David Richmond, RCOG President, writes...
The General Election is six weeks away and there has been a flurry of political activity and the publication of reports just before the traditional pre-election “shut down”. Not least of which was the Kirkup Report on the events at Morecambe Bay NHS Trust. I have already written to Fellows, Members and Trainees on the subject and recently met with Cathy Warwick, CEO of the Royal College of Midwives and the National Clinical Director for Maternity and Women’s Health, Catherine Calderwood to discuss a way forward. Leadership, respect, communication, collaboration and team work remain essential. However, above all there needs to be a complete cultural change where the patient is at the center of decision making and care. The entrenched “them and us” mentality which appears to have pervaded the services at Furness General Hospital is completely unacceptable. Equally, ignorance is no defense. The plethora of guidance and professional standards appear to have been swept aside by an obsession to achieve a particular outcome cannot be condoned. However, I’m also concerned that this may not be a unique situation. The number of times the College is asked to undertake an invited review of an individual or service delivery is nearly always couched as one of clinical performance within the Terms of Reference. Yet equally, there are nearly always behavioural issues in the background with dysfunctional teams and individuals. It is this that needs to change and quickly.
The recent GMC report on Bullying and Undermining illustrates that this is not just confined to our own discipline but is much more widespread within the NHS. The RCOG has made enormous efforts, firstly, by admitting that there is an issue in the specialty, and then by the appointment of a Workplace Behaviours Adviser and Champions in each region around the UK. We have also launched an eLearning resource and toolkit to address the problem. We must encourage learning in an open and supportive environment. Being respectful of each other yet open to dialogue and debate if things go wrong would seem rather elementary and yet these basics are often lacking.
On Friday 13 March, I talked at the National Labour Ward Leads meeting at the College. There is no doubt that there is stress in the system particularly on labour wards. A lot of this is related to workforce issues with significant rota gaps and the difficulty of employing temporary staff often at short notice. There is little flexibility in the system. Finding locums on a Friday afternoon is all too often the scenario and the solutions by and large are unsustainable. Pregnancy and delivery are unique in the range of physiology and pathology which occur and also the situation of having two different autonomous practitioners involved without clear demarcation between the two. Add in the emergency nature of labour and then the issues surrounding temporary staff or locums, one quickly generates a recipe for dysfunction, poor outcomes and the plethora of poor behaviours seen in the Kirkup Report. To that end I have set up a new Working Party “Safer Women’s Healthcare” to look at the standards (Gynaecology and Maternity) and service delivery described in “Safer Childbirth” nearly eight years ago. It is time for an update and some solutions. This report will dovetail with the recent announcements from NHS England and Scottish Government of their reviews of maternity services.
Monitoring of meaningful clinical outcomes such as in Each Baby Counts and the rotation of senior staff within a larger footprint than that of a hospital to that of a network would allow for broader experience and the sharing of workload. That may need extra staffing to facilitate supernumerary attachments, professional development and medical education which are valuable and worthwhile for all concerned. Revalidation principles, particularly involving patient and colleague feedback would certainly have helped the Morecambe Bay NHS Trust. However, action then becomes essential by the professional leaders in situ. I have alluded to the Invited Review system above, but this tends to be reactive. Perhaps there is an opportunity to work with the Care Quality Commission and NHSLA to derive a peer review process which would be proactive and respected. I believe that the Hospital Recognition system we had previously could be re-modeled and then work with other agencies for the benefit of all concerned.
I would be interested to hear any views.