East Kent: A decade of failure in maternity care - BBC News
Why has an NHS Trust failed to improve maternity care after a near-decade of failure?
After health inspectors considered closing a maternity unit over safety fears, the BBC's Michael Buchanan looks at a near-decade of poor care at East Kent Hospitals NHS Trust.

"I've been telling you for months. The place is getting worse."

The message in February, which I received from a member of the maternity team, was stark but unsurprising. In a series of texts over the previous few months, the person had been getting increasingly concerned about what was happening at the East Kent trust.

The leadership is "totally ineffective" read one message. "How long do we have to keep hearing this narrative - we accept bad things happened, we have learned and are putting it right. Nothing changes."

Friday's report from the Care Quality Commission (CQC) is unfortunately just the latest marker in a near-decade of failure to improve maternity care at the trust. The revelation that inspectors considered closing the unit at the William Harvey Hospital in Ashford comes nine years after the trust's head of midwifery made a similar recommendation for the same reasons - that it was a danger to women and babies. The failure to act decisively then allowed many poor practices to continue.

An independent review published last October found that between 2009 and 2020, at least 45 babies may have survived with better care, while 12 other babies and 23 mothers wouldn't have suffered harm if they'd received good maternity care.

Put simply, the trust has repeatedly failed to provide good care - and then failed to act when presented with evidence of poor care.

Consider the extraordinary deaths of two new mothers from herpes at two of the trust's hospitals, just six weeks apart in 2018. The trust told the families there was no connection between the deaths. There were. A BBC investigation three years later found they'd been operated on by the same surgeon, and that the trust had failed to test him for herpes despite being told to do so.

When those disclosures led to an inquest being ordered, the trust delayed its start for weeks by making last-minute legal arguments about wanting the coroner to put reporting restrictions on naming the surgeon, arguments it could have made months earlier, as it had been repeatedly discussed at previous hearings.

When the inquest took evidence, a consultant microbiologist at the trust, Dr Sam Moses, was reprimanded for allegedly coaching a colleague in how to respond to answers while another clinician was sitting in the witness box.

Dr Moses also admitted that he hadn't told one family about the connections between the deaths, despite being in a meeting in which the mother of one of the women who had died asked explicitly about a link. He told the court that "my role was to assist the trust. I didn't know whose responsibility it was to tell" about the connection.

At the heart of the trust's problems, it seems, is a dysfunctional culture that stretches back almost a decade. In 2015, a review of its maternity services by the Royal College of Obstetricians and Gynaecologists found multiple problems, including consultants failing to carry out ward rounds, assess women or attend out-of-hours calls. The report was dismissed as "a load of rubbish" by the trust. A Maternity Improvement Plan, overseen by NHS England, was devised. However, by the end of 2019 fewer than a quarter of its action points had been completed.

Improving care is virtually impossible if colleagues don't get along. An Employment Tribunal decision, published in February, concluded that a "toxic and difficult working environment" existed at William Harvey Hospital's maternity unit where people were "shouted and sworn at over differences of professional opinion".

Olukemi Akinmeji, a black midwife, sued the trust for race discrimination and victimisation after colleagues "joked" that they should "check their bags" on her last day at the hospital. Ms Akinmeji, who worked at the William Harvey between 2018 and 2020, won her case.

The tribunal judgement described hearing evidence of a broken working environment and a foul-mouthed registrar that one former colleague described as "totally unprofessional". Since Ms Akinmeji left the trust, that doctor has been promoted to consultant, after apparently being told to cut out the swearing.

Three former staff have told the BBC there is a clique of senior midwives at the William Harvey, nicknamed by some as "the untouchables". They are described as "watching each other's backs", swearing, prone to talking disparagingly about both patients and colleagues. They've been working there for many years and are resistant to new working methods, and often, outsiders.

"It is the worst trust I've ever worked for," says one, "there is so much unprofessional behaviour". Another former staff member says,"midwives often left the end of their shifts in tears, or broke down during a shift. People felt they couldn't speak up - even the managers had their favourites."

In that context, it's little wonder that the CQC found low morale and low levels of staff satisfaction, particularly among maternity staff at the William Harvey. Last year's staff survey, recently published, found that on all nine measures rated - including "we are safe and healthy" and "we are always learning" - the scores from all maternity staff were significantly lower than elsewhere in the trust. Bear in mind that the trust's overall scores included some of the lowest scores of any trust in England.

It's not as if East Kent has been left alone to sort its problems out. NHS England has been all over the trust for years, overseeing improvement plans and sending, as it announced in 2020, "an expert team into the trust to ensure that improvements are made immediately". Asked why their effort hadn't improved maternity care, NHS England couldn't provide an answer but said they had helped them recruit more nurses and midwives.

In a statement to the BBC, the East Kent trust said it accepted it "was not consistently providing the standards of maternity care women and families should expect." But it says that in the past few years, it has "worked hard to improve services," including investing "to increase the number of midwifes and doctors" and to improve staff training.

On the final day of evidence in the inquest into the two deaths from herpes, in a different room in the same building, a pre-inquest review was taking place into the death of a 14-day-old boy in September 2022 at the William Harvey Hospital. Evidence heard at that hearing suggests that with better care, his death may have been avoided. The full inquest later this year will come to a final conclusion.

The baby's death, the CQC report and its actions at the herpes inquest show that East Kent's problem are deep-rooted and ongoing, and that multiple changes of various directors over many years have led to little discernible improvement.