The deputy chair of NHS England has said it should be as ‘demanding’ of medical cover in obstetrics and neonatal care as it is for emergency departments, to improve safety in the wake of repeated care scandals.
Sir Andrew Morris, who was the long-serving chief executive officer of the well-regarded Frimley Health Foundation Trust, said the service would “expect a consultant to be on duty in an emergency department [from] 8am till 10pm, or midnight, seven days a week”.
Speaking at NHS England’s public board meeting yesterday, Sir Andrew said: “We haven’t set that similar expectation out for [maternity care]. I know we’re saying we’re expecting that two ward rounds are undertaken, each day, seven days a week, but that is very different to the service I think is appropriate for this type of semi-emergency operation, that most trusts run.
“I’d like us to be as demanding of organisations [in relation to obstetrics and neonatal] as we are for the emergency department.”
This year, major quality failings have been highlighted by independent reports into both Shrewsbury and Telford and East Kent hospitals. There is an ongoing investigation into maternity at Nottingham University Hospitals Trust, led by Donna Ockenden, which is thought to involve over 1,000 families; and they follow on from similar findings in Morecambe Bay.
In response to Sir Andrew’s comments, Steve Powis, national medical director for NHSE, said the point was “really important, but equally challenging”.
Sir Andrew also raised concerns about midwifery staffing numbers, describing “quite frightening gaps”.
He said there was a midwife shortage of “around 1,100” and a “demographic issue looming” with “a number of people potentially exiting the service through retirement going forward”.
“I’m not sure we’ve got enough [trainees in the pipeline]” to mitigate that, he added.
Donald Peebles, a senior obstetric consultant at University College London Hospitals, and adviser to NHSE, also addressed the board meeting about medical staffing levels after Sir Andrew’s point.
Professor Peebles said: “We all share an ambition to increase the number of obstetricians, and part of that increased time will be spent on labour wards, and indeed that is one of the recommendations from Donna Ockenden’s review…
“There is not a workforce standard around this at the moment. The RCOG [Royal College of Obsetrics and Gynaecology] have changed their stance over the last ten years from one where I think they were quite directive about ‘if you have so many births in a unit you should have so many obstetricians’.”
He continued: ”I think one of the reasons for backing off is they have realised there are so many variables that coming up with a one size fits all is incredibly challenging.”
He said RCOG was putting together a document about expected behaviours and roles of obstetric consultants on labour wards and also commissioned an obstetric safer staffing tool.
“We should have an answer around what percentage of consultant time is actually spent on labour wards,” he added.