18 July, 2022
A hospital trust faces prosecution over the death of a baby 23 minutes after she was born.
An inquest concluded that Wynter Adams, a baby that survived only 23 minutes after birth might have survived had it not been for "gross failings" by staff at Queen's Medical Centre in Nottingham.
The decision to prosecute was made by The Care Quality Commission (CQC) over failure to provide safe care and treatment.
The date of the 15th of September 2019 will be etched on the minds of the parents forever as the day that their daughter died.
There was a failure by staff to recognise that the mother was in established labour, act on high blood pressure readings or accurately hand over her case between shifts.
The response is that the ward was "overworked and understaffed". The maternity services have been rated "inadequate" by the CQC.
The problems throughout the country seem to be similar to those investigated by Donna Ockenden at the Shrewsbury and Telford Trust. She has now been instructed to perform a further review at the Nottingham Trust after families said they had lost confidence in an earlier planned investigation.
As before, she will speak to the families who have experienced the problems. She said: "Having a baby is one of the most important times for a family and when women and their babies come into contact with NHS maternity services they should receive the very best and safest care."
Sadly, in response to the investigation, the hospital sent out a defensive memo internally which has been leaked. Sharon Wallis, director of midwifery at the Nottingham trust, wrote:
"Some of you will no doubt have seen some of the media fallout.
"Yet again they painted a damning picture of our maternity services, leaving out of their reports the great work that has been done, the improvements that have been introduced and the passion and commitment of all of the staff."
It appears reactive and fails to recognise the real suffering of the families at the heart of the process. The comments made are hostile to criticism and learning. It does not suggest that they will use their best endeavours to learn from their mistakes.
Nottingham University Hospital (NUH) trust subsequently apologised for an internal memo about Ockenden's first meeting with families.
"Our newsletter to staff is intended to share learning and improvement, and our aim is to put the patient at the heart of this - this message was poorly worded and fell short of this aim, and we are truly sorry."
Getting to the root of the problem and preventing it from happening again is at the heart of any investigation. It is not a witch hunt. The price of listening and learning is far less than the human cost to the families and the monetary cost in damages to the hospital. I only hope that the right attitude is adopted, and the right message is now sent to staff, and in turn to the public.
For more information contact Leonie Millard in our Clinical Negligence department via email or phone on 01254 770517. Alternatively send any question through to Forbes Solicitors via our online Contact Form.
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