Maternity services regularly hit the headlines. Wes Streeting has ordered a rapid national investigation into NHS maternity and neonatal services to drive urgent improvements to care and safety It will address problems dating back over 15 years.
And following a CQC report in March 2024 which saw Broomfield hospital’s maternity service’s overall rating decline from ‘requires improvement’ to ‘inadequate’, the CQC has just noted improvements in safety and privacy/dignity at Broomfield’s maternity unit … but concludes that more needs to be done.
The quality of the maternity services waxed and waned during my time as a SWF GP. When I first came to the town the GPs used to provide the antenatal care. Dr Ingold was a qualified obstetrician so her patients received good care and sound advice … even though it was not always sugar coated. Later the midwives took over and the ‘golden era’ was when Naomi Keys was community midwife. She lived in Pertwee Drive and all her patients could easily contact her whenever the need arose. She was made to work her fingers to the bone – it was not uncommon for her to be called into the Labour Ward at night after she’d done a hard day’s work. She wasn’t paid for this – she was told to take “time off in lieu.” Needless to say there was no additional help offered – so if she took time off there was nobody to see the patients she had booked … so, being contentious, she never managed to get any “time off in lieu.”
In the ‘good old days’, Mums were offered a 10 day stay in St Peter’s immediately after the birth so they could be looked after while they bonded with their babies. Many took up the offer as they knew that they’d be straight back into the housework/shopping/chief-cook-and-bottle-washer routine as soon as they got home. Not everything was beyond criticism, though. For example, patients were ‘block booked’ at that time – so half a dozen Mums would be told to turn up “with a full bladder” at St John’s Hospital (where the old maternity hospital was sited) at exactly the same time for their scans. This wasn’t too bad for the first one scanned … but agonising for the last one in the queue!
In the early years of the 21st century, standards began to slip. It started to go badly wrong when, in the era of the late and unlamented Maldon PCT, the antenatal care was moved from the individual surgeries in SWF to the PCT run ‘New Surgery.’ There was no consultation with any of the GPs from the other practices in the town … indeed they were not even told it had happened. (They only found out when patients came back to report that they’d been told they had to be seen elsewhere.) The general assumption was that the PCT was trying to justify the obscene amounts that it was spending on ‘rent’ by putting as many services/facilities as possible into the surgery it ran.
The practices got little if any feedback about their antenatal patients from that point on – and the staff from the other practices in the town would sometimes be heard to say that they didn’t even know which of their patients were pregnant any more as their contact with them was so limited.
The result was that we all woke up very late in the day to the fact that the ‘service’ being provided had degenerated. When the patients were being seen in their own practices we were getting regular feedback – but out of sight was also, sadly, out of mind.
We had high hopes that things would improve when the Mid Essex PCT took over. This did not happen … indeed, as the videoed interviews made at the time (see below) make clear, things had gone from bad to worse. The health professional interviewed for the ‘videos’ both independently volunteered the information that they felt patients were being put at risk by allowing the status quo to continue.
One problem was that communication was difficult. Patients were given 9 mobile phone numbers and reported back that very often none of the phones were answered and nobody got back to them if they left a message. The practice staff had similar difficulties. Another problem was that there was little or no continuity of care as patients were followed up by ‘the Phoenix team’ rather than by a named midwife. This is important in all aspects of medicine as Prof Sir Denis Pereira Gray pointed out in a recent letter to The Times which stated: “Two systemic reviews have found that continuity is associated with lower patient mortality. Given the usual emphasis on patient safety, the policy blind-spot on continuity is surprising.”
Management was very defensive and for a long time showed no enthusiasm or ability to improve the service – so, although we could ill afford it, my practice (Greenwood Surgery) took on an exceptionally well qualified midwife (Margaret) who provided an excellent service to our patients AND facilitated continuity of care.
Unfortunately some patients were told they were not to see her – particularly in the later stages of pregnancy when continuity of care is all important. One such patient told me she had developed Helpp syndrome – a dangerous condition which is rather like pre-eclampsia but is often more difficult to diagnose. She had noticed that her face was swelling which would have been quickly picked up if she’d been allowed to continue seeing the same midwife but was missed by ‘the team.’ To explain … if you see a patient for the first time and she has a big fat face you risk getting punched in the gob if you say: “My word, madam, what a big fat face you’ve got!” … as that might be its normal state. But if you see a patient with a face that rapidly increases in size from one visit to the next, alarm bells ring. It’s not rocket science. Fortunately in this case the syndrome was eventually picked up before significant harm was done to mother or baby … but we got the distinct impression that it could have been handled better.
Margaret was very good at communicating the importance of a baby’s movements during pregnancy – we had posters up all over the practice reminding Mums-to-be of their significance.
To see her describing the situation at that time click here or cut and plaster this link in your browser: https://www.youtube.com/watch?v=SPZMlzaCCK8. It’s well worth the effort.
At Brickfields Surgery, Dr Anne Dyson did her own antenatal clinics (throughout this period and beyond) to enable that practice’s patients to have continuity of care.
In 2007, having made no progress, I resorted to videoing some of our patients and Margaret (plus one of our practice nurses) – getting them to tell their story and sending the recordings to those in charge. Anna Sasse was an example of a patient who’d had particular difficulties with the service – and she ‘socked it to ’em! (See: https://youtu.be/-xORx_BAT_M )
The patient’s testimonies were very powerful and we were extremely grateful to them for supporting the effort to improve antenatal care. In so doing they benefitted the ‘mums-to-be’ who followed in their footsteps.
Eventually the combined pressure from the GP practices in the part of Mid Essex worst affected (and pressure from the patients) resulted in improvements which were sustained … but getting there made swimming through treacle look easy peasy!
Dr John Cormack