NHS England to Withhold Information from Baby Death Review Process

Despite pressure from campaigners, NHS England has indicated that it will not publish results of a national audit prompted by the death of a baby girl.

The organisation has been exploring the quality of investigations that were carried out after the tragic incident took place.

But the commissioning body has indicated that although it accepted the recommendations of an independent review, it will not make public the methodology or findings of a national audit suggested by it.

The process had been instigated by the untimely demise of baby Kate Stanton-Davies.

Kate tragically died at a midwifery unit run by the Shrewsbury and Telford Hospitals Trust in March 2009.

It is accepted that there were numerous failures made at the unit at the time of Kate’s death.

The parents of the child have reacted angrily, not unreasonably pointing out that they expected to see a process that could be described as transparent.

Yet NHS England has described the ongoing reaction to the investigation as an internal matter.

NHS England is the existing supervising authority for midwives practising in England.

As part of this responsibility, the organisation commissioned expert Debbie Graham to review events surrounding Kate’s death.

This followed a jury inquest and an investigation by the Parliamentary Health Service Ombudsman in 2013 which both concluded that the death was avoidable.

Both processes also concluded that there had been huge failures in the care throughout the time that Kate stayed in the hospital.

Graham went on to heavily criticise the local supervisor, suggesting that the quality of investigation carried out have been entirely unfit, particularly in terms of containing multiple inaccuracies.

The report had stated at the time that NHS England should carry out an audit in order to “seek assurance that the weaknesses in the investigatory process identified in this review are no longer inherent in the current process.”

Yet it seems now that the results of this process will never be made public. It is those understandable that parents of the infant are extremely disappointed by the process.

According to investigations, Kate was born “hypothermic, pale, floppy and grunting” at Ludlow midwifery led unit in Shropshire, in March 2009.

Her mother had been incorrectly classified as being low-risk.

That decision will be viewed as controversial, and indeed there will be question Marks regarding precisely why it has not been published.

It seems that these questions will go unanswered.

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Baby Dies Due to Bacteria at Glasgow Royal Hospital

The Glasgow Royal Hospital for Children has been rocked by the death of a baby, following its infection with harmful bacteria.

This incident occurred in a maternity unit linked to the new Glasgow Royal Hospital for Children at the weekend, after the infant contracted Serratia marcescens.

It is notable that the baby had been born prematurely, and was already suffering from complex medical problems.

Nonetheless, there are serious question marks regarding hygiene in the institution as an investigation gets underway.

As the hospital begins to explore the terrible news, it has already been found that the same bacteria was present in five other babies in the maternity unit.

Seven others who have already left the hospital were also found infected with the Serratia marcescens bacteria.

However, thankfully none of these infants offer any cause for concern.

Serratia marcescens can occur naturally, and its presence in the body is not harmful to healthy individuals.

Certainly the incident would not have been considered worrying had an adult been infected.

However, young infants are particularly vulnerable to the bacteria, with colonised bacteria that gets into the bloodstream causing particular difficulties.

The US military used the bacterium during the Cold War to simulate biological warfare by bursting balloons of it over urban areas of California.

However, research into the virus has indicated that it poses no threat to adults, and is not even harmful to healthy babies.

According to personnel from the hospital, none of the five colonised babies in the neonatal unit should be considered cause for concern, despite being infected with Serratia marcescens.

“Since the increase in incidence of Serratia marcescens colonisation cases was indentified as part of our routine surveillance we have been closely monitoring the situation in line with national guidance. Given that there are no other cases of infection and that all the appropriate infection control procedures are in place the unit will continue to admit new patients as normal. Our staff are in communication with the families to keep them fully informed,” a spokesman stated.

A previous investigation into the bacterium suggested that there had been a small increase in colonisation cases during routine surveillance.

This will be some cause for concern after the tragic death of this particular infant.

The neonatal unit linked with this issue had opened back in 2009 as part of the redevelopment of the former Southern General Maternity Unit.

Since its opening it has been consumed by the maternity unit at the Royal Hospital for Children.

Both units form part of the £842m new “super-hospital” campus, which also includes the new Queen Elizabeth University Hospital.

An investigation into the issue is ongoing.

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Units Dealing with Sick and Premature Babies Struggling According to Report

According to a report from the Bliss baby charity, the majority of intensive care units dealing with sick and premature babies are currently overburdened.

Bliss found that nearly 90 per cent of sites across the United Kingdom are consistently caring for more infants than could reasonably be considered safe.

This contributes to a picture of the NHS being stretched to breaking point, at least according to the authors of the report.

This was underlined by the fact that almost 900 babies were transferred between hospitals in the last year owing to a shortage of staff.

It also became evident during the preparation of the report that clinical leaders in neonatal units are being excluded from funding discussions by higher levels of management.

More than half of neonatal units said their clinical leaders were not included in debates about activity levels and funding for their neonatal service.

Furthermore, 64 per cent of neonatal units (52 out of 81) did not have enough nurses to meet national standards on safe staffing levels, while two-thirds of units did not have enough specialist nurses.

Experts who collated that report suggested that over 2,000 additional nurses are required in order to care for premature and sick babies in the NHS system.

The figures will once more be cited as evidence that the NHS is experiencing serious financial and organisational difficulties.

At a time in which there is serious conflict over junior doctors’ contracts, and the health service is running a vast deficit of £2 billion, this is precisely the sort of news that those who are passionate about the NHS would rather avoid.

It particularly suggests that the plans for an extension of the seven-day culture of the National Health Service must be called into question.

The combination of this scheme with the existing organisational and financial difficulties that the NHS faces at present certainly represents a critical period in the history of one of Britain’s most revered institutions.

Among the text of the report, the following was stated:

The report said: “Our findings reveal a system in trouble, with a significant shortage of nurses, doctors and other professionals that are needed to deliver safe and high-quality care to premature and sick babies.

“The dedicated, hard-working staff at neonatal units across the country are being stretched to breaking point – putting babies’ safety and survival at risk and impacting their long-term development.”

Professor Edward Baker, deputy chief inspector of hospitals at the Care Quality Commission, indicated that the information would be taking on board as part of a current and ongoing review.

“We welcome this report from Bliss. It is right to highlight the problems that staffing can have on the quality of neonatal care, and this echoes what we found on some of our inspections. Where we have found concerns we have told trusts to make improvements. We expect trusts to look at staffing in a sophisticated way focused on the quality of care, patient safety and efficiency, rather than just crude numbers and ratios of one group of staff,” Baker stated.

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Young Women Should be Offered ‘Fertility MOTs’ on the NHS

The British Fertility Society (BFS) has suggested that women from the age of 25 should be offered so-called ‘fertility MOTs’ on the NHS.

Central to these check-ups should be counting how ovaries these young women have left remaining.

Despite the fact that fertility actually diminishes rapidly during a woman’s thirties, this is a morsel of information that often escapes the notice of couples attempting to produce a baby.

Indeed, Prof. Adam Balen suggested that “every week in our clinics I see couples where surprise is expressed – they didn’t realise the degree to which fertility goes down in your 30s.”

In particular, the British Fertility Society noted that career women who consider themselves to be ‘in control’ on their own lives were often surprisingly ignorant of their dwindling ovarian reserve.

With this in mind, a national system of five-year checks, beginning at the age of 25, could help prevent women who wish to conceive from being unable to do so due to lack of ovarian produce, according to the BFS.

Cervical screening would be central to this process, but the British Fertility Society has also called for a wider program of education.

In particular, the aforementioned Balen has suggested that lessons for teenage girls and university students in how to protect and prolong fertility should be considered essential.

Family planning lessons should also be carried out at both schools and universities, as far too many women are currently optimistic about their biological clocks on the basis of anecdotal evidence.

“There is lack of understanding of the dramatic decline in fertility, and there are pressures to develop careers,” Balen suggested.

With regard to the new schemes, it has been pointed out that such checks are already offered regularly in other countries, with Denmark being a particular pioneer.

Regular screening could allow women to have a real insight into their current level of fertility, which could then have an impactful benefit on their decision or otherwise to attempt to conceive.

Women should also be given diet and lifestyle advice, with obesity and anorexia – which damage fertility – both on the rise according to advice from the British Fertility Society.

This latest advice comes in the context of a trend in which the age of motherhood continues to rise.

With this increasing average age of mothers, comes a parallel increase in the risk of infertility, miscarriage or babies suffering abnormalities.

Figures have also indicated that British women begin families later than equivalent females in other countries.

The average age at which women conceive in the UK is 30, which represents an increase of nearly two years in the last twenty years alone.

This figure compares to 28 in France and Scandinavian countries, and just 25 in the United States.

Balen suggested that the late 20s or early 30s should be considered the latest point for young couples to start a family.

There were 695,233 live births in England and Wales in 2014, a decrease of 0.5 per cent from 698,512 in 2013, and the total fertility rate decreased to 1.83 children per woman, from 1.85 in 2013.

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