Urgent review launched into N&N’s maternity department over hospital breach as midwives are tasked with overseeing too many births

Pregnant mums have been turned away from the N&N maternity unit because it's been too full. The unit

Pregnant mums have been turned away from the N&N maternity unit because it's been too full. The unit is among the least well staffed in the hospital. - Credit: PA

Health bosses are carrying out an urgent review into midwifery at the region's biggest maternity department.

The hospital's maternity unit has struggled to fill vacancies.

The hospital's maternity unit has struggled to fill vacancies. - Credit: PA

The investigation, at Norfolk and Norwich University Hospital (N&N), was prompted by months of problems at the unit – which was ordered to improve by a health watchdog earlier this year.

Among the issues facing the department are:

- A midwife-to-birth ratio that is higher than national guidelines;

- Unfilled midwifery and nursing shifts;

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- Patients taken to other hospitals after two temporary closures of the unit in the last four months.

Meanwhile, the national union for midwives warned of a growing shortage within the profession which is causing a negative impact on standards of care.

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Today mothers who have given birth at the N&N since the CQC's visit told of their experience, with several highlighting the quality of care from staff but also a lack of midwives and nurses.

Frances Bolger, head of midwifery at the N&N, said: 'The hospital has a number of plans under way to help increase patient flow and capacity.'

Jo Parker, with her husband Shaun Parker and son Toby Parker. Toby developed jaundice after Jo gave

Jo Parker, with her husband Shaun Parker and son Toby Parker. Toby developed jaundice after Jo gave birth at the N&N in October 2015. - Credit: Archant

The maternity department, which employs 195 midwives, was told to improve by health watchdog the Care Quality Commission (CQC) following an inspection in early November last year, though staff's care was praised.

The department is supposed to have a ratio of one midwife per 28 births in national guidelines set by the Royal College of Obstetricians and Gynaecologists (RCOG).

In its March report the CQC found the N&N was operating with one whole time equivalent midwife per 34 births.

Ms Bolger said the N&N is currently operating with 1:31, but that figure includes maternity support workers – who are not qualified midwives.

Destiny Hoffman with her partner Lee Skoulding with their son Elijah.

Destiny Hoffman with her partner Lee Skoulding with their son Elijah. - Credit: Archant

She is carrying out a review into the ratio in a bid to reduce the number of births midwives are responsible for.

It is not yet known when her review will be completed.

Meanwhile RCOG guidelines also state a unit the size of the N&N's should provide consultant obstetrician cover for 198 hours per week, yet the N&N is currently only providing less than a third of that at 60 hours per week.

Additionally nursing shifts required for safe staffing levels are not being filled.

Leanne Alden with her son Chase.

Leanne Alden with her son Chase. - Credit: Archant

The hospital's average midwifery/nursing shift fill-rate since January is 93pc and 84pc for day and night shifts respectively, according to the latest figures available.

Low levels of staffing has even led to the hospital bosses having no choice but to take the radical step of closing the whole unit to new patients due staff sickness and a lack of capacity.

This has happened twice since April and meant six women had to have treatment at other hospitals.

Ms Bolger said all the maternity departments across Norfolk (at James Paget and Queen Elizabeth hospitals) worked together to manage patient demand when a hospital's department is forced to close.

She also added the hospital was 'actively recruiting two consultant obstetricians' to be compliant with the 198-hour cover per week guideline.

Further afield the James Paget Univerrsity Hospital (JPH) in Gorleston has recruited people to all its midwifery vacancies as bosses aim to drive down spending on expensive agency staff.

Both the JPH and Queen Elizabeth (in King's Lynn) hospitals have also not achieved 100pc fill-rate for midwifery/nursing shifts consistently.

Six mothers describe their experience of giving birth at the N&N

Every woman who has given birth knows the enormity of the occasion and it can be a hugely stressful experience for both them and their partners.

Births can range from wonderfully simple acts of nature to the harshest challenge us humans can cope with.

But common for all expecting parents is a desire for good care to be provided at what can be the toughest time of their lives.

Here six mothers from across Norfolk share their experience of the treatment they were given at the N&N's maternity department within the last ten months.

• Jo Parker, 37, of Norwich, told how her baby had jaundice and then turned blue after he was delivered at the N&N.

Her son Toby arrived one month early, in October 2015, and was taken to the neonatal intensive care unit (NICU) as his breathing was raspy.

Two days later Toby was taken off his drip at the NICU and returned to her at the Blakeney Ward.

'They just left him with us that night,' Mrs Parker said. '

Nobody checked on us or told us what we were supposed to be doing.'

Toby developed jaundice and had to be put under blue lights over the next week to recover.

But Mrs Parker said he became so cold on his first day with them at Blakeney ward that he turned blue, before someone brought a heater in for them.

'There are great people there but the communication between the departments was the problem,' she said.

• Destiny Hoffman, 30, of Beccles, said she could not fault the midwives at the unit after giving birth to her son Elijah in May.

Elijah was born with a rare congenital heart defect called tricuspid atresia (a heart deformation), and Ms Hoffman said the midwives involved in her care were 'absolutely fantastic'.

'I was in labour for three days and throughout that time they were supportive and caring,' she said.

'Even if they weren't seeing me during a shift they would pop their head in to see how I was and asking about how things were going.

'The midwives I had during the actual birth were fantastic with how they kept me calm and talked me through my breathing.

'I only wish I could remember their names and I literally could not fault the care I received.'

Elijah was treated at the NICU and later transferred to Great Ormond Street Hospital, London.

• Leanne Alden, 24, of Mile Cross, Norwich, said her stay at the department during the birth of her son Chase was 'the worst hospital experience I have ever had'.

But she added the only thing that 'held me together' was that the staff were doing their best to help her.

After a gruelling stint in labour she was told doctors would perform an emergency caeserian section, and she lost a lot of blood in the process.

She said she was told by a doctor she needed to be in theatre as soon as possible to get stitches, but she had to wait while he treated another patient who needed help urgently.

'The doctor came back within 20 minutes and couldn't apologise enough,' she said.

'I assured him it was fine and wasn't his fault as they were so under-staffed and he was trying his best.'

• Sherry Locke, 39, of Wymondham, gave birth to her second child Ethan at the hospital at the end of October last year.

She said: 'Upon being admitted at 38 weeks I had a quick and straightforward labour where the staff could not be faulted.

'I was told I was lucky I had been admitted when I had been, as a couple of hours later the Midwife Birthing Led Unit had been closed and the delivery suite was closed except for emergencies.

'It just seems - like many public services - there are some excellent staff working to provide a service that is more and more stretched beyond its capabilities.'

• Nakita Louise Harden, 26, of Sprowston, said described most of the staff as 'amazing' but added there were little incidents that could easily be fixed for future mothers.

Mrs Harden, a type 1 diabetic, gave birth to her daughter Sofia in January.

She weighed in at just 2.35kg and spent time in the NICU, meaning Ms Harden stayed at the N&N for ten days.

She said she was given non steroid anti inflammatories despite being intolerant and was also told to eat food that would trigger her irritable bowel syndrome.

But Mrs Harden said she could not fault most of the staff and added Norfolk is 'lucky to have such a fantastic maternity team here'.

She suggested mothers be allowed to make supervised visits to the hospital's gardens and courtyard in order for them and their babies to access fresh air.

• Victoria Wade, of West Rudham, near King's Lynn, who is due to give birth in October, received specialist treatment at the N&N for a suspected problem with her baby.

'My husband Peter and I went to the Queen Elizabeth Hospital for my 20-week scan, and we were told the devastating news that they had seen something unusual,' she said.

She was referred to the N&N where she was seen by a specialist called Richard Smith, whom she described as 'absolutely fantastic'.

'He was extremely reassuring throughout the whole process,' Mrs Wade said.

'I had to have extra ultrasounds and the end conclusion was there shouldn't be a problem.

'Dr Smith even went out of his way to scan me and get me a very clear photo image of my baby's face which I could take home.

'It was an extremely tough time for myself and my husband and we had to have a lot of 'what if' conversations, but everyone we saw at the N&N was so helpful.'

N&N says steps are being taken

A number of steps are being taken to improve services at the maternity department, according to the Norfolk and Norwich University Hospital's head of midwifery, Frances Bolger.

She said: 'The trust has been actively recruiting with eight new members of staff starting recently and a further 11 due to start in September following their qualification from the University of East Anglia.

'The national programme GROW was started in Norwich in 2012 which was aimed at reducing still-births, but this has increased the number of inductions and length of stay for some mothers.

'This month we have introduced outpatient inductions allowing soon to be mothers with a low-risk pregnancy to go home and purchased additional cardiotocographys which record the fetal heartbeat and the uterine contractions and allows further maternity care in the community.'

She said the number of births at the hospital had risen from 4,000 when it was built in the early 2000s to 6,000 last year.

'Providing the very best care is very important to us and the feedback from our maternity patients is very good,' Ms Bolger added.

'In the recent CQC report the inspectors labelled the care in our maternity department as 'good' and the midwife-led 'Birth reflections' clinic as 'outstanding'.

The department has also recently gained international recognition from Unicef (United Nation's Children's Fund) and been fully accredited with its prestigious Baby Friendly Initiative Award.'

Union warns of growing midwife shortage

A union has warned of a growing shortage of midwives nationally.

According to the Royal College of Midwives figures published last month reveal the shortage of midwives in England has increased from 2,600 to 3,500, prompting fears of staff being overworked.

And the Royal College for Obstetricians and Gynaecologists (RCOG) said many maternity units are 'seriously stretched at times when workload is greatest.'

Suzanne Tyler, of the RCM, said: 'When staff are overworked under intense pressure and struggling to provide the best care, their physical and mental health suffers.

'This has a negative impact and standards of care and safety decline.'

The union has launched a campaign called 'Caring for You', which aims to improve midwives' wellbeing at work.

Meanwhile Ian Currie, vice-president of the RCOG, said: 'Currently one of the most pressing issues in our specialty is that there are gaps in middle grade rotas approximately 30pc of the time, due to time being taken out of training for research, maternity leave, sickness and less than full-time training.

'Many units are seriously stretched at times when workload is greatest. This has a significant impact on retention of staff at all levels.'

• Have you got a story about maternity at our region's hospitals? Email our health correspondent at nicholas.carding@archant.co.uk

• Do you have a story that needs investigating? Email tom.bristow@archant.co.uk

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