Thursday 13 February 2020
Health and Social Care
Maternity Services: East Kent
I made a statement on 28 January about concerns regarding maternity services in East Kent Hospitals University NHS Foundation Trust. I explained that I had sought reports from both the health service investigation branch and the Care Quality Commission and asked them to report back in 14 days. I have now received those reports and an update from NHS Improvement and NHS England and would like to make a statement.
The most important thing when having a baby is that you expect to receive the safest possible care. When things go wrong that lead to harm, it is devastating for all concerned. Therefore, I would like to express my deepest and heartfelt sympathies for the patients and families of those affected.
The key partners within the health system continue to work with the trust to identify the problems in maternity services and to ensure that swift remedial and appropriate action is taken. We all want and need to know that the care delivered is of the highest standard we would wish for ourselves and for our families.
Diagnosis (HSIB and CQC)
The healthcare safety investigation branch has conducted a number of maternity investigations at the trust as part of its national maternity investigation programme. It has started 25 maternity investigations at the trust since July 2018, of which 16 have been completed. These have identified a number of safety concerns, including the availability of skilled staff, particularly out of hours, access to neonatal resuscitation equipment, the speed with which patient concerns are escalated up to senior clinicians and obstetricians, along with failings in leadership and governance.
As requested, the Care Quality Commission carried out an unannounced inspection of East Kent Hospitals University NHS Foundation Trust’s maternity service between 22 January 2020 and 5 February 2020. The Care Quality Commission inspected the maternity provision at William Harvey Hospital, Ashford and the Queen Elizabeth the Queen Mother Hospital, Margate. These two sites provide the acute inpatient care and the vast majority of the trust’s maternity service.
The Care Quality Commission has written to the trust with an overview of its findings and the full inspection report will be published in due course. The CQC received additional information from the trust on Tuesday, following its request for further assurance on triage and day care and medical staffing. The CQC is considering this information and is in regular contact with the trust leadership to gain assurance of the required actions. The Care Quality Commission will continue to engage with the trust on all these issues and consider whether any further action is necessary.
It is important that everyone is aware that, the CQC is in regular contact with the trust and will continue to be so for the foreseeable future.
Robust actions in hand
From the findings provided to me it is clear that the challenges at East Kent point to a range of issues including having the right staff with the right skills in the right place, effective multidisciplinary working, clear collaborative working between midwives and doctors, good communication and effective leadership support. But it would be wrong to speculate that there is one single cause.
NHS England and Improvement are working very closely with the trust, and they have taken some immediate actions.
First, the regional medical director and regional chief nurse are providing support to the trust. The medical director will address concerns surrounding appropriate senior medical oversight.
Secondly, the regional chief nurse is providing support to the director of nursing and head of midwifery to prioritise and focus their local maternity improvement plans to address identified safety concerns. They will also review the effectiveness of clinical governance and executive leadership support, and this will include ensuring the trust is taking the learning from all historical cases and disseminating that learning throughout the trust.
England’s excellent chief midwifery officer, Jacqueline Dunkley-Bent, has sent an independent clinical support team into the trust to provide assurance that all measures possible are being taken. This expert team includes a director of midwifery services from a CQC-rated outstanding trust, two consultant obstetricians and consultant paediatrician and neonatologist. She has placed the very best at the heart of the trust, on the wards, at the bedside of patients with fresh eyes to oversee the care delivered.
The independent team is working with trust staff to deliver immediate improvements to care and to put in place robust and comprehensive processes to support improvement in standards over the long term. This input will also support East Kent to meet the 10 essential safety actions set by NHS Resolution’s maternity incentive scheme.
Along with the 14 day reports, I can offer further reassurance that Jacqueline Dunkley-Bent personally visited the trust two weeks ago to assess changes being put in place and that improvements are moving at pace.
Jenny Hughes, chief midwife for the south-east region, is also working with the trust directly.
NHS England and NHS Improvement regional and national teams will continue to work with the trust, with families where appropriate and with the intensive support team.
The trust’s board is taking the issues seriously and is working closely with NHS England and Improvement. The trust has already implemented a number of actions to improve safety. It has created and filled several specialist midwife posts. Safety huddles, where safety issues are regularly and frequently discussed, have been embedded on both sites to anticipate problems before they occur, and multi-disciplinary teams work collaboratively and effectively within these huddles. A protocol to ensure that CTGs—records of contractions and foetal heart rate—are subject to a “fresh eyes” check by another member of staff is working well.
The trust has also developed its approach to working with families in the sad case of a death, to ensure that it always provides a point of contact and that it includes and involves families in its investigations of these incidents, from the moment a serious incident occurs.
Sympathies and assurance
A dedicated quality surveillance meeting with the trust, Care Quality Commission and key health system partners is scheduled for 21 February 2020 to consider the trust’s actions to date and any further interventions required. I have asked for regular frequent updates plus a further update after this meeting.
We will never be complacent, and I can confirm to the House that I have had assurance from the Care Quality Commission that they are content that the trust is taking the issues identified seriously and has a genuine desire to make the necessary improvements. The Care Quality Commission also notes that the trust has a number of mitigations in place, including accepting NHS Improvement’s offer of maternity safety support, and the Care Quality Commission will be closely monitoring how the trust responds to the issues that it needs to address and I expect to be regularly updated.
It is critical that we continue to strive to make maternity care the safest it can be and to ensure that we build a learning culture in the NHS as set out in the NHS patient safety strategy. This requires leadership at all levels. This is why I have sought and had assurance from each part of the health and care system that they will continue to work with clinical and executive teams at East Kent Hospitals to make improvements to maternity and neonatal services across all sites operated by the trust.
Once more, I would like to express my deepest sympathies for the patients and families of those affected.
75th Anniversary of Victory in Europe Day: Licensing Hours
Section 172 of the Licensing Act 2003 allows the Secretary of State for the Home Department to make a licensing hours order (“order”) relaxing opening hours for licensed premises (any premises with a premises licence or a club premises certificate) in England and Wales to mark an occasion of “exceptional international, national or local significance”.
The Government have consulted on a proposal to make such an order to relax licensing hours in England and Wales to mark the 75th anniversary of Victory in Europe (VE) Day. The order, which was laid before the House yesterday, will extend licensed opening hours from 11pm on Friday 8 May 2020 to 1am the following morning on Saturday 9 May 2020, and from 11pm on Saturday 9 May 2020 to 1am the following morning on Sunday 10 May 2020, for premises licensed for the sale of alcohol for consumption on the premises and for premises licensed for the provision of regulated entertainment.
An impact assessment has been prepared and will be published alongside the order on legislation.gov.uk.
Work and Pensions
Automatic Enrolment Thresholds
Automatic enrolment into workplace pensions (AE) has been a great success to date with over 10 million people having been automatically enrolled and more than 1.6 million employers meeting their duties. Over 2019-20, working people will save an estimated extra £18.8 billion into workplace pensions as a result of these reforms.
The main focus of this year’s annual review of the AE earnings trigger and qualifying earnings band (the AE thresholds) is to ensure the continued stability of the policy while learning from the April 2019 AE contribution rate increase. We also want to ensure that our approach continues to enable individuals, for whom it makes economic sense, to save towards their pensions while also ensuring affordability for employers and the Government. The review has concluded that the earnings trigger will remain at £10,000 and both the lower and upper earnings limits will continue to be aligned to the national insurance contribution thresholds.
I intend to lay an order before Parliament following the February recess which will serve to amend the Pensions Act 2008 so that, for 2020-21:
the lower limit of the qualifying earnings band will be £6,240;
the automatic enrolment earnings trigger will be maintained at £10,000;
the upper limit of the qualifying earnings band will remain at £50,000.
The analysis supporting the proposed revised AE thresholds will be published in due course. A copy of this will be placed in the Library of the House and will be available on the www.gov.uk website, following publication.