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

Proposal to bleed 1/5-1/3 of a baby’s blood within 4-24 hours of birth in order to reduce neonatal jaundice

Guest blog by Emma Ashworth

A randomised controlled trial has been proposed by Andrew Weeks and Susan Bewley which aims to reduce neonatal jaundice in newborn babies.
The key ongoing argument from obstetricians, neonatologists and paediatricians who continue to cut babies’ cords immediately after birth (known as immediate cord clamping or ICC) is that babies who have delayed (about a minute) or optimal cord clamping (wait for white) have higher rates of jaundice compared to their ICC peers. Despite the fact that we are well aware of some of the dangers of ICC, which include neonatal anaemia and cerebral palsy, plus reduced fine motor skills and social functioning in 4 year olds, Weeks and Bewley argue that, “[ICC] remains entrenched, undocumented and unmonitored in the UK, which had one of the highest rates in Europe.”

The authors note that the additional cord blood available with ICC leads to a higher level of stem cells if cord blood is being collected for commercial storage, thereby giving a strong financial incentive to cut the cord immediately. They therefore suggest that rather than berating what they call “vampire capitalism”, they instead propose a randomised controlled trial which they refer to as the “PrEmature cord clamping vs. Routine umbilical vein VEnesection blood volume ReducTion study”. Take your time.

Essentially, the study suggest comparing ICC with OCC followed by an umbilical vein catheter inserted which will, over about an hour, drain off about 19ml/kg of the baby’s blood. They note that this might cause some distress to the parents, which they suggest might be offset by taking the baby away and doing the procedure in another room, playing reassuring music or encouraging the parents to watch a video. They propose that perhaps, over time, the procedure would become more acceptable and even be a part of the birth ritual “whereby the father is encouraged to participate in the ‘releasing of tension’ through the draining of blood.”

I do hope that there are no Born Stroppy readers who are not actually horrified by this proposed research project, and that you have all recognised that this is what they call an “Implausible, but not impossible” satirical suggestion. Bewley and Weeks finish their proposal with, “Those who question the satirised ethics of this RCT should also examine the ethics of inaction while premature cord clamping continues.” We agree, and we ask that everyone who reads this makes the next step of sending it to their local Trust’s neonatal, obstetric and paediatric team, MSLC/MVP and the maternity CCGs. The sooner that the dangerous practice of bleeding babies at birth through immediate cord clamping is stopped, the better.