The Professional Standards Authority has responded to the publication of Reading the signals: Maternity and neonatal services in East Kent, the report of the independent investigation into maternity and neonatal services in East Kent.
The report, which examines the maternity services at the Queen Elizabeth, The Queen Mother Hospital (QEQM) at Margate and the William Harvey Hospital (WHH) in Ashford, between 2009 and 2020, concludes that sub-standard care may have contributed to the deaths of at least 45 babies.
Themes identified by the report include a lack of joined up working between regulatory and other bodies across the system to identify problems, failures of Trust management to address known issues and cultural issues within the Trust. These included failures of teamworking, professionalism and compassion. It also found there were barriers to patients being heard.
Sadly, the report echoes the findings of other public inquiry reports. The Authority, in its recently published report Safer care for all, has called for a mechanism to ensure that the themes and findings from public inquiries are acted upon in a timely and joined-up way to break the cycle of harm. We recommend the creation of a Health and Social Care Safety Commissioner for each UK country to carry out this role.
Alan Clamp, Chief Executive of the Professional Standards Authority said:
‘Our thoughts are with all of the women and families who have been impacted by the failures described in the report. We welcome their bravery in speaking out to bring about change.
‘The Authority will be examining the findings of the report in detail and working with the professional regulators we oversee as they and we review any actions that need to be taken in response.
‘However, we also believe that this report, coming so soon after similar findings from other inquiries and reviews, should lead to an examination of the national structures in place to identify and act on patient safety risks.
‘We would welcome consideration of the recommendation from our recent report Safer care for all, for a Health and Social Care Safety Commissioner for each UK country with the responsibility for identifying and addressing safety risks as well as coordinating public inquiries and reviews, and monitoring implementation of recommendations.’
ENDS
Professional Standards Authority for Health and Social Care
Email: media@professionalstandards.org.uk
Notes to the Editor- Reading the signals: maternity and neonatal services in East Kent – the report of the independent investigation was published on 19 October 2022 and is available here.
- The Professional Standards Authority published its report Safer care for all – solutions from professional regulation and beyond on 6 September 2022. The report makes a range of recommendations for Governments and wider stakeholders within health and social care to address some of the major challenges affecting the quality and safety of health and social care. The headline recommendation in the report is that there should be a Health and Social Care Safety Commissioner (or equivalent) for each UK country with responsibility for identifying, monitoring, reporting, and advising on ways of addressing patient and service user risks. Amongst other specific functions they would coordinate public inquiries and reviews and monitor how recommendations are implemented.
- The Professional Standards Authority for Health and Social Care oversees 10 statutory bodies that regulate health and social care professionals in the UK.
- We assess their performance and report to Parliament. We also conduct audits and investigations and can appeal fitness to practise cases to the courts if we consider that sanctions are insufficient to protect the public and it is in the public interest.
- We also set standards for organisations holding voluntary registers for health and social care occupations and accredit those that meet them.
- We share good practice and knowledge, conduct research and introduce new ideas to our sector. We monitor policy developments in the UK and internationally and provide advice on issues relating to professional standards in health and social care.
- We do this to promote the health, safety and wellbeing of users of health and social care services and the public. We are an independent body, accountable to the UK Parliament.
- Our values are – integrity, transparency, respect, fairness and teamwork – and we strive to ensure that they are at the core of our work.
- More information about our work and the approach we take is available at www.professionalstandards.org.uk