Commission Publishes Recommendations Following Antenatal Care Backlog At East London Health Trust

Main Category: Pregnancy / Obstetrics
Article Date: 29 Sep 2007 - 2:00 PDT

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The Healthcare Commission published its recommendations following an incident at an east London NHS trust where 788 mothers-to-be referred for antenatal care were not booked for appointments.

It is releasing a summary of its intervention into the maternity service at the Newham University Hospital NHS Trust, which identified the problem last April.

The trust, NHS London (the local strategic health authority) and Newham PCT have all accepted the recommendations made by the Commission.

As reported at the time, the trust became aware that approximately 800 women had been referred to the trust for antenatal care, but had not been booked for an appointment or received antenatal care.

The trust found the main causes of the backlog were a demand for services in excess of the trust's capacity, a lack of recognition by staff to the seriousness of the situation, a failure to escalate the problem and a failure to monitor the situation once the problem and initial solutions were identified.

The trust took action to remedy the immediate problem, and contacted the Healthcare Commission's team to inform them of the situation and ask for their involvement.

The trust made urgent efforts to contact the women affected by the backlog and additional antenatal clinics were set up to see these women. A helpline was established to respond to any concerns that women had about their delayed antenatal care.

At the time of writing 95 of the women who had not received an appropriate antenatal service had given birth. The trust has made a commitment to track and monitor all the remaining women affected by the backlog until the end of their pregnancy.

The Commission worked with the trust to establish the causes of the incident and made several recommendations to ensure that action was taken to reduce the risk of failures of this kind occurring in future.

The recommendations included a review of the arrangements for clinical leadership within the maternity service and action to address the long standing questions of staffing that have affected on the care given in the unit.

The Commission's investigation team recommended that the Strategic Health Authority, the Primary Care Trust and the trust should work together to manage the problems associated with the increased demand for maternity services in Newham and review the capacity in the unit to meet the demand.

Nigel Ellis, Head of Investigations for the Healthcare Commission said: "This was a very serious incident and the trust must ensure that lessons are learnt. The Commission has asked that it be kept up to date with the trust's monitoring of the progress of the women affected by the incident.

"All women and their families are entitled to expect safe maternity services backed up by robust administrative systems.

"Newham University Hospital Trust recognised the seriousness of its failure to provide all women in its care with access to antenatal services and took appropriate action to manage the situation.

"The Commission is working with the local Strategic Health Authority to monitor the trust, to ensure that necessary action is taken."

The trust is already working with an external team and the local supervising midwifery officer for London to make improvements.

The trust has also engaged an expert in human resources to advise on performance management and levels of sickness within the team.

The Commission will formally review progress and make its findings public in six months, to ensure that improvements have been made.

Summary of intervention and action plan

Information on the Healthcare Commission

The Healthcare Commission is the health watchdog in England. It keeps check on health services to ensure that they are meeting standards in a range of areas. The Commission also promotes improvements in the quality of healthcare and public health in England through independent, authoritative, patient-centred assessments of those who provide services.

Responsibility for inspection and investigation of NHS bodies and the independent sector in Wales rests with Healthcare Inspectorate Wales (HIW). The Healthcare Commission has certain statutory functions in Wales which include producing an annual report on the state of healthcare in England and Wales, national improvement reviews in England and Wales, and working with HIW to ensure that relevant cross-border issues are managed effectively.

The Healthcare Commission does not cover Scotland as it has its own body, NHS Quality Improvement Scotland. The Regulation and Quality Improvement Authority (RQIA) undertakes regular reviews of the quality of services in Northern Ireland.

http://www.healthcarecommission.org.uk