Formal Complaint Letter to LTHT re Antenatal Scans

Birth Rights are Human Rights

Dear Julian,

I am writing to complain about the Trust’s continuing policy towards the attendance of partners at maternity scans and video calling at them.  I also wish to complain about the statements put out by the Trust on the topic which are frankly insulting to the many women who have read them.  I will go through last week’s statement in detail below.

Her-story

However, first for you to understand the gravity of the situation I wish to share a post by a mother about her scan:

“Today I went in for my 10 week scan, alone. Due to COVID, spouses aren’t allowed at your appointment which meant when the tech said “I’m sorry, there is no heartbeat” I had to process that information, alone.

I had to get off the chair and collect my things in tears while nurses asked me questions I couldn’t even comprehend. 

I had to hold my composure and walk to another room alone to wait for the doctor to tell me what I already knew. 

I had to sit, alone, in a room by myself until they finally allowed my significant other to come inside. 

How are we allowed to go shopping, drink at bars, and eat at restaurants, but I can’t have support with me when someone tells me my baby is dead? That moment was absolutely soul shattering and I had to do it alone, with no one to turn to because the clinic says “spouses cannot attend ultrasounds”. 

Today is a terrible day and it’s one I’ll never forget. Sadly, my significant other wasn’t there to experience it so he will never fully understand what it felt like to look at our baby in real time and see no heartbeat. I saw it, alone, and it was heartbreaking. 

If I can shop, dine, and drink, my significant other should be able to attend the appointment to see his child. 

✌️❤️ Rest in peace little one.”

This is not a game, this is not about beating those stroppy mums who keep moaning and complaining, this is about the hearts and lives of mothers, fathers and their children.  It is for this reason that I am particularly incensed by the latest statement which I quote in its entirety below in case you have not read it.  My complaint is detailed point by point below.  Because of the seriousness of the situation, and the persistently poor and evasive responses from the Trust, I am copying this letter to key people across the maternity sector, to local MPs and national politicians with a remit for the sector. This matter needs to be resolved but not in the manner the Trust is attempting at present. For a start, respect is required.

Trust statement:

Following further discussions with LTHT and the Radiology department, we have been able to establish that there is legislation in place that allows patients to record consultations with their doctors. However, an ultrasound scan is considered a diagnostic test, not a consultation, and therefore considered differently. In line with guidance from The Royal College of Radiologists and other National professional societies, the Radiology department have advised that video recording of these appointments cannot be permitted. Reasons given for this decision relate to levels of distractions created by video calling or recording and staff safety.

Discussions have been had with other trusts across the country and the decisions within LTHT are in line with those at other trusts.  Unlike many other trusts, LTHT have been able to ease restrictions on the attendance of partners at most scan appointments.  As women now have the support of their partner this should reduce any need to film the scan. Video capture / footage can be purchased through private scan providers, Radiology would not endorse or recommend any one specific provider.

Unfortunately, having been able to clarify this point, the MVP have been advised that this is the final position of the Radiology department at this time. The MVP will continue to share comments in relation to this, however, have been made aware that this decision is unlikely to change in the near future.

We sincerely apologise for this outcome, and can only advise those that are affected by this to make a formal complaint if they feel that their care has been affected by this decision. The MVP are able to support those who chose to do this.

Point by Point Complaint

1. Medicolegal reasons. We have still not been given medico legal reasons strong enough to deny women their right to have support and to video call any consultation. Your statements so far do not bear scrutiny.

2. Diagnostic Test. It is an interesting argument to say that the scan is a diagnostic test and therefore is exempt from the right to record or video call.  Interestingly there are no definitions given but by my definition this would mean, therefore, that the woman is given NO information during the scan itself and the sonographer could answer no questions as to what is observed or measured. If they were to do so, the test immediately becomes a consultation. This means that at a placental placement scan, if the sonographer shows the woman where the placenta is, or at a growth scan if the sonographer communicates any measurements or concern, then the diagnostic test becomes a consultation and under the rules as stated above can be recorded.

3. Legal Advice. In no legal advice we have read so far in the interests of patients has there been this discrimination between diagnostic and non diagnostic consultations.  The advice is to record all consultations overtly or covertly as necessary because both are admissable in court. There is NO legislation in place to deny women the right to record any consultation, diagnostic or not. Either the Trust needs to publish your lawyers advice for all to see and scrutinise or this should be rescinded.

4. Distraction.  I think is just that  – a distraction.  We have repeatedly asked precisely what is the difference between the distraction of a partner in the room which is acceptable, and a partner present via video link which is not. Due to this being about Covid19 restrictions to prevent infection, we cannot understand why the radiology department thinks it is safer to have a partner in the room than to have the partner attending via video link. None of the superficial reasons given early on (in June/July) stood up to any scrutiny  – is this why we have no answer?  This statement does not answer the question but repeats the word distraction without defining it.  This is not good enough.  And demonstrates the ongoing disrespect for our intelligence and the reasonable request of an honest answer to a straight question.

5. That the problem has gone away because partners are allowed to attend scans.  The problem has not gone away because not all scans are accessible to partners and this has been raised and clarified on a number of occasions on both the MVP forum and on the E Midwife group.  It is in these scans that video recording is an essential tool to enable partners to fulfill their role as parent and women to receive the support they wish to have.  If the restrictions tighten once more, then video calling is an essential fallback position for women and,therefore, it is not acceptable to say the problem has gone away.

6. Paying for scans. To say in a forum concerning NHS care that women can purchase footage or scans as an alternative to being present at the scan consultation in reality or virtually, beggars belief in a Covid 19 pandemic where hundreds of families have lost their jobs and incomes. The Born in Bradford Survey states that 1 in 10 of the parents said their food did not last and that they could not afford more (BBC News website)

7. Consultation with the Royal College of Radiology.  In essence this means the Trust has consulted with the Sonographers’ Union, that is a body set up primarily to promote the interests of Sonography and its members.  It is not primarily set up to represent the interests or needs of women and their families. For the Trust to state openly that it has consulted with the professional associations of sonographers but not to have consulted with similar institutions representing women’s interests such as Birthrights, the NCT, AIMS or even the National Maternity Transformation Programme Board  is astonishing. It clearly demonstrates a Trust that puts the needs of women and families in its care a poor second to the interests and idiosyncrasies of staff unions.  It is at this point that I feel that I must live in a parallel universe where the NHS was set up to care for the health of the people in its care and is paid for, and accountable to, the public – not to unions or professional associations however august their names.

8. We are in line with other Trusts we have talked to.  This looks very much like an organisation trying to justify itself by saying it is no worse than its friends.  I am not sure I want to dignify this point with a response.  Good practice and morality have never been based on what other people do but on what is right, proper and appropriate. And indeed in a court of law, Leeds Trust would be answering for its own actions and not that of others.

9. Closing down the debate. I am concerned at the precedent this latest statement sets in terms of the Trust relationship with the MVP.  As I understand it, the MVP is a forum where the stake holders in maternity care meet to discuss issues of interest to us all.  The MVP is not the messenger for the Trust when it wants to close down an ongoing debate.  I am disappointed that the Trust did not see fit to write its own statement to service users and the public but asked the MVP to pass on the message.  Presumably so that the MVP could take the flak and not the Trust because the Trust does not want to hear anymore about the subject.  This is not how democracy and accountability work.  And I am disappointed that you put the MVP in such a position. Until a solution agreeable to all sides is found, then it is the duty of the Trust to continue to listen to the concerns of public and service users.  You cannot unilaterally close down the discussion.  I think an apology is in order here to the MVP for using them in this way and to those stakeholders who this statement has tried to exclude.

10. Making a formal complaint. This letter is in part a response to the invitation to make a formal complaint.  However, I must inform you that another woman has made a complaint via PALS and the first response was to ask for her full name, her Date of Birth and Her NHS Number.  She was incensed by this intimidatory behaviour and refused to provide the information and the request was withdrawn and an apology made.  However, if this is the treatment women receive when invited to make a complaint on this matter to the Trust, I am appaulled and I hope that you are too.  Many women are already afraid that any complaint they make about their care may affect the future care they receive  – this confirms that fear. As an addition to the Trust responses so far, this demonstrates again a wholly unacceptable attitude to the women and families in your care particularly anyone who expresses disagreement with policy.  What I require is a formal apology to the woman concerned by the Trust, an enquiry into the handling of complaints by PALS and the Radiology Department to ensure this NEVER happens to anyone else.  And I would like a statement on the MVP and E-Midwife Forums explaining clearly the complaints process and rights women and their families have within that. Finally the statement should reassure women that they will be treated with respect and confidentiality throughout the process and beyond, with no repercussions for future care.

Conclusion

I think the saddest part of this affair is the lack of compassion for women and their partners and the unwillingness to work in partnership with us to find an acceptable solution in this time of crisis and restriction.  The statement indicates a ‘them and us’ perception that sees those of us who criticise as ‘them’, and as a problem, rather than part of a team working together for the benefit of women and their families. This attitude must cease at all levels, especially in the sonography department if this issue is to be resolved without more upset.

 Actions:

What I really want is for you to intervene in this issue to ensure the best interests of women and their partners and families are served.  There is a solution out there that is agreeable to women and staff if we all show flexibility and creativity and there is real dialogue between ALL stakeholders not just staff.  My ultimate aim is to ensure that no woman is separated from her partner/support network when she receives bad news or has to make difficult decisions about her baby.  And the recognition that a woman’s partner or birth partner is not a visitor or an optional extra in maternity care but an essential co-parent of the baby.  I do not think this is an unreasonable thing to ask for, do you? And given the technologies we have available, every woman and her chosen partner should be able to fulfill their right to a family life.

If you can take the above forward in a positive manner, putting actions in place to remedy the issues raised above and taking us with you as joint stakeholders in our care, then I am not all that bothered about a formal response to this letter.  However, in any response to this letter please answer point to point and do not patronise or insult us by avoiding giving answers or by giving us silly answers to our serious questions. For this to work out for everyone including the Trust, we need genuine and positive discussion and problem solving.

Looking forward to your commitment to sorting this out!

Ruth Weston

cc.
stuart.andrew.mp@parliament.uk
hilary.benn.mp@parliament.uk
richard@richardburgon.com
fabian.hamilton.mp@parliament.uk
andrea.jenkyns.mp@parliament.uk
rachel.reeves.mp@parliament.uk
alec.shelbrooke.mp@parliament.uk
Alex Sobel MP
rebecca.charlwood@leeds.gov.uk, Councillor for health wellbeing and adults
alan.lamb@leeds.gov.uk Chair of scrutiny board ( children and families)
fiona.venner@leeds.gov.uk Councillor executive member for children and families
Baroness Julia Cumberlege
Matt Hancock MP and Minister for Health
Professor Jacqueline Dunkley Bent
Dr Matthew Jolly
Harry Kretchmer, BBC Radio 4, You and Yours Programme
Elizabeth Duff, National Childbirth Trust
Debbie Chippington-Derrick, Chair of Association for Improvement in Maternity Services (AIMS)
Kathryn Gutteridge, President of the RCM
Editor of the Yorkshire Post
Northern Editor of the Guardian

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.