Thursday 30 October 2014
The Nursing and Midwifery Council (NMC) has today published its Extraordinary Review of the Local Supervisory Authority (LSA)'s midwifery supervision in Guernsey, as well as additional evidence that it gathered during the Extraordinary Review.
The Minister for the Health and Social Services Department said:
"Today I was given the responsibility by Guernsey's Assembly of leading the Health and Social Services Department, and my first priority, and that of my new Board, is delivering a positive, robust, sustainable and long-term response to the NMC's Extraordinary Review. The safety of our patients is of paramount importance, and the NMC report shows that our midwifery and wider maternity services do not currently serve our patients well enough in that respect.
"I can assure Islanders that delivering a high quality midwifery and maternity service for the women and babies we serve is our immediate and top priority. The steps HSSD has already taken, and the steps we will take next, provide clear evidence of that commitment.
"My Department has had a short period of advance notice to view the NMC reports, and I know that we received the final draft from the NMC within the last 24 hours. We will publish our finalised and detailed action plan in response to the Extraordinary Review by mid November - and we are engaging positively with the NMC and the LSA in the development of that action plan. This plan will reflect regulatory standards but also be tailored to the island's needs. The steps already taken, and the steps we will take next, should reassure the public that we are doing all we can to ensure that the midwifery service is of the highest quality, meeting, if not exceeding, the NMC's standards. We will ensure that where changes are recommended to ensure that we meet NMC standards, we will make those changes.
"We recognise that the public at large, and our maternity patients in particular today, need us to show determination and leadership to put things right quickly. This we will do. Today marks the starting point of building, over the next five years, a truly integrated health and social care system, one which can be held up as an exemplar of best practice, delivering professional excellence and the best outcomes. We will prioritise existing resources we need to do that, and indeed have already started to do so.
"It is important to note that the NMC's Extraordinary Review had limited access to the majority of service users and also, understandably, was not able to take account of the steps that has already been taken, nor of the effectiveness and impact of those steps in reducing any potential risk of compromising patient safety. For that reason we have invited the NMC to come back to Guernsey in order to evaluate the impact of our actions. In extending this invitation, we hope to assure the public we serve that we will be open and transparent about the progress we make."
We have responded by taking immediate precautionary actions. Some of the changes that have already been put in place are:
- Increased staffing levels with revised rotas and rota management
- Increased management cover
- Changes to policies and procedures and the ceasing of verbal orders
- Increased presence of obstetricians on the Loveridge Ward, subject to on-going review
- Development and implementation of a preceptorship programme
The Minister for the Health and Social Services Department said:
"There is already momentum in the actions we are taking in response tot the NMC's findings, and we will ensure that momentum continues. For example, we have already recruited an experienced Supervisor of Midwives and developed a major training and management development programme for our midwives and their managers which will be delivered by a UK University with a reputation for excellence in nursing and midwifery education. In addition, we have been discussing with Jersey the current arrangement whereby they have been supporting the supervision of our midwives.
"Effective midwifery supervision will ensure that midwives should not have to operate outside their scope, and that the staff-patient ratios are at the level recommended by the NMC. This is a significant step forward in reducing any risk of compromising patient safety in Guernsey, and it will be a foundation for long-lasting improvements.
"As the Minister, I want to be as open and transparent with local people about the wider ramifications of the NMC's findings. Because of the confidentiality around the NMC Extraordinary Review it has not been possible to do so before today. The NMC has notified other organisations about its findings: the University of East Anglia and the General Medical Council. I need to inform the public, therefore, that as a result of its discussions with the NMC, the University of East Anglia (UEA), who are the registered provider of our nursing programmes delivered through the Institute, has decided to temporarily suspend all practice placements for our nurse students. Although I am disappointed by its response, the UEA has been working closely with the Institute over the last two weeks to design and deliver an audit of every nurse practice placement setting. This audit commenced earlier this week and is scheduled to last for three weeks. I should stress that the quality of nurse teaching delivered through the Institute is not at question here. Indeed, provided the UEA's audit confirms its previous findings (it audits practice placements on a routine basis in order to test the quality of the practice environment and learning experience for the nurse student), the planned practice placements will continue as previously.
"I can confirm that the General Medical Council (GMC), wrote to our Chief Officer and Responsible Officer earlier this week to inform us that they have decided to defer the revalidation of doctors and consultants on the islands for 6 months, as a neutral act to protect the integrity of the revalidation process. We will be working with HSSD directly-employed doctors as well as our medical colleagues in the Medical Specialist Group and PCCL to take every step possible to ensure that in six months' time the GMC feels assured that Guernsey has the appropriate clinical governance in place to allow them to end its deferral. To this end, we are already seeking to add to our internal governance capacity and capability within HSSD and to work with MSG and PCCL."
"We also take the additional evidence report published today by the NMC very seriously. We are proactively detailing the further steps that we need to take in order to address the concerns raised in terms of standards of the care environment, policies and procedures, governance, leadership and management, and organisational culture in our health and social care system. I would like to say to each of those people and families whose experiences are reflected in that report that we are sorry we got it wrong for you, and that we take your experiences extremely seriously. That includes our frontline midwives and their managers ."
HSSD will publish an action plan of steps to take in response to the report. Work on the action plan is on-going, and it will cover areas such as ensuring safe staffing levels in the midwifery practice, preventing midwives acting out of scope, and ensuring consistently effective supervision is in place. It will also cover areas such as ensuring effective leadership in maternity services and acute services from senior staff, improving clinical governance and data protection, ensuring continuous professional development, ensuring robust programme management and evaluation of the implementation of the action plan is in place. The Chief Officer is setting up a planning meeting with the NMC and the LSA for the 4 November to review and refine the draft action plan - so that the HSSD Board may be totally satisfied that both organisations are satisfied and agree with the additional actions we will take.
Dr Nick Lyons, Responsible Officer said:
"The GMC have written to me, in my capacity as Responsible Officer, earlier this week to inform me of their decision. The GMC have stressed that is a neutral act: it does not mean that our doctors and consultants cannot continue to practice - or that their practice is unsafe. Rather, the GMC has decided to take this step because it, too, wants an additional layer of assurance as a result of the NMC's findings - most especially those set out in the "additional evidence" report that points towards wider systems issues, especially governance - to be improved before the Guernsey revalidation process can restart. I'll be working closely with the Health and Social Services Department during the deferral period."
Dr Carol Tozer, Chief Officer of the Health and Social Services Department said:
"The NMC reports describe how our midwifery and wider maternity and governance systems have not provided the services that Islanders are entitled to expect. For that I wish to offer an unreserved apology: mothers, fathers and their babies have the right to expect better of us - and I know that I speak of behalf of all my colleagues when I say that we are determined to improve and change in order to meet those expectations. But my apology is hollow unless backed up with purposeful, proactive and productive action and change that is based on evidence of best practice from elsewhere and is widely "owned", properly resourced, and evaluated for its impact.
"Over the last ten days, a very small number of us have been allowed access by the NMC to their draft reports. These have been embargoed by the NMC until today's publication. We have been working closely with the NMC in drawing up our action plan and we are seeking to address every single one of their recommendation. Our draft action plan has also been developed with input from NHS England. It covers areas such as safe staffing levels in the midwifery practice, preventing midwives acting out of scope, and ensuring consistently effective supervision is in place. The draft action plan also covers areas such as effective leadership in maternity services, improving clinical governance and data protection, ensuring continuous professional development, improving the physical environment at the Loveridge Ward and ensuring that robust programme management and evaluation of the implementation of the action plan is in place.
"The broader issues highlighted in the NMC's second report of additional evidence provide the backdrop against which the specific issues in the supervision of midwifery occurred. We must pay as much attention to these broader issues as we pay to the very specific findings in each of the standards we were inspected against.
"That means ensuring that all of the information we receive is as robust as it should be. Our internal and partnership arrangements around clinical governance must be strengthened. The LSA must do its job properly, too and I remain disappointed that, some of the issues found by the NMC were not flagged earlier by the Local Supervisory Authority as part of its annual and independent audit of midwifery supervision standards.
"I am especially mindful that both NMC reports conclude that some staff have previously raised concerns, yet these have not effected change. HSSD has a long-standing whistle blowing policy - but that policy can only work properly if accompanied by an organisational culture that is mature enough to embrace critique and concern, especially from within its own teams. Managers at all levels need to take seriously the concerns of their staff, and explain the response they make when they receive concerns, and this is something that is being re-emphasised at our staff meetings. And if senior managers then fail to respond, then that needs to be reported also to our HSSD Board."
A full copy of the NMC's Report can be found here.
Any members of the public with concerns or questions about HSSD's maternity services should contact the information line 01481 707490 between 10am-4pm Mondays to Fridays.
1. Deputy Paul Luxon was elected to post of Minister for the Health and Social Services Department on 29 October 2014.
2. Dr Carol Tozer took up post as Chief Officer of the Health and Social Services Department on 15 September 2014.
3. Dr Nick Lyons is HSSD's appointed Responsible Officer. You can find out about his role at the following link https://gov.gg/article/111507/HSSD-Appoints-Responsible-Officer-to-support-doctors-in-demonstrating-high-quality-practice
4. Although Guernsey is not part of the United Kingdom https://gov.gg/article/1866/Constitution
Guernsey recognises UK regulators and does not seek to apply different regulatory practices:
The Nursing and Midwifery Council (NMC) sets the standards for midwifery professionals. All Guernsey midwives are regulated by the NMC as individuals. http://www.nmc-uk.org/
The Local Supervisory Authority (LSA) is part of NHS England and is the statutory body that audits whether NMC standards are being met. http://www.england.nhs.uk/ourwork/qual-clin-lead/supervision-of-midwives/