Today, I’ve read and reread everything I can find on the Morecambe Bay Report.
It’s cold and cloudy outside, but that's no bad thing. I'll be in my writing spot all day (I can’t write at a desk, I don't know why. Student essays, my blog, and my book were all written on the sofa, or if it was especially cold, in bed).
So now you know my exact location, let’s get down to the point of this post.
I’m writing about one of THE most overwhelming situations you’ll ever run into as a midwife…
When death or harm happens because of something health professionals have done.
Now, this case is so huge that I can only give you an account as I understand it. Plus, it's ongoing. I believe history is being made.
I also believe there are two major changes coming to UK midwifery, which I'll tell you about.
What happened at Morecambe, nutshell version:
- Morecambe Bay hospitals were in trouble for having the highest mortality rate in the UK back in 2011. Alarms also rang from public complaints from events starting in 2004
- In particular, James Titcombe, father of a baby who died from an infection aged 9 days, felt the death was preventable. He also felt that his son's chart had gone missing, possibly destroyed before it could be used as evidence
- So the police and the government and the NMC got involved
This is where the governmental side of things starts to get a bit weird.
- The Care Quality Commission -- the government organisation that's supposed to make healthcare better -- was internally accused of a cover-up of the way Morecambe Bay was governed
- This accusation was looked into really roughly. One government staff member was dragged in off maternity leave with her 3-month-old, and:
'the interviews were very aggressive and bullying in tone.... some staff were driven to tears...'
- It ended with the government being sued, successfully, for libel in 2013. This was by staff who were supposed to have been involved in the cover-up
So what the heck was going on?
The truth is, we have no idea what's going on in government.
But whether there was some kind of cover-up or someone was just looking for a scapegoat... it looks like Morecambe wasn’t getting the support it needed. For years.
What's going on now:
- The Morecambe Bay Report came out on the 3rd March
- It looked into Morecambe hospitals and the Care Quality Comission
- It was put together by Dr Bill Kirkup (the same person who looked into the Jimmy Saville case)
- It describes really awful mistakes and practices...
- ... ranging from poor relationships between midwives and obstetricians to major organisational failures, and substandard care
- Also, it looks at more deaths of mothers and babies that appear to be preventable
- Worryingly, a small group of midwives calling themselves ‘the musketeers’ are accused of ‘pursuing normal birth at all costs’, causing death and harm
What this means:
There are big, positive changes afoot from the Morecambe Bay Report. This includes 50 new midwives and doctors starting work in the hospitals, which is great, though the effort needed to change things is immense.
Two big changes coming to UK midwifery:
1. Getting Rid Of Supervisors Of Midwives
Supervisors of Midwives support practice and protect the public. They're usually hugely experienced.
So why is the government looking to get rid of supervision, a form of support for midwives and women that's been around for 100 years? Sounds like the last thing we need.
There are clear reasons why it's being considered.
Two midwifery supervisors in Morecambe looked into a case of a baby death and decided the care was good -- but later, it was found the care was substandard in places.
The Morecambe Bay report says that one supervisor in particular was also staff rep -- causing a conflict of interest for her between supporting colleagues and investigating them.
So the government think supervisors are not a healthy, modern way of regulating midwives.
This is making many sad and worried about the future of midwifery.
Supervision means 'self-governance' to a lot of midwives.
They argue, if midwives can't self-regulate, how the heck can they have the power to fight for and support women's birth rights?
Others feel a newer method of regulation may be a positive change and an opportunity for midwifery to get safer.
2. Normal Birth In The Media
There are suddenly lots of 'The cult of natural childbirth has gone too far' type articles around.
This is understandable right now, but not great.
I think there's going to be an issue with the credibility of midwives and normal birth.
We know, empirically, that when midwives are the lead practitioner for healthy women and babies, mortality and morbidity go down.
Promoting normal pregnancy and birth is one of the things that makes midwifery so important and unlike any other kind of care.
Navigating between supporting normal birth, reducing unnecessary intervention, and ensuring women and babies get the medical attention they need is the epic task of midwives.
I think that it's not surprising that a trust failing in many areas had this core part of midwifery fall apart. But just because one (undersupported) trust got so many things wrong, doesn't mean that midwifery's function of supporting normality is wrong.
All this sounds very dark and serious -- and it is. Mothers and babies have died.
BUT I absolutely believe we shouldn't judge the midwives involved. There's so much more to this.
Because this is such an immense topic, I've split my thoughts.
I'll be putting out 'part two' soon, which is on why it's REALLY IMPORTANT for every midwife to get educated on how powerful they are.
If you haven't already, why not consider subscribing so you don't miss it.
In the meantime, I'd love to hear from you. 1) Is there anything in this post that you didn't know already? Or 2) Do you have a perspective or information to share, so we can learn and grow from the Morecambe Bay Report?
Ellie x
I didnt know that the suggestion was to get rid of Supervisors – what will the replacement be? I’ll look into it more soon, but am revising on other things before int on Friday so trying to get an overview of this report. Your article is extremely helpful for making it easier to access!
No worries GeeGee, we don’t quite know what the replacement will be yet. This is what’s going on in the House of Lords currently: http://www.theyworkforyou.com/lords/?id=2015-03-03a.168.0 Thanks and good luck with your interview!
Hi Ellie, Thanks for this post it is really helpful. Also you emailed me back about interviews around a month ago so thank you for that too. 🙂
No probs Ruth, so glad you found it helpful 🙂
Thanks Ellie for published this! Can’t wait to read the second part!!x
Thank you for your excellent and compassionate post about this report.
Thanks Beccy!
Fab!
Thanks Shaney!
Thank you for your insight into this and that it is written in plain language too.
I am a retired NHS midwife as from the 28th March and I agree with what you have written. My concern, as always is the scapegoat mentality that appears to always takes place in these serious reviews and that it will be just midwives that will be held to account, when it is very clear that it was the culture of this unit that was to blame. There have been various stories in the media over recent years of those who have ‘blown the whistle’ for example, loosing their credibility and careers as a result. It rarely results in those in high management, who weld the power, who make the rules, that held up as an example in these cases or held accountable.
I am very concerned at the future of midwifery in the UK and I hope that we continue to fight to maintain what we do, as we can have an amazing impact on families lives, hopefully for the better. I for one, don’t want to end up as in the States as just an OB nurse as opposed to being respected midwives.
We also need to fight for Midwifery Supervision to continue as in any field regardless, there are sometimes bad apples in the barrel and we need the courage to weed those out. Most colleagues are frightened of the potential outcomes that may occur as has been evident in the media previously, if they go ahead and put their heads above the parapet.
I do hope that the impact of all of this results in a much more compassionate safer maternity service all round.
Hi, thanks for your comment, some real wisdom there. Yes, the scapegoat aspect is quite scary. Again we come back to a fear culture causing difficulties…it is hard, to be honest I think getting basics right like making sure people are paid on time, get breaks and are appreciated for what they do would work wonders. But in the meantime, making sure midwives realise they have the power to knock poor culture on the head might be the next best thing.