Dr Eddie Morris writes to the membership...
No obstetrician and gynaecologist in the UK could have possibly avoided the coverage of the final Ockenden report published last week. I apologise to our international fellows and members for the very UK bias this month but if you read on I am sure you will realise why I have focussed in the way I have.
The report covers an investigation into a series of adverse outcomes in the delivery of maternity care in one unit in the UK over approximately 20 years. Amongst many other issues, the report concentrates on tragic outcomes and the influence of these on the affected families and their understandable desire for a clear understanding of what happened and why.
For me, the biggest take home message, second to effect on the families, is the effect of the enormous pressures all of us have experienced in the NHS during the time covered by the report and the financial constraints that have been imposed on the system over these years. Working in maternity none of us can fail to have felt the pressure of numerous financial squeezes. This has resulted in staff shortages which, in our speciality, amongst many issues are felt in overbooked antenatal clinics, pressures to cancel gynae lists to do elective caesareans and of course rota gaps.
I know that if you work in a team under pressure, almost all of your time has to go on providing safe care, with precious little left for some of the additional activities that we know we must do. These include clinical governance activities such as risk management, labour ward and fetal monitoring leadership, serious incident investigation, CPD to develop as professionals and keeping up to date with drills and skills training, so important in the fast paced world of obstetrics. The consequences of being unable to find the time for these vital pieces of governance and career development, due to the pressures of direct patient care, can be managed in the short-term but in the long-term, the result can be an out of date workforce with poor governance practices, that does not work well, especially in an emergency situation. That is not safe.
The UK, however, remains one of the safest places in the world to have a baby, as evidenced by the work all of us put in to reduce indices such as perinatal mortality, which continues to fall in the UK. But we cannot rest. Each Baby Counts reinforced the well-known fact that whilst giving birth in the UK comes with some unavoidable risks, for babies delivered at term who suffer an adverse outcome there are a large proportion – around three quarters - where care could have been improved. None of us in our specialty goes to work to cause harm, of that I am certain. But we work in a complex system of intertwining demands that pull on our attention when we should be allowed to concentrate first and foremost on delivering the best frontline care we can for women and babies.
Before 9/11 I was lucky enough to be in the cockpit of a 747 during its landing at the old Hong Kong airport. The approach to this airport was incredibly complex – flying in between high rise apartment blocks, literally being able to see what was drying on the washing lines on the numerous balconies as we passed. I was in awe of the pilots’ concentration, skill and composure.
Supervising a busy, understaffed labour ward is not dissimilar but with some key differences. You can’t regulate the distractions that will come your way and the teams we are working with on each shift often haven’t worked together before (accepting the caveats about training above). There are also many more emergencies than are experienced in most flights nowadays.
As a College we accept the recommendations in the Ockenden report and are committed to using them to really effect change. I hope you have noticed that prior to and during the pandemic my team of officers and I – combining our strengths in education, training, workforce, membership support, global activity, guidance, and using major projects such as “Each Baby Counts: Learn and Support”, “Avoiding Brain Injury in Childbirth” and Our Tommys’ app - continued to drive home the message that maternity staff are working as hard as they can but need more resources. Our joint statement from the representative bodies for staff working in maternity and neonatal services echoes these calls and sets out our commitment to deliver the positive change that women, families and staff deserve.
During my career I have worked to place the RCOG alongside the Royal College of Midwives as the bodies that are best placed to provide the expertise to effect change. The Secretary of State for Health and Social Care last week gave us this mandate. Now is our opportunity to show to families that the learning from this report and other investigations must be used to change the system. We need more staff, we need managers to listen to us and support us, not just to do our day jobs but also to help us investigate cases where things go wrong so that we can learn. But most of all we need those at the top of the NHS and the Boards of the Trusts and Health Boards we work in to promote an open culture, so we are free to speak up and free to demonstrate full candour to our patients.
We are at a watershed and so I urge you to talk about the report in your governance meetings, challenge your leaders and speak up. We must all feel free to talk openly and your leaders must listen and respond to your concerns.
Whilst maternity occupied much of my working life as your President over the past month I was also working hard on two other major projects close to my heart. Firstly, the disproportionate rise in gynaecology waiting lists. Gynaecology is considered by many Trusts and Health Boards as the speciality you can ‘cancel’ first when under pressure. Our new report shows clearly that we must reset the narrative. Please read the report, discuss it with your managers and surgical teams and tell them of the suffering of the patients in your units. The RCOG now has a lot of work to do on this topic and I will keep you informed.
The second key area of activity this month was to protect the delivery of telemedicine for early medical abortion in England. Telemedicine for EMA was one of the major success stories of the pandemic. We were therefore surprised and disappointed by the Government’s decision to stop the service in August this year. Thankfully, after much briefing of Peers and MPs, Parliamentarians voted to ensure telemedicine services will remain in place permanently, via the Health and Social Care Bill. This brings England into line with Wales, where telemedicine services will remain. We are now just waiting to hear from Scotland and are hopeful the Government there will reach the same decision.
Again, I apologise for the length and UK centric nature of this month’s blog. Team RCOG have worked for you without rest and I hope this blog goes some way to keeping you up to date with what we have been doing behind the headlines. I am, however, really looking forward to our World Congress in June this year which is our first ever hybrid Congress. Thousands of you came to our last, fully digital Congress and it was a huge success. This time the event will be delivered from our base in Union Street with a mix of in person and remote digital content. I am looking forward to seeing you there in person or as one of our global attendees. You can find out more and register here.