Today, Nottingham University Hospitals NHS Trust (NUH) pleaded guilty to charges brought by the CQC under the Health and Social Care Act 2008 for failure to provide safe maternity care and treatment to Sarah Andrews and her daughter Wynter, who sadly died in 2019.
Sentencing will take place at Nottingham Magistrates Court on Friday 27 January.
Wynter died 23 minutes after she was born by Caesarean section in September 2019 at the Queen’s Medical Centre.
The criminal prosecution is one of only two the CQC has brought against an NHS maternity unit.
The court heard the CQC brought the charges after the trust’s mistakes meant Wynter and her mother Sarah Andrews did not receive safe care and treatment in its maternity services.
The trust entered its pleas at Nottingham Magistrates’ Court on Wednesday and will be sentenced at the same court on Friday.
Following the hearing, Chief Executive Anthony May said:
“We are truly sorry for the pain and grief that we caused Mr and Mrs Andrews due to failings in the maternity care we provided. We let them down at what should have been a joyous time in their lives.
“Today, we pleaded guilty and will accept, in full, the findings of the court.
“While words will never be enough, I can assure our communities that staff across NUH are committed to providing good quality care every day and we are working hard to make the necessary improvements that are needed for our local communities, including engaging fully and openly with Donna Ockenden and her team on their ongoing independent review into our maternity services.”
Since Wynter’s death, NUH has implemented a number of changes to its maternity services, including:
- Improved access to clinical guidelines with the introduction of the Pocket Pal app for maternity staff and aligned Trust guidelines with national recommendations where available
- Implemented BadgerNet, a maternity digital clinical system to support seamless care across all parts of the pregnancy pathway
- Investment in staff training for obstetric emergencies, foetal heartbeat monitoring and human factors
- Investment in equipment, including foetal heartbeat monitoring machines and devices to measure jaundice in babies
- Introduced foetal monitoring leads for midwifery and obstetrics, tasked with supporting the team to follow best practice
- Strengthened the senior clinical team, appointing more consultant obstetricians and providing better cover across our two hospitals
- Ongoing recruitment of midwives, including from overseas and the appointment of two heads of midwifery
- Focus on retaining midwives, offering the option to work flexibly to suit their needs
- Introduced a flow coordinator role to support the maternity service 24 hours a day, seven days a week
- Separating our emergency and routine assessments at both hospitals, leading to over 90% of our women and families being seen in triage within 15 minutes
- Launched a 24/7 Maternity Advice Line, so anyone using our service can speak to a dedicated midwife about any concerns before or after birth
- Ongoing improvement of our staff feedback service and encouraging colleagues to raise any concerns through our Freedom to Speak Up Guardians and through other channels
- Improving record-keeping, including the assessment of risks and handovers between midwives and medical staff
- Developed a comprehensive Maternity Improvement Programme, overseen by the Maternity Oversight Committee, led by one of our Non-Executive Directors
- Developed a maternity dashboard to identify themes and trends in activity, clinical incidents and staffing to ensure better oversight of the service
If women and families currently accessing maternity services at NUH have any concerns or questions about their care, please talk to your midwife or consultant.