A leaked report on Shrewsbury and Telford Hospital NHS Trust has revealed a “toxic culture” in the maternity services of the Trust’s two hospitals the Royal Shrewsbury and the Princess Royal in Telford. According to the report clinical malpractice was allowed to continue unchecked for over 40 years, leading to avoidable deaths, serious injuries and then further trauma subsequently inflicted on grieving families.

What does the Report Say?

This leaked report is an interim update report, from an independent inquiry ordered by the Government in July 2017. The inquiry was launched following the efforts of two families whose children died shortly after birth in 2009 and 2016. The initial scope of the inquiry was to examine 23 cases but this has now grown to more than 270 covering the period 1979 to the present day. The cases include 22 stillbirths, three deaths during pregnancy, 17 deaths of babies after birth, three deaths of mothers, 47 cases of substandard care and 51 cases of cerebral palsy or brain damage.

According to The Independent, who obtained the leaked report, significant issues include:

  • A long-term lack of informed consent for mothers choosing to deliver their babies in midwifery-led units – where risks can be higher if problems occur – which “continues to the present day”
  • A long-term lack of transparency, honesty and communication with families when things go wrong. This supported a culture that was “disrespectful” to families who had been “damaged” as a result
  • Failure to recognise serious incidents. Many families who had undergone horrific experiences were told they were the only ones and lessons would be learnt. The report said: “It is clear this is not correct”
  • A long-term failure to involve families in investigations that were often poor and described as “extremely brief” and “overly defensive of staff”
  • A lack of kindness and respect to parents and families with multiple examples of deceased babies given the wrong names in writing or referred to as “it”
  • Not sharing learning, meaning “repeated mistakes that are often similar from case to case”. Failure to learn was present from the earliest case of a neonatal death in 1979 to cases occurring at the end of 2017
  • A lack of support for families who have “experienced significant loss and tragedy”
  • A long-standing culture at the trust “that is toxic to improvement effort”

Are Human Rights Involved?

The Human Rights Act protects the right to life (Article 2), the right to be free from inhuman and degrading treatment (Article 3) and the right to private and family life (Article 8). The right to private and family life includes the right to participation in decisions, dignity and privacy, and support from family and others.

NHS bodies (and other public service providers) have a legal duty, under the Human Rights Act, to respect, protect and fulfil people’s human rights every day. This Human Rights Act sets out to create a culture of respect for human rights, which should be respected in staff’s every day interactions with the people that use their services. The Act is there to help public officials, such as NHS staff, to make difficult decisions and to support people and advocates to challenge decisions which might not be rights respecting. 

Human rights are not just about being nice or kind, they are the law. This means that, when people are using NHS services, such as women giving birth, the law sets out down how we should be treated. Good, human rights-compliant, maternity care means properly anticipating risks to life and taking steps to prevent them as a fundamental means of protecting the right to life (Article 2). When things go wrong, and in the worst scenario deaths occur, fulfilling the legal obligation for the right to life should mean there is an independent investigation.

In any interaction with a public service such as the NHS we should not be treated in an inhuman or degrading way (Article 3). In the context of maternity this includes ensuring that proper consent should is obtained for medical procedures. Women and their babies should receive proper care in post-natal wards as they are particularly vulnerable at this time. There should be no harm abuse or neglect, even if unintentional.

The right to private and family life (article 8) includes the protection of physical and mental wellbeing and having choice and control over what happens to you (including being involved in care and treatment decisions). In a maternity context this includes women being supported in any choice they make about pregnancy and childbirth, protecting the privacy of women during labour an on post-natal wards and involving and supporting birth partners and/or family members during the birth and afterwards.

Changing Cultures

The Human Rights Act means that human rights should be sitting across all the decisions being made by authorities, such as NHS Hospital Trusts. This means that maternity care provided, treatment decisions, and any procedures for when things go wrong, all must comply with human rights. This is a must because it is the law.

Establishing a human rights approach within organisations is about every day decision making, but it is also about the culture and ethos of a service: putting the protection of people’s human rights front and centre. This is about challenging and changing the type of toxic cultures which lose sight of people, such as the one reportedly present in Shrewsbury and Telford Hospital NHS Trust. At BIHR we often hear that the system services operate within is broken and therefore bad things happen. In many cases this is true; there are considerable systemic issues within our society and institutions that are in themselves risking and breaching human rights. However, understanding and practically using human rights as the framework for public services does not accept the inaction that can result from identifying systemic issues. A human rights lens focuses on accountability, as a matter of law, for individual people, and across public services. Human rights are about addressing the individual risks AND systematic failures.  

Just as importantly, although often missed, is the preventative function of human rights. Embedding a human rights approach, which is based on proactively meeting human rights duties means not breaching rights, and managing the risks so that positive action is taken to protect rights. The real value of a human rights approach is that is becomes the frame through which we understand what has gone wrong, how to fix it and how to prevent such things happening in the first place through changes practice and policy.

Human Rights in Practice

We have worked with Birthrights and the Royal College of Midwives to develop Midwifery and Human Rights: A practitioner’s guide. We consulted with a range of midwives from trainees to managers, teachers to frontline workers with years of experiences to develop this resource, ensuring it is  as relevant and practical as possible. Although developed with and for midwives the guide is relevant for practitioners in maternity services generally, including obstetricians and maternity support workers. It is also useful for women accessing maternity services and their families and carers. You can download the guide or order hard copies here.

The guide covers key human rights for maternity services such as the right to life, to not be treated in an inhuman way and the right to a private life, and provides flowcharts which provide midwives with a visual guide to decision-making when it comes to human rights issues. The guide also contains real-life scenarios that midwives may face, highlighting the value of human rights. As the RCM said when we published the guide:

“this is an invaluable tool and support for midwives in their practice. Human rights are central to the promotion of women’s health and as well as to the provision of high quality maternity care and this guide will enable midwives and other practitioners in maternity services to provide better care for women.”