The following piece appeared in Essentially MIDIRS news, vol 5, no 4, p12

The Health Secretary, Jeremy Hunt, has announced that a new initiative, Sign up to safety, is to be formally launched in June in an attempt to reduce ‘avoidable harm, such as medication errors, blood clots and bed sores’ (GOV.UK 2014) in the NHS in England, thereby preventing an estimated 6000 deaths over the next three years. The campaign, which is voluntary, will recruit 5000 ‘safety champions as local change agents and experts — safety ambassadors, safety agitators, safety evangelists — a grassroots safety insurgency across England which will seek out harm, confront it and help to fix it’ (Hunt 2014). A new team is to be created, consisting of senior clinicians, managers and patients who have a track record of tackling unsafe care. A dedicated section, How safe is my hospital, will also be added to the NHS Choices  website to allow members of the public to compare hospitals in England on a variety of safety indicators.

Cathy Warwick, chief executive of the Royal College of Midwives, responded to the announcement, agreeing that safety should be at the heart of all NHS services, but “I worry that I have heard this before from Governments without any real  progress being made.”

“Safety is about having the right numbers of staff and high performing teams working together to deliver the best care, and this is crucial if we are to deliver safe maternity care. Safety also needs NHS staff being treated properly with trusts promoting open, honest and caring cultures if they are to get the best out of them; you can only have candour if staff feel their concerns will be  listened to, they are treated with compassion and that they will be given the support they need.

“There are a number of areas in maternity services where real progress could be made to reducing avoidable harm and improving safety. These include ensuring that women get much better continuity of care, one-to-one care in labour and better postnatal care so that problems such as postnatal infection are spotted and treated.”

These last two statements could equally reflect her contribution to The people’s inquiry into London’s NHS, which recently released its report, London’s NHS at the crossroads (UNITE 2014a). Cathy’s contribution to the inquiry hearings outlined the current situation in maternity services in London, stating that the increase in midwives since 2001 was positive, but that these increases are not evenly distributed so that the midwife to woman ratio varies enormously across the city, and that in London caesarean rates are higher and home births rates are lower than elsewhere in the UK. When asked for her opinion on how the replacement of NHS London with 32 Clinical Commissioning groups in April 2013 had affected services, she responded: ‘The impact is enormous: what I would say is contracting is largely ineffective. The new system is a disaster’ (UNITE 2014b:33).

The RCM also made a written submission to the inquiry questioning the centralisation of maternity services in London (RCM 2013), which has been driven by the supposed need for the round-the-clock presence of a consultant obstetrician. Although this may be appropriate for high-risk women, it is not necessary for low-risk services and is unaffordable at the present time ‘without a major consolidation of units’ (Unite 2014a:60). Sadly, the RCM’s suggestion that, ‘Midwife-led models of care contribute to improving the safety and quality of maternity care at no additional cost’ (RCM 2013:16) did not convince all the inquiry panel members. However, the report does recommend ‘further research to establish the evidence for the clinical safety of stand-alone midwife-led units in the context of the social conditions in London’ (Unite 2014a:60).

References

GOV.UK (2014). Halving avoidable harm and saving up to 6,000 lives. http://tinyurl.com/qdyqzbt [Accessed 31 March 2014].
Hunt J (2014). Sign up to safety – the path to saving 6,000 lives. http://tinyurl.com/ksfcopw [Accessed 31 March 2014].
RCM (2014). Submission to the people’s inquiry for London’s NHS. http://tinyurl.com/njlhtno [Accessed 31 March 2014].
UNITE (2014a). London’s NHS at the crossroads. London: Unite.
UNITE (2014b). People’s inquiry into London’s NHS Nov 29. http://tinyurl.com/o4cta49 [Accessed 31 March 2014].

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