What happens when a hospital does not listen?

Not Listening image

By Ruth Weston

The Maternity Department of Leeds Teaching Hospitals Trust is experiencing an object lesson in what happens when you don’t structure listening to your patients into your decision and policy making systems, and using management speak when you do not include your clients as stakeholders in your decision making.

What is so upsetting from my point of view is that the lessons should have been learnt – look at Telford and Shrewsbury NHS Trust’s problems over the intermittent, then final closure of the Midwifery Led Units, and then the baby death scandal there. Look at Morecambe Bay and Kirkup.  The lesson is VERY, VERY CLEAR: If you don’t systematically seek feedback from your clients and your frontline staff, when you don’t listen to the concerns of patients and families and midwives and treat them seriously – particularly if concerns are repeatedly raised, and when you isolate, control and silence dissenting voices within your staff – then things can go badly wrong.

In my view, the action – or rather inaction – of Leeds Maternity is many things, but from their own point of view it was foolish.  Foolish, because in a situation as sensitive as this, with so many people affected, it only takes one small incident for the whole issue to ignite into a massive row and mess over which you no longer can have control. The initiative is completely wrested from your grasp.  Like a hydra, as fast as you cut off one head of controversy another two erupt forth.  This is what has happened, and the Trust is floundering as it is hit by waves of anger from women, their families and their supporters.

Listening means having compassion and empathy for the service user.  Seeing it from their point of view and responding with kindness to their concerns.  It means taking seriously concerns which are raised about service user wellbeing and engaging with it. Sympathetic posts on social media are not enough. You have to engage with the issues raised and find solutions. Leeds Maternity, I think, suffered by being too centred in its own organisation and was not able to see their policy and actions from any other perspective.

Listening means engaging with the issue and finding solutions that work for all stakeholders – and one of the key stakeholders are your service users.  Women understood and were sympathetic to the ban on partners being present at the beginning – agonising though this could be.  But then they had a solution – if I cannot have my partner holding my hand, surely I can hold them in my hand via my mobile? To say no to this without giving a reasonable reason was a big mistake by Leeds Maternity. Service users, staff and birth activists are intelligent people. We can tell an excuse, an obfuscation when we see one.

Listening means telling the truth and not hiding behind vague, non-specific terms.  An infographic that claims that “medico-legal reasons” meant that recording or video calling during a consultation wasn’t possible, without being willing, when asked, to say what they are, enrages rather than calms the growing discontent.  Particularly after FOUR weeks of waiting for an answer to the question. It is clear that the Trust would rather change the policy than tell us what those “medico-legal reasons” are!

Looking around for medico-legal advice on video and recording we found advice from the MDA saying that patients not only have the right to record their consultations but should, whether openly or clandestinely.  Such evidence is admissible in court.  So, for my money, I would say that the medico-legal advice is that the trust must protect itself from litigation by preventing wholesale recording of consultations during lockdown.  If I am right and I think I am, then the policy of Leeds Trust starts with the word shoddy and goes from there.

Listening means including the service user voice systematically into the decision making process at every level, not at the end, or as an add-on, or as a token voice, but as intrinsic to the process itself.  The feedback loop of policy impact HAS to include the service user response.  This prevents bad user response and anger, but also provides an early warning system so managers are not taken by surprise when everything erupts in their face – as it did here.  Leeds did not include the user voice in the process, did not listen to the concerns raised by midwives, women and other birth workers and so did not act how they should when they should.  And now they are overwhelmed, with one poor midwife having to field the anger and discontent of hundreds of people on Facebook alone (one Leeds Trust Maternity Facebook page has only one midwife admin).

Listening means being timely.  It means recognising that if you are going to allow visiting across the hospital then it is going to be expected that it is also safe for partners from the same household to attend antenatal consultations and scans.  It means putting out an infographic, but then answering the clarifications and requests for more detail within seven days max. Four weeks and still counting is not good enough when every day women and families are being so badly affected.  Being timely is finding technical solutions such as video conferencing to enable both parents to engage with antenatal appointments.  And it means not being complacently content with things as they are because it does not harm you – even though it harms the women and families in your care.

Listening, ultimately, is an act of compassionate care, but also an act of self-interest to ensure that all stakeholders are taken along the policy path and that the path taken is the right one for all stakeholders. This balances the needs of all stakeholders reasonably, rather than leaving the least powerful in the system uncared for.  Leeds did not act from a compassionate heart. In doing so, whilst believing it was acting in its own self-interest, it was not, because as a public body it ultimately is accountable to the public. And we are angry and appalled at what is happening, and we are even more angry at the complacent and slow response to reasonable questions.  Leeds has not learnt the lessons of Telford and Shrewsbury and Morecambe Bay, and I fear for everyone involved as a result.

For Whom This Bell Tolls

Image of candlePity for whom this bell tolls.

By Ruth Weston

In recent weeks I have found myself getting involved in a controversy in some of the Leeds Teaching Hospitals Trust Maternity groups.

Mothers, birth workers and midwives were raising concerns about the policy of preventing partners from attending scans. While scans are often thought of as being a welcome chance to see the baby, their purpose is to look for possible problems. In around one in twenty scans something of concern may be found and women are being forced to hear information that their baby may not be completely healthy without anyone to support them. Partners are being completely excluded from this information at this time, and from the opportunity of asking questions themselves, about their own child.

Sometimes, it is found that the baby has died. One cannot imagine the suffering of a women forced to be separate from her most loved and trusted ones at the point of learning her child is dead. 

Despite restrictions on visiting being lifted, women are prevented from even taking their partners into scans via video call. A number of women have picked up the issue and have been pushing hard for change.  This particularly came to a head when the Trust put out an infographic on what was allowed and not and why.  “Medico-legal” reasons were cited as the reason for not allowing video calls at a scan – so we asked what these medico legal reasons are.  Three weeks later, we still have no answer. I can think of medico reasons aplenty why women very much should have video calling and indeed recording at a scan and antenatal appointment – I cannot think of any good and honest ones that should stop a woman having that support and protection.

The infographic also explained there was a time issue with having a partner – even remotely – attending the scan – for health and safety reasons in the small scan room staff wanted to limit the time with each woman, and an extra five minutes was too much.  Why are five extra minutes needed to tell a partner the same thing as the woman? If there was a video call during the consultation, no additional time would be needed. As yet, we still have no answer.

I pointed out that if a staff member increased their theoretical risk by spending five minutes more with each woman, then they would see fewer people per day, thus reducing their theoretical risk of contracting or spreading Covid-19.  That argument could be played both ways.

Then there was the old chestnut – the video call would distract the staff member from their important work. My response? Tell everyone to be quiet, like you would if they were in the room, and when the scan is done go ahead and ask questions as normal!

A birth worker shared a woman’s post of her experience of being told her baby was dead at a scan – alone and without her partner.  And then things fired up.  Because the question is not about the “medico-legal” issues, or “health and safety”.  The question is whether we as a health service, we as staff members, have compassion for the women and families in our care.  The question is whether we are kind.  If we are kind and compassionate then we will look at what must happen and then find ways to make the service humane.  I look at what is happening here and see systems justifying themselves in negligent cruelty to women. That cruelty is the outcome of decisions not  intended in themselves to be cruel but which are made without compassion being central to the decision making.

We are told that our concerns have been raised with the staff on a number of occasions, we are told that our representations have been made strongly, but three, four weeks later there is still silence.  And that silence clangs loudly like a warning bell of a self-supporting system that acts without compassion.  In such a system kind people can be cruel, and courageous people can be crushed.  I pity those for whom this bell tolls.