National Maternity and Neonatal Investigation
Discussion
I appreciate this sub forum is male dominated by quite some margin and this specific topic might be of far greater appeal to another audience but some might be interested.
https://www.bbc.co.uk/news/articles/c4g45ev3gkdo
It’s not a great read. Full Review expected next year.
My experience of the NHS through our “productive” years varied between disappointing, shameful and scandalous. Admittedly with odd moments of acceptable standards being met. The treatment we received has continued to impact my wife’s mental health to this day and I expect for her lifetime. It seems like service standards are a bit of a lottery. At least it did around that time (call it 2005-2020). Exposure to parents before and since suggests our experience isn't unique or that things are widely better these days.
A small sample size and anecdata doesn’t count yadda yadda..
For all their faults reviews such as these tend to shine a light. I sincerely hope improvements are made.
https://www.bbc.co.uk/news/articles/c4g45ev3gkdo
It’s not a great read. Full Review expected next year.
My experience of the NHS through our “productive” years varied between disappointing, shameful and scandalous. Admittedly with odd moments of acceptable standards being met. The treatment we received has continued to impact my wife’s mental health to this day and I expect for her lifetime. It seems like service standards are a bit of a lottery. At least it did around that time (call it 2005-2020). Exposure to parents before and since suggests our experience isn't unique or that things are widely better these days.
A small sample size and anecdata doesn’t count yadda yadda..
For all their faults reviews such as these tend to shine a light. I sincerely hope improvements are made.
Our experience with both kids was that maternity care is basically stretched to breaking point because it didn't have enough resources. It's always going to be a s
t show if you don't have enough staff etc to do it properly. Staff also vary wildly in competence.
The "not listening to patients" thing is difficult. I think a lot of it is that the nurses are used to pregnant women, understandably, worrying a lot about their baby. So real issues get lost in the noise. With our daughter if I hadn't kicked off about the fact that my wife has a ridiculous pain tolerance so, if she says she's hurting really badly, a couple of paracetamol and seeing how she gets on overnight is a terrible idea things might have turned out badly. As it was they got the (excellent) consultant in and a swift unscheduled c-section followed within a few hours.
t show if you don't have enough staff etc to do it properly. Staff also vary wildly in competence.The "not listening to patients" thing is difficult. I think a lot of it is that the nurses are used to pregnant women, understandably, worrying a lot about their baby. So real issues get lost in the noise. With our daughter if I hadn't kicked off about the fact that my wife has a ridiculous pain tolerance so, if she says she's hurting really badly, a couple of paracetamol and seeing how she gets on overnight is a terrible idea things might have turned out badly. As it was they got the (excellent) consultant in and a swift unscheduled c-section followed within a few hours.
We had two ok experiences (1 natural, 1 c-section) at one of the early identified problematic maternity units (QMC). Perhaps we were lucky.
However it’s clear they were overstretched. I feel for the staff trying to deal with everything from disrespectful scrotes, to half the woman barely speaking English.
However it’s clear they were overstretched. I feel for the staff trying to deal with everything from disrespectful scrotes, to half the woman barely speaking English.
scenario8 said:
I sincerely hope improvements are made.
They won't be. Improvements require investments, you get what you pay for.Most people don't want to pay more tax whilst at the same time demanding a perfect high quality service which means that more and more money is spent on bureaucracy.
hairykrishna said:
Our experience with both kids was that maternity care is basically stretched to breaking point because it didn't have enough resources. It's always going to be a st show if you don't have enough staff etc to do it properly. Staff also vary wildly in competence.
The "not listening to patients" thing is difficult. I think a lot of it is that the nurses are used to pregnant women, understandably, worrying a lot about their baby. So real issues get lost in the noise. With our daughter if I hadn't kicked off about the fact that my wife has a ridiculous pain tolerance so, if she says she's hurting really badly, a couple of paracetamol and seeing how she gets on overnight is a terrible idea things might have turned out badly. As it was they got the (excellent) consultant in and a swift unscheduled c-section followed within a few hours.
You refer to them as nurses. They are not and that's part of the problem. Historically midwives and nurses trained together to begin with or qualified nurses do a conversion course. So historically midwives had a lot of nursing experience. At the same time it was decided that nursing and midwifery should be knowledge based so degree qualifications rather than an apprenticeship model with a massive reduction in hands on experience at the time of qualification. Newly qualified midwives have much less experience of properly sick patients and struggle to identify when things are going wrong or have the humility and common sense to seek helpt show if you don't have enough staff etc to do it properly. Staff also vary wildly in competence.The "not listening to patients" thing is difficult. I think a lot of it is that the nurses are used to pregnant women, understandably, worrying a lot about their baby. So real issues get lost in the noise. With our daughter if I hadn't kicked off about the fact that my wife has a ridiculous pain tolerance so, if she says she's hurting really badly, a couple of paracetamol and seeing how she gets on overnight is a terrible idea things might have turned out badly. As it was they got the (excellent) consultant in and a swift unscheduled c-section followed within a few hours.
I've worked in Obs and Gynae. I don't think I ever came across a midwife who recorded a fully completed vaginal examination of a woman in labour. Their records were full of obfuscations to disguise this. Most commonly they would record excessive swelling of the baby's scalp to cover the fact that they could not feel or interpret the orientation of the sutures (bony junctions) in the foetal skull to make an accurate assessment of presentation. Inability to accurately assess progess in labour or lack of it puts mothers and babies at risk.
There are interprofessional rivalries in other parts of the NHS but nothing comes close to the ideology and hubris of midwife independence.
Undoubtedly poor staffing contributes to this woeful picture but the other parts of the picture are unrealistic expectations meeting poor training, practise and professionalism.
Countdown said:
scenario8 said:
I sincerely hope improvements are made.
They won't be. Improvements require investments, you get what you pay for.Most people don't want to pay more tax whilst at the same time demanding a perfect high quality service which means that more and more money is spent on bureaucracy.
This is an utter disgrace. I am male, have no kids, but have every sympathy for parents and mothers in particular with the issues in the investigation. Having a child is something that sets you up, potentially, for both massive highs and also appalling lows. I cannot imagine the worry, fear and upset experienced by those failed by the maternity system.
Resourcing isn't exactly short, it's just often very poorly applied and utilised.
And there are (as with many other functions) far too many staff who either aren't competent or just outright don't give a st about doing their jobs. And no-one can be arsed to monitor or fix this.
If you're lucky you get through the system without mother and/or child dead or maimed from entirely avoidable causes.
And there are (as with many other functions) far too many staff who either aren't competent or just outright don't give a s
t about doing their jobs. And no-one can be arsed to monitor or fix this. If you're lucky you get through the system without mother and/or child dead or maimed from entirely avoidable causes.
Digga said:
The NHS piss money away on inefficiency. Their productivity, since the pandemic allowed them to hide from their actual customers - patients, as opposed to their government paymasters - is risible. Why, automatically, is more money into a failing institution the default suggestion?
Could you give me an example of the inefficiency which is a fault of the NHS rather than something imposed on them or as a result of circumstances beyond their control?One of the biggest inefficiencies (IMO) is the level of micromanagement and control from central Government in terms of monitoring, recording and reporting stuff upwards without much if any benefit. But that's imposed on them from central government.
Countdown said:
JoshSm said:
Resourcing isn't exactly short, it's just often very poorly applied and utilised.
same question really - where would you move resources from / to ?The National Audit Office (NAO) said an increase in the number of claims, the rising costs of each settlement, and soaring legal fees had all contributed to the government’s liability in England quadrupling from £14.4bn in 2006-7 to £60bn in 2024-25.1
In 2024-25 damages for very high value claims (over £1m) such as child injury caused by poor maternity care accounted for 68% of total costs, despite only representing 2% of all claims, auditors found.
For reference, annual spending on maternity care is estimated at £3-5 bn
Can anyone think of another business/activity that could survive with that income and those liabilities?
oddman said:
Countdown said:
JoshSm said:
Resourcing isn't exactly short, it's just often very poorly applied and utilised.
same question really - where would you move resources from / to ?The National Audit Office (NAO) said an increase in the number of claims, the rising costs of each settlement, and soaring legal fees had all contributed to the government s liability in England quadrupling from £14.4bn in 2006-7 to £60bn in 2024-25.1
In 2024-25 damages for very high value claims (over £1m) such as child injury caused by poor maternity care accounted for 68% of total costs, despite only representing 2% of all claims, auditors found.
For reference, annual spending on maternity care is estimated at £3-5 bn
Can anyone think of another business/activity that could survive with that income and those liabilities?
Jasandjules said:
At one point being told "The doctor requires this" - I made it quite clear what the doctor could do.....
Sorry you've had a bad experience. I've no idea what you're referring to but any medics here will recognise that as a classic 'nursism'. Unwilling or unable to give you a rationale for an action, decision or refusal to follow what you want so pushes it onto a doctor.Almost implying they don't agree. Pretty typical of the toxic culture in obs/midwifery.
I've worked on labour ward and PICU and the team work and collaboration is off the scale better on PICU because there is no turf war or fantasy of independent practice
DeadShed said:
But getting things right requires enough people to do the job. One of the fundamental issues is that there s just not enough people and everyone is over stretched. Can you think of any business that would expect to take on more customers with zero extra capacity or income. How would restaurant staff manage if you doubled the number of covers from the same sized kitchen and the same number of tables? How many of the staff would work overtime for no extra pay because people need to eat .
Completely agree - was making the case for investment. But the culture needs fixing tooEdited by oddman on Tuesday 9th December 19:01
oddman said:
Sorry you've had a bad experience. I've no idea what you're referring to but any medics here will recognise that as a classic 'nursism'. Unwilling or unable to give you a rationale for an action, decision or refusal to follow what you want so pushes it onto a doctor.
No the doctor came in about 10 mins later and got told the same thing and rather swiftly retreated.......... It worried me how they think they can bully some people etc and people in labour who are in pain, not thinking etc (I think we had been awake for 20 hours by that point)...Jasandjules said:
No the doctor came in about 10 mins later and got told the same thing and rather swiftly retreated.......... It worried me how they think they can bully some people etc and people in labour who are in pain, not thinking etc (I think we had been awake for 20 hours by that point)...
What were the Nurse and Doctor asking that you disagreed with?Jasandjules said:
oddman said:
Sorry you've had a bad experience. I've no idea what you're referring to but any medics here will recognise that as a classic 'nursism'. Unwilling or unable to give you a rationale for an action, decision or refusal to follow what you want so pushes it onto a doctor.
No the doctor came in about 10 mins later and got told the same thing and rather swiftly retreated.......... It worried me how they think they can bully some people etc and people in labour who are in pain, not thinking etc (I think we had been awake for 20 hours by that point)...If people were treated with some courtesy and respect then outcomes could be different. The really poor outcomes for low income white women and ethnic minority women speak to this.
I had a boss that said that NHS staff should be sent to train with cabin crew as the key skills of courtesy communication and building confidence in a short space of time in a pressure situation are essential for effective care. I think he had a point.
Quite apart from the best part of a decade or more of underinvestment, there will be other factors at play.
At a guess these will be: staff ignoring best practice, not engaging with continuous / quality improvement programmes, a fear culture, ignoring critical incidents and not reporting these properly, SHA's not systematically reviewing data relating to patients in their care, and discouraging whistleblowers.
Although infant mortality has declined and has levelled out, maternal mortality has increased to something like the same level as 20 years ago.
At a guess these will be: staff ignoring best practice, not engaging with continuous / quality improvement programmes, a fear culture, ignoring critical incidents and not reporting these properly, SHA's not systematically reviewing data relating to patients in their care, and discouraging whistleblowers.
Although infant mortality has declined and has levelled out, maternal mortality has increased to something like the same level as 20 years ago.
Edited by Yahonza on Tuesday 9th December 19:22
We’ve had both sides of it; daughter was born at 26 weeks and the care and professionalism was outstanding. Son was by C-section and post birth care was beyond atrocious. The most dangerous are the nurses who push the breast feeding - they almost killed my son through dehydration. Idiots.
A friend has left nursing because no one would question seniority to the point that it was massively compromising safety. Other industries (aviation etc) have moved on from such massive gradients but, from her accounts, it still prevails in medicine.
A friend has left nursing because no one would question seniority to the point that it was massively compromising safety. Other industries (aviation etc) have moved on from such massive gradients but, from her accounts, it still prevails in medicine.
oddman said:
DeadShed said:
But getting things right requires enough people to do the job. One of the fundamental issues is that there s just not enough people and everyone is over stretched. Can you think of any business that would expect to take on more customers with zero extra capacity or income. How would restaurant staff manage if you doubled the number of covers from the same sized kitchen and the same number of tables? How many of the staff would work overtime for no extra pay because people need to eat .
Completely agree - was making the case for investment. But the culture needs fixing tooSlightly O/T but a friend who's now retired was the first male midwife in the UK. I got the drift that the way things had gone within the NHS was a catalyst to his retirement.
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