Maternity staffing levels double at scandal-hit Shrewsbury and Telford NHS Trust in last year

The NHS Trust says it has completed 110 of 210 recommendations from the Ockenden report Credit: ITV News Central

Maternity staffing levels have doubled at Shrewsbury and Telford NHS Trust over the last year.

Ten months ago a major independent review found serious, repeated mistakes in care led to hundreds of deaths and injuries to mothers and babies.

Senior midwife Donna Ockenden examined cases involving 1,486 families affected by a maternity scandal at the Trust.

The review was launched by then-Health Secretary Jeremy Hunt in 2017 on the basis of 23 deaths at the Shrewsbury and Telford NHS Trust.

Since then, it has ballooned making it one of the biggest health scandals in NHS history.

There were 210 recommendations for the Trust to put into place to tackle failings.

Almost one year on, the Trust says it has completed 110 of those recommendations.

The Trust has made improvements in several areas, one of which is the growth in maternity staffing levels.

Louise Barnett, chief executive of the Trust, and Hayley Flavell, director of nursing, sat down with our reporter Charlotte Cross for an in-depth interview.

During the interview, it was revealed that in March last year, maternity staffing levels were at 42%, but now as of January 2023 that has now risen to 86%.

Ms Barnett said: "Clearly the Ockenden Report sets out that we failed our communities.

"So for us, the most important thing was to really thoroughly listen to the accounts that were provided by the families.

"And we thank Donna and the families for that. So to really understand what this report was saying.

"And that was absolutely critical because we needed to understand it to then face into the actions that we needed to take and to bring about the improvements."

Ms Flavell said: "From a maternity perspective, as of today, we have 213 whole-time equivalents who work for us, and our staffing model is 90% midwives and 10% maternity support workers.

"There have been some challenges. We've done incredibly well with our student midwives.

"We've maintained all of our protectees who are newly qualified."

Ten things we learned from our interview with the health bosses

1. Number of recommendations

In total, between the final report and 2020’s interim publication, there were 210 recommendations for the Trust to put into place to tackle the chronic failings.

Many were labelled “immediate” and “essential” by the report’s author, Donna Ockenden - but almost a year on, the Trust has completed little more than half.

To date, they have fully implemented 110, delivered 34 but not evidenced and 66 are not yet delivered.

Ms Flavell said: "From the first report we've delivered 89%.

"We've got six actions outstanding. Two of those actions are within our gift, and we are absolutely on track to deliver those via the four actions of our external independent.

"So we are working with external partners to deliver those actions.

"From the second report, we've delivered 62% of those actions and we are absolutely on the trajectory in delivering the remaining actions.

"So the 62% is the delivered not in totality and 42% of those are delivered with evidence.

"There's a lot to do and I'm really proud of the teams. What they've delivered so far notwithstanding, we've still got an awful lot of work to do."

2. Staffing levelsDirector of Midwifery, Annemarie Lawrence, started at the Trust in March last year - at which point, staffing levels were just 42% well short of the 85% minimum safe level.

But now, after a major recruitment drive and hiring 30 newly-qualified apprentices, as of January this year they had managed to reach 86%.

  • 42% staffing levels in March 2022 (against a target of 85%).

  • 86% staffing levels in January 2023.

Ms Flavell said: "We have some further work to do to make to maintain those levels.

"We have internal national recruitment happening with our midwives, which I'm really excited about is have been very successful in the nursing part of the organisation.

"We've got the midwifery apprenticeship route as well.

"So there have been some challenges, but we are in a very healthy position at the moment."3. Number of stillbirths

Staff at the trust revealed details of the number of stillbirths at the trust.

There were 11 stillbirths between 1 April 2022 and 4 January 2023, with up to five cases of babies suffering brain injury due to lack of oxygen during that time.

4. They never use agency staff

Offering up to 200% pay incentives for the Trust’s own bank staff to cover shifts at risk of falling below the minimum level.

There is also a team of on-call community midwives on hand, in case of unexpected sickness or a rise in patient numbers. 

5. A positive culture of reporting

Speaking to ITV Central, the Trust's executive chairman claimed that there was a "positive culture" around the reporting of patient safety issues.

“What the incidents are showing us is there is a culture of reporting which I think is a really positive culture of reporting,” Ms Flavell said. 

“We also need to address each of those incidents, which we do as an organisation.

"And again, it is about openness, honesty and transparency. Hence that's why they go to the public board.

6. "Serious incidents" of patient safetyHowever, patient safety incidents are on the rise.

Credit: Shrewsbury and Telford NHS Trust

In October there were 1,940 - including eight "serious incidents", one in maternity.

In September there were 1,687 - including 15 "serious incidents" and four in maternity.

Ms Flavell said this was in part due to the aforementioned positive culture surrounding reporting.

"Women are safe here, so much work has happened because of the Ockenden Report," she said.

"We've got safe staffing and we've obviously got a CNST and were declared ten-out-of-ten of our safety actions, so yes our women are safe."

7. A challenge, but a good one

Ms Barnett says it’s been a challenge, but is hopeful for the future.

She said: "I'm so proud of our teams and I think we're absolutely determined to move forward and deliver great care for everyone.

"And we all making progress. I mean we've had a further inspection by the CQC and that noted some significant improvements.

"I think we're definitely moving forward in terms of maternity and I think we've got our ambitious plans for the longer term as well.

"So for me, I think it's been a privilege to work here for three years and I really proud of our teams. I would also thank our communities because we couldn't do what we do without them.

"And I think it will be hard for people sometimes to come forward and but we're so grateful because it's that feedback and it's that sharing of their experiences.

"That is what gets us up in the morning. And we really just want to do a fantastic job. And they can be proud of us and I'm hopeful for the future."

8 . Consultants on call 24/7

The Trust has announced that consultants will be on call 24/7, with managers also on-call all day.

This is a change from before the Ockenden review when managers generally didn't work on the weekends.

9. New risk assessments to ensure mothers are being listened to

A new risk assessment strategy has been introduced, with certain risks posted on a board in the hospital's handover room.

This is meant to ensure that staff newly on shift start work aware of the risk factors surrounding certain patients.

"If a woman is pregnant and comes to our services, they have contact with our services they are risk assessed," said Ms Flavell.

"We know that pregnancy is a really dynamic pathway so having that risk assessment at every contact is really important to make sure that the women are on the right pathway, they've got informed choices."

10. Patient choice forms to be issued to expectant mothers

Patient choice forms are being put on the walls of delivery suites, which expectant mothers can edit.

This means that staff are aware of patient concerns - and preferences - as they prepare to go into labour.