Despite NHS England's warning to Trusts to improve maternity outcomes in the wake of the Morecambe Bay scandal when 11 babies died, many are still struggling to offer a good standard of care, despite introducing many new initiatives to try and tackle some Trusts' underperformance.

The latest maternity units to face the unwelcome glare of publicity are those of the Royal Shrewsbury Hospital and The Princess Royal in Telford, operated by the Shrewsbury and Telford NHS Trust. Not only has the investigation been widened for the third time into allegations of poor maternity care, but the Trust has also been put into special measures due to patient safety concerns across both hospitals and, furthermore, the CQC has recently issued a warning about staffing levels.

Three investigations uncover crisis in maternity care

In 2017 Jeremy Hunt ordered an investigation into the deaths of 23 babies born at the Shrewsbury and Telford NHS Trust between September 2014 and May 2016. Earlier this year, the investigation was expanded, following a review by the Royal College of Obstetricians and Gynaecologists (RCOG), to include a total of 40 babies born between 1998 and 2017, of which 12 were considered sufficiently serious to warrant further examination. The number of cases was then increased to 100. Today (14 November 2018), the BBC reported that 215 families have come forward alleging poor maternity care. The BBC reports sums up the situation by suggesting that 'this is shaping up to be one of the biggest crises in maternity care in the history of the NHS.'

Initiatives to improve maternity care lack teeth

Against the backdrop of the Morecombe Bay tragedy when 11 babies were found to have died unnecessarily, the situation at the Shrewsbury and Telford NHS Trust is deeply depressing for those of us who have been here before. The avoidable death of a baby is not something any parent will easily recover from.

Although we should acknowledge that errors will occur even in the best run hospital, when a pattern of inadequate care emerges and efforts to improve fail, all the evidence points to major systemic failure. The situation at Shrewsbury is even more depressing given the government's commitment to reducing the number of stillbirths and neo-natal deaths; seven recommendations from NHS England to improve maternity outcomes, including safer care and better working between professionals (another source of concern at Shrewsbury following allegations of a bullying culture by a former nurse); and the 2016 launch of the Royal College of Midwives (RCM) 'Caring for You' charter, which aims to improve services for women and babies. Those of us who regularly monitor the state of patient services across the whole health service are experiencing a strong sense of deja vue.

Shrewsbury's maternity service has been struggling for decades

Although there is evidence to show that locally-led initiatives are more likely to succeed through small, incremental changes at Trust level, a combination of poor leadership, staff shortages, a rising birth rate, and funding shortfalls will always conspire to undermine any number of initiatives – and this may well prove to be the case at Shrewsbury and Telford NHS Trust which has obviously been struggling over a long period to deliver the sort of safe maternity care parents expect. Hopefully, no more unpleasant revelations will be unearthed and at least the Trust is co-operating with the investigations and has admitted liability in a number of cases, including one on which I am currently advising.

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