East Kent Maternity Deaths: Babies Might Have Survived With Better Care
The title of this post, is the same as that of this article on the BBC.
This is the first paragraph.
Up to 45 babies might have survived if they had received better care at East Kent NHS Hospitals Trust, a damning independent review has found.
As a father of three, who has experienced the death of both his wife and youngest son, I know that this is a tragedy for too many families.
But episodes like these seem to come along regularly in the NHS. We have had two cases, where nurses were murdering babies, the notorious Harold Shipman and several abuse cases in mental health.
Is the monitoring of the outcome of patient treatment up to scratch?
In the 1970s, I was asked to do some programming for Bob, who was the Chief Management Accountant of Lloyds Bank and before that he had been Chief Accountant of Vickers. Bob had very definite ideas about how to ascertain the performance of various divisions and departments in a company or organisation.
He taught me a lot as we applied his ideas to check out the performance of various branches in the Bank. A lot of his experience was incorporated into Artemis and other programs I have written.
One of the things we did with bank branches was to plot groups of branches in simple scatter diagrams, so that those with problems stood out.
Does the government do similar things with hospitals and GP surgeries?
I even went as far as to suggest that my software Daisy could be used to find rogue practitioners like Harold Shipman. I was thanked for my submission to the report, but was not told my ideas were mentioned in the report.
Conclusion
I believe that more babies might have survived in Kent, if a statistician had been comparing results between hospital trusts and actively looking for problems.
I suspect the reason, there is no serious analysis, is that there is a belief in the NHS, that no-one ever makes mistakes or is evil.
The Anonymous Widower 
This sort of tracking is very carefully done for critical care units by ICNARC (I think data is collected twice a day)
https://www.icnarc.org/
They were heavily involved in the acute covid-19 trials as a result
Comment by David John Collier | October 20, 2022 |
Thanks!
Comment by AnonW | October 20, 2022 |
Our youngest daughter was born in Kent – although not East Kent. Thankfully things were straightforward. But the maternity dept didnt have it’s own theatre for mothers needing c-section. There was just one theatre in the who hospital. When it was decided that I was having a c-section, they told me they would interrupt the theatre list, and I would then be delivered. =I asked 2 questions – 1. – what was the list, and 2 were I or my baby in any danger from waiting a few hours. I was a children’s ENT list – tonsils out etc, and no I was in no there was no danger in leaving the c-setion for a few hours. So that is what we did – I knew people whose children’s tonsil surgery etc had been cancelled halfway through the list. Most hospitals either had maternity only theatre, and/or a couple of delivery rooms which could be used as a theatre in an emergency. The hospital I am talking about has now been demolished and the maternity dept in the new hospital is apparently state of the art. But with the figures for East Kent, I can’t help wondering what sort of emergency procedures they had available.
Comment by nosnikrapzil | October 20, 2022 |
A friend of mine was having her baby in a hospital in East Anglia. It was decided she needed a C-Section, so was moved forty miles by ambulance down the A14, to another hospital.
I also remember an incident in East Anglia, where in August there were so many multiple births, they ran out of incubators, so some babies were taken after delivery to Bedford. That is only a resource management problem if you have enough spare incubators ready in the region.
Some years ago, I got a fish-bone stuck in my throat and Addenbrooke’s A & E told me to come back the next day, where they would knock me out and remove it. Unfortunately, all spare capacity in the operating theatres was used up, by a serious multiple pile-up on the A14, so I took up a bed all day.
In the end, a feisty Australian staff-nurse found a junior surgeon, who was prepared to remove my fish-bone without the anaesthetic. He succeeded with the help of a sultry Spanish nurse.
Having been cared for in Addenbrooke’s and a couple of London hospitals, I feel that Addenbrooke’s are more likely to take an alternative procedure to get things moving. They also use methods that need less equipment and staff, where they are appropriate. For instance, I have had to endoscopies there without a sedative. They do that so you can drive home and they don’t need to have any recovery beds.
Comment by AnonW | October 20, 2022 |