The NHS’s worst maternity scandal raises fundamental questions about the culture and safety of our health service.
The Independent has revealed that an inquiry into maternity care at Shrewsbury and Telford hospital NHS trust has uncovered dozens of avoidable deaths and more than 50 babies suffering permanent brain damage over the past 40 years.
The trust joins the roll call of NHS hospitals where endemic poor care has caused harm and death. Failings uncovered at Shrewsbury include a lack of transparency and honesty, defensiveness, a disrespectful and unkind attitude to families, a failure to learn from or even recognise serious incidents, and a “toxic” culture.
The 2015 inquiry (pdf) into deaths of babies and mothers at University hospitals of Morecambe Bay NHS foundation trust, the Francis inquiry two years earlier into failures at Mid Staffordshire, and the 2001 landmark public inquiry (pdf) into children’s heart surgery at Bristol Royal infirmary all revealed layer upon layer of systemic failings. These included the breakdown of teamwork, poor leadership, lack of respect between professional groups, a tolerance of poor standards, defensiveness, dishonesty, failure to assess risks, and repeated failures to recognise and investigate serious incidents.
Boards, senior NHS management and regulators either missed the problems or did not take decisive action.
While these NHS scandals have sunk into the national consciousness, numerous less publicised failures scatter the history of the health service, such as the ongoing case of the feuding heart surgeons at St George’s hospital in south London.
As Morecambe Bay and Shrewsbury highlight, the quality of maternity care has been a longstanding concern. In 2016 the National Maternity Review reported widespread problems with quality and safety, missed opportunities to prevent stillbirths even when the mother had expressed concerns, massive underreporting of safety incidents and a failure to learn from mistakes.
Staff shortages and underfunding are not the root causes of scandals – they do not explain why neighbouring departments and hospitals under similar pressure do not fall over – but they ramp up the risks of failure, pushing dysfunctional services closer to the edge.
The default response to NHS scandals is to establish an inquiry and tighten regulation. That has its place but achieves more for public relations than safety. More encouragingly there is a growing focus on helping clinical teams understand how the quality of their care compares nationally and where they can improve.
But so many NHS initiatives to improve care are on shaky ground. Local health services are being encouraged to think and work as integrated care systems, but it is highly questionable whether many areas have the leadership, resources and skills to deliver on such a big promise. There is a risk that the organisational furniture will be rearranged without fundamentally changing the way care is delivered.
Most NHS leaders will publicly support the idea of abolishing blame culture, stopping bullying and ensuring staff have the freedom to speak up about risks and failures without jeopardy. But no matter how many times these principles are repeated, celebrated and stuck on noticeboards, the mounting wreckage from the careers and lives of people who believed the NHS was sincere in these ideals reveals the reality.
Data – the most precious healthcare resource after staff and money – is squandered wholesale. The truth about quality and safety is in the numbers and can often be seen in real time, not months or years later. Yet the NHS is nowhere near establishing the processes and culture to identify failing systems early.
Too many hospital boards complacently believe “it couldn’t happen here”. Instead of constantly testing the quality and reliability of their services, they look for evidence of success while explaining away signs of danger.
Across the NHS there are passionate clinicians and managers dedicated to building a culture that delivers consistently high quality care. But they are undermined by a pervasive willingness to tolerate and excuse poor care and silence dissent. Until that changes, the scandals will keep coming.
• Richard Vize is a public policy commentator and analyst
