Kirkup Report: Inhuman healthcare

The Kirkup Report was published this week. It catalogues the failings in the maternity unit at Morecambe Bay between 2004-2013, when clinical errors contributed to the deaths of 3 mothers and 16 babies. As the Report acknowledges, healthcare professionals can be expected to make mistakes, but in Morecambe Bay, like Mid-Staffordshire and Queen’s Hospital Romford before it, those mistakes can be traced to a rotten institutional system that privileged its staff and reputation above the care of its patients.

Dr Kirkup makes clear his suspicion that many of the hospital’s failures are endemic in the NHS generally. The Report particularly criticises the ‘rudimentary and flawed’ investigations that took place after the deaths and suggests that investigative failures are widespread in NHS Trusts. Birthrights supports that view. Women who contact us frequently describe unsatisfactory hospital investigations into their complaints. We have heard of ‘investigations’ that do not interview relevant staff, that are hampered by missing or falsified notes and seem designed solely to protect the hospital’s interests. Women consistently report a refusal to acknowledge mistakes and a failure to treat them with compassion or respect. It is not only patients who suffer. Health professionals themselves can become the target. We have advised midwives going through punitive investigations (both by hospital management and Local Supervisory Authorities) that are used to silence them when they have raised concerns about culture and clinical standards.

Dr Kirkup singled out for blame a group of midwives who styled themselves ‘the musketeers’. They perpetuated a ‘them and us’ culture, dishonestly concealed mistakes and pursued ‘normal’ childbirth ‘at any cost’. The charge that midwives sacrificed safety to an ideological agenda is an interesting one. It has led to inevitable clamour in the right-wing press that midwives (the Daily Mail’s favourite witches) bully women into natural childbirth in spite of the risks. In fact, ‘normal’ childbirth is promoted by maternal healthcare organisations around the world because it has been shown repeatedly to lead to the healthiest outcomes for the large majority of mothers and babies. Normal birth is not championed by midwives because of medieval blood lust, but because it is usually the best means of ensuring that woman and baby emerge from labour in good health. The motivation for the Morecambe Bay midwives’ exclusion of obstetricians from the unit is unlikely to have been principled adherence to evidence-based care (‘musketeer’ would be an unusual choice of title for a natural birth advocate); rather, they appear to have initiated an unethical and toxic battle for professional control over decisions in the maternity unit that had fatal consequences for women and babies. It is a sad consequence that the pursuit of well-evidenced maternity care has been conflated with their impropriety.

As a consequence of the Kirkup Report, the Telegraph reports that the Department of Health has commissioned a review into the safety of midwife-led care (I cannot find any confirmation of this on the DoH website). The worth of such a review has to be questioned in light of the findings of the Birthplace Study, which comprehensively assessed the safety of midwife-led units in 2011, concluding that they led to better outcomes for women with low-risk pregnancies than other options. Rather than scapegoating a single profession, the Department of Health would do better to look at the systemic failures of communication and management that arose in all of the professions – midwifery, obstetrics, peadiatrics – implicated by the Report.

Kirkup analyses the failings at a single NHS Trust; it does not answer the enduring question that arises from every hospital scandal – how can those charged to protect health end up doing harm? But yet Kirkup’s conclusions hint at a fundamental unease in modern healthcare – is inhumane, and even fatal, treatment inherent in large-scale institutional care? Within his recommendations, Kirkup suggests that the opportunities afforded by smaller units with a high-level of personal responsibility have been overlooked. Morecambe Bay, Mid-Staffs and the inevitable scandals yet to unfold, ought to make us to ask: have our healthcare institutions become too big to protect the humans at their heart?

Elizabeth Prochaska, Birthrights

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