On Saturday 25th October 2008 at 9pm my wife’s waters broke. It was three weeks away from the baby’s due date. That night we went to Furness General Hospital (FGH) where my wife was assessed by a midwife. I remember very clearly being told that if it wasn’t a weekend, we would have been kept in overnight but that the hospital ‘didn’t do inductions at weekends’ as there were no consultants available. Instead, we were told to go home and keep an eye on things.
Joshua was eventually delivered two days later on Monday 27th October. Just 24 hours after his birth, Joshua collapsed from an infection that was eventually to lead to his death 8 days later. We know that the major failings in Joshua’s care occurred after his birth, but we have always questioned why we were sent home over that weekend. I still can’t help but think that things might have been different had we not been.
Five years later in 2013, I attended a meeting with 6 other families affected by failures in care at the maternity unit at FGH. The meeting was attended by the Chief Executive of the Care Quality Commission (CQC), David Behan and CQC’s former Chair, David Prior. As each family told their story, a pattern seemed to emerge prompting an important question. When had the failures occurred that led to the tragic outcome for each of the families at the meeting? For all but one of the families present the answer was the same; it was at a weekend. Of course, the problems at Furness General Hospital were far wider and more complex than the issue of weekend staffing alone, but at that moment there was a palpable sense of shock amongst everyone present that this couldn’t just be down to coincidence alone.
In September 2013 the Royal College of Obstetricians and Gynaecologists (RCOG) published figures which showed that across the NHS as a whole, a third of maternity units had no consultants at weekends. In the same year, a National Audit Office study showed that babies were 13% more likely to suffer harm in UK maternity units during the weekend, than during the week.
The UK still has some of the poorest perinatal mortality rates amongst developed nations. If we achieved the same outcomes as Sweden for example, we could save the lives of 1,000 babies per year. It came as no surprise to me when I recently came across a review of maternity services in Stockholm which showed that the model of maternity care there provides for 24/7 consultant cover.
Strong evidence shows a similar trend in increased weekend mortality across the NHS as a whole. A 2012 paper published by the J R Society of Medicine found that patients admitted to hospital on a Sunday were 16% more likely to die than patients admitted on a Wednesday
We know that many factors contribute to patient safety. Systems, processes, communication, culture and the nuances of human behaviour are complex and important factors. But in a modern NHS that truly puts the patient first, how can we accept such large variation in outcomes due to something as simple as failing to ensure safe staffing at weekends?