the last 8-10 months for exactly these sorts of problems, since the change in senior midwifery and obstetric management last Sept.
Although it may be of little consolation to you I'm glad that the Triage and Labour ward staff treated you with dignity, kindness and respect. It help those of us who are dedicated to improving the service for all our mums to know when things like this happen so we can make sure they are not repeated and offending staff dealt with appropriately.

If you can spare the time and effort to write a complaint then please do write and address it to:
Lead Obstetrician,
Delivery Suite,
Royal Free NHS Trust,
Pond Street,
NW3 2QG

and then it will get to me. b

The optimistic part of me half hopes that the offending MW(s) may have already been removed! Unfortunately in every work force there are 'bad apples' whose attitudes and actions tarnish the efforts and good intentions of everyone else!

Hi umf,
The postnatal debrief clinic is run by Miss Wright but is a relatively new service.
Presently myself and Miss Wright try and identify postnatal mothers who have had difficult deliveries/postnatal problems directly from the postnatal ward (via our regular ward Consutlant ward rounds) and by liaising with the Midwifery PN ward staff.

In due course we will be advertising the service via all the local GP surgeries and with posters in the Antenatal Clinic and on the Postnatal Ward.
We would be happy to set up a system to accept self referrals by phone, but presently a short letter addressed to :

Miss Alison Wright,
Consultant Obstetrician,
Dept of Obstetrics & Gynaecology,
Royal Free Hospital,
Pond Street,
London NW3 2QG

will be sufficient to get an appt arranged.
Hope that helps!

Hi SympatheticConsultant,

I'm glad to hear about this being set up. Gladdened by your posts generally.

What are the purposes of the debrief? I can think of several possibles. Eg to...

1. give mothers a chance to talk through and come to terms with their experiences
2. explain why particular decisions were made in the pressured situations of childbirth
3. justify actions of the obstetric staff
4. discourage formal complaints
5. reduce trauma-induced PND
6. help mothers face future births
7. obtain feedback about mothers' experiences of services

I've never used one of these debriefs (since they weren't in place when I had ds at RF). But have two friends who went to them at Addenbrookes here in Cambridge. One felt that points 3&4 were uppermost. She was almost as upset by her debrief as by the birth itself.

Second felt points 1&7 were main focus. She felt listened to and that her points were actually being noted. (She saw different staff.)

SiL had debriefs in Sweden, where they are routine and the main points seem to be 1&2.

That was all a bit technical, but I suppose what I'm trying to say is that while debriefs have to be a good thing, especially since they can be a major source of user feedback for the hospital, they can descend into confrontation and defensiveness, especially in a low goodwill, low trust setting. And given the litigation worries.

Hope yours is working well. Has it provided useful feedback? Do you think it will in the future?

Things may have moved on from this debate, but I thought I should chip in, having had 2 RF babies, 1 in mid 07 and 1 in Dec 08.

So far as the 07 experience went, I found ante-natal care adequate if uncaring and the post natal care on the wards appalling, although as others have said my experience of the delivery suite was fabulous. My wonderful midwife (Cynthia) stayed with us throughout and correctly anticipated and prepared us for a difficult labour turning into a c-section. This meant that when the doctors finally recommended a section, we were able to go ahead in a calm unhurried way that made me feel I had some control over the process. The other factor that led us back to the RF was the fact that when we needed to use the neonatal unit we found it wonderful - staff were helpful and extremely kind. Special mention to Dr Canswick who took great pains to reassure me that what had happened was not my fault (DD going into kidney failure because of serious weight loss due to poor feeding). Having said that, I do feel in retrospect that the feeding problems were exacerbated by shambolic treatment post natally - several midwives/LLL volunteers etc picked up that DD was not feeding as well as she might, but all it led to was conflicting unhelpful 5 mins interventions from a large number of people.

I'd say my '08 experience was better, but also mixed. This time I could not fault the birth or postnatal experience. Had an easy VBAC birth second time round, but felt enormously helped by both midwives who looked after us. Our second midwife also very kindly arranged for our discharge from the ward and took the initiative in getting the paediatric check done on the delivery suite so we did not have to go to the ward.

Having said that, I found antenatal care very frustrating. Partly this was the new computer system (I was there on launch day...!), but I accept that this is something that will (and probably has been ironed out) and in fact the delays were handled with charm and good humour by the midwife in charge. What I found more frustrating was the lack of consistency and knowledge in relation to the advice I was receiving. This time round I was on consultant led care, but each time I saw a doctor (junior - I never actually saw a consultant thoughout the pregnancy) I was faced with a different approach to treatments. For example, I was trying to make an informed decision about whether to have a VBAC, so queried the stats in the 2007 maternity services report, which showed RF as having a very poor VBAC rate. The answer I got was simply "its just the choice of the mothers in the area" from a doctor who said she didn't know what the RF's policies were or whether it had changed anything since 2006/7. Similarly, I kept being sent for ultrasound scans for no obvious reason - to the point where the sonographer asked why exactly I had come for the scan (as no growth issues, no gestational diabetes and no other issues). In some ways I feel that the late 2008 experience may have been a misguided overreaction to the laissez-faire attitude in 2007.

I would still recommend the RF on the basis of both my deliveries and the superb staff on the neonatal unit, but fear there is still work to do on resolving the day to day issues.

Hi all,

I am 24 weeks and have had all my care from the RF so far. I am considering switching to UCH based on the stories I have heard from these threads and the good experience a few friends have had at UCH.

That said, I do want to give the RF a chance if it is trying to improve the way it works (but not at the cost of a positive birthing experience). Thus far, I have seen a midwife twice (though I had to call to find out why I had missed an appointment), had both my scans right on 12 and 20 weeks and seen a junior consultant about my asthma. That all seemed to go well. I have called the hospital twice with queries, they said they would call me back with a response and one out of two times they did. I am booked to see an anesthetist closer to my due date as well. So thus far, the appointment and scan booking seems to have been handled very well.

I'm not sure how best to go about making the decision of whether or not to stay with the RF. I would love to hear more recent stories about birthing experiences there. It's a wooly sort of question - but does anyone have any suggestions on how we should make the decision of which hospital to go with? SympatheticConsultant, I would welcome your thoughts on that too.

SM

SympatheticConsultant - just wanted to say how impressed I am with your approach and taking the time to respond on here. Perhaps if all consultants were this way inclined we would not have a problem with maternity services!

Out of interest - what is your professional opinion of St Thomas's in London?

I know that this might not be the correc t forum, but I was treated like dirt by a RF midwife
Much more worrying is that she had me pushing at 9cm - this contributed to my undercarriage swelling up, ds getting stuck, and me having an EMCS.

I now have her notes which have obviously been rewritten after the fact. But Her name begins with a F. I obviously have her full name but I don't want to post it on here in case that would be in breach of MN rules.

But Sympathetic Consultant, if you know who she is and she is still thereI am happy to email you privately.

would say that tha the post natal care was shocking - cold and heartless.

But there was one midwife - don't know her name I'm afraid, who was lovely.
Think she was quite senior, a quite young, black woman. And very beautiful. Frankly she looked as if she had just walked out of Holby City, and very out of place amongst the worn out mothers, and the other scowling midwives. She didn't do anything particularly special, but took the time to talk to me, smile at me, and reassure me. I will never forget her kindness.

I think that it's great that you are all working so hard to make the RF better. Good luck.

I personally will never set foot in that hospital again if I can help it.

Hi all,
Sorry i have nt had a chance to catch up on this thread for a while. Am just on annual leave at the moment and hence a bit of spare time.

sassmonkey: It is a difficult decision and so many factors do weigh into the equation. Unfortunately you will hear good and bad stories about every maternity unit in London on the forums. To an extent if you are a low risk mother there is always a little element of chance as you cannot predict which midwife will be on duty and looking after you at the precise time you go into labour (but that again is the case in most units). Its the overall safety of the service that you will be ale to get some indication on from national reports etc. I do agree that most mothers will go by the experience of friends and stories they have heard. But I would still urge you to try and arrange a visit to each unit you are considering. Take into account the location and ease of access for clinics scans etc. If things remain low risk the majority of your care tends to be provided by your GP and midwives (unless its at UCH where I believe the MW clinics are not in the community but are based at the hospital site). If your experience at the Royal Free thus far has been acceptable/good please do stick with us! We have an extensive range of additional services (antenatal classes and 6 types of specialist Obstetric physio sessions to help prepare our pregnant mothers for pregnancy, childbirth and postnatal life which i would also urge you to try!

NigellaTufnell: I'm so sorry you have had such an uncaring experience from our service. Can I ask whether this was a recent delivery or some time ago. In the last 12 months we have at considerable expense and effort tried to raise customer awareness amongst all our staff. Our staff have consequently been put through externally run REACT training courses to improve and provide a customer based experience (to deal with the issues you mentioned). Without reviewing the details of your case its difficult for me to comment on the specific comments you raised about your LW midwife. I would however be keen to know which midwives were involved with your care both during labour and additionally on the postnatal ward. Its not clear from your post who these may have been. (Do let me know how PM's can be set up).

susie100: Thanks for your kind words. I have never worked at St. Thomas's but do know a few of the Consultants there. What I have heard generally about the unit is that they do provide a very good maternity service and together with King's College probably provide the best overall levels of maternity care in SE London! I gather they are however currently over subscribed and are now limiting maternity bookings to women living within the immediate vicinity of their catchment area, although this may change from month to month.

Hope that helps!

Sympathetic consultant,

I think we are all cheered by the efforts that you are going to to change opinion of the Royal Free. I am 23 weeks pregnant and was initially booked at the RF as it's a short walk from home.

I'm sorry to say that today I visited my GP to request a transfer to UCH. This is not a decision that I have taken lightly, but I'm afraid that my experience to date has failed to impress or inspire me with confidence.

Admin niggles aside (never receiving an appointment for the 12 week scan, and then receiving a letter berating me for not turning up to said appointment, which meant I ended up going private) it was our experience at the 20 week scan that really put us off.

The initial sonographer in the ultrasound department was fantastic - professional, calm and kind. She sent us up to the Fetal Medicine Unit having spotted a potential issue (nothing major as it turns out). We were then shunted into a room with 3 doctors who didn't once introduce themselves or tell us what they were looking for/at. The poor sonographer (again, very professional) was doing her best to answer our questions while the doctors stayed entirely silent for the best part of 45 minutes. At no time did any of them (three of them!) attempt to communicate with either me or my husband, who obviously didn't know what on earth was going on. I had to endure a complete repeat of the scan that had been done downstairs (even though Sonographer 2 recognised that this was a waste of time as all the measurements had already been taken and challenged the doctors on it) in a very stressful environment.

We were then told that an appointment had been made for me to see a consultant the following week. We turned up on time and waited an hour to be told that there was no record of our appointment. Another hour and some complaints later, we were slotted in. I'm pleased to say that the consultant we saw was far kinder, clearer and more communicative than those we had seen the previous week. However, by that point we had totally lost faith in the system and those running it. This may all sound rather petty, but I'm sure you appreciate that we all just want the best for our babies.

One final point is that the midwife I have been seeing seems to be rather behind the times. I asked her about the current thinking on the swine flu vaccine and she replied "The what? I don't know anything about that." I knew more about it than she did from just reading the newspaper.

Best of luck with your endeavours - there is certainly scope for you to make a real difference.

my friend had baby a months ago at Royal Free and she said it was very good experience, she had C-section

Dear 'nwthree',
I'm sorry you have been let down by your experience at the RFree. I have just returned from 2 wks leave and as I work on the FMU I assume the 3 Dr's who did not introduce themselves may have been our new FMU research fellows who are in relatively early stages of their training. I have told them all before about introducing themselves to all parents who are coming onto the unit, but the message ha obviously not got through yet. I do apologise! A number of them are relatively junior and other than introducing themselves it sounds as if they were there simply to observe and be supervised. I'm assuming the Consultant you saw was Miss Kadir who has her scan list on a Monday morning?

It really saddens me when our local mothers are turning to book elsewhere. It seems such ashame not to use our local facilities and to have to trudge into central London for all your remaining antenatal visits and delivery.

If you are anyway in two minds about transferring I will however make you a departing offer:
I would be more than happy to personally take over/share your antenatal care. In practice you could then see me for all (or if you wish some of your antenatal consultations (if you also want to see your GP). Furthermore if later in the pregnancy any additional scans are necessary these can all take place on my dedicated FMU scan list. In terms of continuity of care there should not be any problems and I'd hope you'd find our care to be exemplary.
If you decide otherwise then I do understand

Irregardless best wishes for the remainder of your pregnancy

SC

Just wanted to chip in my bit. Sorry this is a bit negative. I also self referred to UCH 2 weeks ago from Royal Free. I will admit that I wanted to go to UCH in beginning but was told wrongly I couldn't by GP. Since being sent to RF by GP I have read so many bad comments about RF that frankly I was getting nervous from the start, it's my first and I just want the best care I can possibly get like all mums-to-be.

I didn't have a serious problem at RF but it was enough for me. At a MW app I was told I had suspected urine infection and they would send off test. A week later I tried calling and calling to get results completely unable to get anyone to answer over a 3 day period, no MW's available that could give me result, I was sent round the houses. From comments read this just felt like it could be first blip and enough to make me feel I would try and transfer. Was no problem and was seen very quickly at UCH.

Sympathetic Consultant I am sure your efforts will be and are paying off to improve things. I am sorry if you feel I did not give RF enough of a chance but it may interest you to know that in the 20 mins I was waiting for a scan at UCH last week I met 3 other women who had transferred - from RF, because of disatisfaction with service they received. They were all further along and each said I had made right choice moving as early as possible.

I may as well add my recent experience of the RF too..

Antenatal care was good until I was admitted to 5 South. My advice would be to bring a notebook and record everything you are told, as I had to haul myself out of bed and down to the nurses station repeatedly to explain, post shift-change, that I needed monitoring, explain to every, frequent visitor to my bedside what the last person had said, make repeated requests for the growth scan the consultant who admitted me requested, and fight my corner with reception down in radiography. No one could ever find my notes when needed, and would wander off to find them and not come back. If I hadn't been alert to what was going on, and able to channel communication between the dozens of staff around me, it could have been disastrous.
But despite the poor sharing of information, I actually think the ward care was fairly kind and concerned, apart from a few impatient midwives. When things went really wrong and I needed an emergency c-section, everyone kicked into action as needed. A lovely midwife named Alice looked after me pre and post theatre and kept me sane. Postnatally its a bit of a blur but they were fine. I heard complaints from other women later but I REALLY missed 5 South when I got transferred to the Victorian hell of the Murray ward at the Whittington in order to be near my baby.

Sympathetic consultant - despite the waiting times at Royal Free which I would have had anywhere, I just wanted to say that Royal Free has been good so far. I don't really rate the midwife team but that's probably because I prefer a more medical approach, but I just have to say that Dr Choudry (not how she spells it) on Miss Tuck's team is exactly what you want in a medical professional - informative, pragmatic and but caring and very reassuring. Shame she's coming to the end of her contract at royal free.

Hi pecanpie,
I will pass on your kind words to Dr Choudhury, she was working with me in my AN clinic this morning! All our trainee's generally work with us for a year and then rotate to another hospital within the region throughout their 7 years of specialist training.
Its always ashame when you have a good Dr who you have trained up who then has to leave!

Dear Sympathetic Consultant

Many thanks for your message, and apologies for the delay in my response.

Having considered my position and taken on board your comments, I would like to take you up on your kind offer (if it still stands) to take over my antenatal care at the Royal Free. I currently have a scan appointment for 28th September, although, predictably, I have no idea who it's meant to be with!

I hope that by staying at the Royal Free I will be able to give positive feedback on my experience from hereon in about my care at the hospital, and assure other mothers that things are changing.

All the best.

Dear Sympathetic Consultant,

Thank you for your encouragement to stick with Royal Free. I am going to check out the birth centre this weekend (I hope).

I am very envious of your offer to nwthree. Is there any chance that if I choose to stick with the Royal Free, you would extend me the same offer? I have no further scans planned (am at 29 weeks), so may not need your assistance, but I would feel reassured about sticking with the hospital if I knew I had a lovely-sounding ally to call upon, if required. I know you can't make the offer to all and sundry, but maybe just one more newbie mum-to-be?!

I too will broadcast positive feedback if I have a positive birthing experience at the hospital.

Sassmonkey

nwthree,

Have you also considered getting a Doula? If you go to the Doula UK site you can get one for £200 or if money is an issue then you may be able to get the hardship fund its means tested! All the best!

I like the royal free BTW!!! xx

Ema xx

Thanks Ema - I'm definitely going to look into it x x x