On December 10, the Independent Review of Maternity Services at the Shrewsbury and Telford Hospital NHS Trust (SaTH) published an “emerging findings report” based on 250 cases of death or injury.
In it, review chairman Donna Ockenden said some mothers were blamed for the loss of their babies, medics and the trust used “inappropriate” language towards grieving families, and some deaths went “uninvestigated”.
In a report for SaTH’s board, chief executive Louise Barnett said the trust immediately assessed its position against the new standards and linked them to its ongoing maternity improvement and transformation work.
The Independent Review’s work continues, with its final report, examining more than 1,800 cases dating from 2000 to 2019, due to be published later this year.
The interim document outlined 27 “must-do” recommendations for SaTH itself and 25 more, grouped into seven “essential actions”, for all English maternity care providers.
Speaking to MPs on the Health and Social Care Committee the week after publishing the report, Ms Ockenden said SaTH – which runs the Royal Shrewsbury Hospital and Princess Royal Hospital – seemed to have pursued a “normal birth at any cost” policy, but obstetricians on her inquiry team saw cases where they would have recommended caesarean sections or other interventions but natural births went ahead.
She added that families in the county still feel guilty after “dismissive, unkind” letters from the trust appeared to blame them for their children’s deaths.
Writing for the SaTH board, Ms Barnett says the independent review’s report was “harrowing and concerning” to read.
“This independent review happened only as a consequence of the diligence and determination of the families involved in continuing to seek answers to an accountability for the harm and suffering they have endured and continue to endure,” she writes.
“These are families that tried to raise concerns about care and safety with the trust’s maternity and aftercare services but were not listened to and cared for as they should have been.
“This should never have needed to happen.
“On receipt of the report, the trust commenced work immediately to: assess progress against these actions, cross-reference all of these required actions against the current work with the Maternity Improvement Plan and Maternity Transformation Plan and pick up any new required actions that were not in place already.
“Whilst in its early stages still, progress is being made against the required actions.”
Ms Barnett says a fuller assessment of the trust’s position against all 52 actions is underway and will be presented to the board.
The trust’s board will receive Ms Barnett’s report, along with progress reports and action plans, when it meets remotely on Thursday, January 7.