Agenda item

The Committee will receive a verbal update from Dr T Kenny, Medical Director on the current Covid situation at the Hospital and the recovery plans for bringing services back.


The Committee will then hear from Ms Heidi Beddall, Head of Midwifery at Buckinghamshire Healthcare NHS Trust following the publishing of the Ockenden Report in December 2020.


Background on the item:


In the summer of 2017, following a letter from bereaved families, raising concerns where babies and mothers died or potentially suffered significant harm whilst receiving maternity care at The Shrewsbury and Telford Hospital NHS Trust, the former Secretary of State for Health and Social Care, Jeremy Hunt, instructed NHS Improvement to commission a review assessing the quality of investigations relating to new-born, infant and maternal harm at The Shrewsbury and Telford Hospital NHS Trust.


Following the review of 250 cases, the emerging findings and recommendations from the independent review of maternity services at the Hospital were published in December 2020 and the report highlights the actions which the independent review believe need to be urgently implemented to improve the safety of maternity services at The Shrewsbury and Telford Hospital NHS Trust as well as learning that should be  shared and acted on by maternity services across England.



Dr T Kenny, Medical Director, Buckinghamshire Healthcare NHS Trust

Ms H Beddall, Head of Midwifery, Buckinghamshire Healthcare NHS Trust



·       Link to Ockenden report below


·       Buckinghamshire Healthcare NHS Trust’s response to Immediate and Essential Actions – December 2020

·       Buckinghamshire Healthcare NHS Trust’s response – February 2021

·       Assurance Assessment template – February 2021




The Chairman welcomed Dr Tina Kenny, Medical Director at Buckinghamshire Healthcare Trust, and Ms Heidi Beddall, Head of Midwifery at Buckinghamshire Healthcare Trust.


Dr Kenny provided Members with an update on the current Covid-19 situation at the Hospital and the recovery plans that were in place. The general trend was that Covid-19 cases were decreasing locally which was credited to the national vaccination programme. At its peak, there had been 232 patients being treated for Covid-19 at the Hospital and this was now under 80. The Trust was participating in public health Covid-19 studies and was recruiting staff and patients for these. The Recovery Restore Board, which was multi-organisation and involved GPs, the CCG and the Trust, had been meeting to consider Covid recovery as well. One of the elements of recovery was being mindful of staff mental health and support their wellbeing. Patient referrals to the Hospital had continued and the Trust encouraged the public to raise health concerns with their GP as normal. The Hospital had taken steps to be a Covid safe environment so patients referred to the Hospital were encouraged to keep their appointments and follow medical advice issued to them. During the pandemic, some services, such as chemotherapy, had been moved away from Stoke Mandeville; these were now returning to the Hospital.


The Trust had developed ‘virtual’ wards with patients based at home and equipped with pulse oximeters to measure their oxygen levels. The patient would then have telephone contact with medical experts. This had meant patients could stay at home if this was appropriate for their care. There had also been an innovative partial booking pilot which booked patients in no more than six weeks in advance for outpatient clinics. As a result of the pilot, disrupted appointments had fallen and cancelled appointments had reduced by 30%. The Trust’s cataract service had opened a Covid safe cataract surgery separate from the Hospital site, and carried out nearly 3,000 operations since May 2020. This innovation had generated national interest and a video of the set-up was on the Trust’s website to reassure cataract patients.


Following this, Ms Beddall outlined the Hospital’s response to the immediate actions that had been requested by the NHS as part of the key findings from the Ockenden report. The report had transferrable learning and action points that applied across the UK, and the service was ensuring that they worked towards any recommendations that were not in place. The service was compliant of the first seven immediate actions in December 2020 and at the time of the meeting, nearly 100% of the Ockenden recommendations were in place. This was credited to the Trust developing a culture of learning and being proactive following the Morecambe Bay report and the East Kent inquiry.


Members raised the following points during discussion:-


·         The Ockenden report recommended all serious maternity incidents are reviewed internally monthly at Trust panel level; this already took place at the Hospital. The service worked with the patient safety team to strengthen these reports so that incidents were transparent and detailed. Externally, serious incidents would be shared at system level across Buckinghamshire, Oxfordshire and Berkshire West to share learning and recognise local themes. Not all serious incidents were published however the Trust’s response to watershed reports was published.

·         Serious incident reporting was introduced ten years ago against a national framework and definitions. There was no legal process in serious incidents however the reports were shared with families involved who may then chose to proceed legally using the report.

·         The Trust was confident in their robust processes and had a positive reporting culture.

·         There were clear guidelines in place for surrogate pregnancies and it was estimated there were 1-2 surrogate pregnancies per year. Surrogate pregnancies were more complex but none of the serious incidents had involved surrogacy.

·         There was no further information available regarding the Independent Senior Advocate role that was recommended in the Ockenden report as there was no national guidance or job description. It was hoped that the role would be at provider level so that the support they offered would be local. 


The Chairman thanked Dr Tina Kenny and Ms Heidi Beddall for their attendance, and wished Dr Kenny luck in her new, upcoming role.

Supporting documents: