Independent healthcare safety investigators will be called in to look at ‘serious incidents’ which occurred in Nottingham hospitals maternity units.
Historic and recent problem births at Nottingham University Hospitals [NUH] are being reassessed as to whether they should have been recorded as ‘serious incidents’.
In May 2021, the regulator CQC visited the trust and found some improvements had been made – but its maternity services remained inadequate.
The Independent news website and Channel 4 News revealed earlier this year that the trust had paid out £91 million in compensation after more than 30 deaths.
Trust board papers show that in June 2021, a total of five serious incidents were declared – one of which occurred in 2019.
Two of those incidents will now be investigated by the Healthcare Safety Investigation Branch [HSIB].
The others will be looked at by the Local Maternity and Neonatal System [LMNS] and one will be investigated by NUH.
Further details of an incident in April 2021 – also declared as serious in June – were revealed due to ‘an infant born in poor condition following a forceps birth’.
Another incident in June 2021 concerning the ‘post-partum haemorrhage of mother’ was reported as serious.
In total, NUH said 16 maternity-related serious incidents (SIs) were declared over two months, six of which were historic cases.
Serious incidents are now being declared retrospectively by the Clinical Commissioning Group [CCG] and the Local Maternity and Neonatal System [LMNS] to ensure they have been categorised in the right way.
Serious incidents can range from events which stop a provider from delivering acceptable healthcare to unexpected deaths or injury.
It comes after it was announced that NHS England and the Clinical Commissioning Group (CCG) will be conducting an independent review into NUH’s maternity services dating back five years.
Speaking on NUH’s progress following the CQC inspection, papers from a meeting in June 2021 said: “There was disappointment on pace; however, this was not a reflection on the amount of positive work and number of actions taken forward. There is a determination to progress at pace.
“The Board was assured that there was a real focus on maternity as the top most item for discussion at executive, divisional and service meetings on a daily basis.”
It was also revealed during the meeting that the trust had not met all ten safety actions set by NHS Resolution.
The health service insurer launched the Maternity Incentive Scheme in 2018, giving hospital trusts ten “essential safety actions” to improve maternity care.
Of the 10 safety actions, by June NUH had met the standard for six; partially met for three, and had not yet met one.
It was added: “The Chair remarked that even though it was disappointing to be non-compliant, good progress has been made and it was important to demonstrate honesty.”
Michelle Rhodes, who is Chief Nurse at Nottingham University Hospitals, said: “Offering the best care to women and families is a top priority and our maternity teams are working incredibly hard to make the necessary improvements to our services. We are determined to continue progressing this work as efficiently and effectively as possible.”
