Twins will not be born at Darlington Hospital as interim measure following maternity services review

An external review was commissioned following concerns around “interpersonal behaviours" and a series of serious incidents.

It is the second such review of maternity services at County Durham and Darlington Foundation Trust since 2009, and explored the culture and provision of services in units at Darlington Memorial Hospital (DMH) and the University Hospital of North Durham (UHND).

In a shocking report, experts found:

• Poor working relationships and tensions between maternity and paediatric services

• Concerns regarding neonatal resuscitation skills and competence

• A long history of poor behaviour by consultants being tolerated

• Some staff, mainly consultants, refusing to following national guidelines because they “don’t agree with them”

• Bullying among staff at all levels and a 'blame culture'

• Evidence of 'heated disagreements' and consultants overriding decisions taken by other consultants

• Meetings held in kitchens following the closure of a staff room

The new arrangements regarding mothers expecting twins will be announced by the Foundation Trust later today.

The Northern Echo understands that they are being implemented following a serious incident at Darlington involving twin babies.

The trust has agreed arrangements with South Tees NHS Foundation Trust to have one of their clinical specialists in fetal medicine lead clinics at Darlington Memorial.

The specialist will support ante-natal care for complex maternity patients and women currently expecting twins will go to Middlesbrough’s James Cook University Hospital.

Sue Jacques, chief executive at County Durham and Darlington NHS Foundation Trust, said: “Patient safety and the consistent delivery of high quality care are our priorities.

“We promote an open culture of reporting and learning and regularly monitor serious and adverse incidents across all of our clinical services.

“As part of this monitoring and in response to feedback from our clinical teams, an independent review was commissioned to seek assurances on safety and identify any areas where improvements could be made within the trust's maternity services.The report concluded that the maternity services are safe and makes some recommendations.

“The trust believes there are further quality improvements we could make to maternity care for twin pregnancies and deliveries.”

She added: “As part of this, twin deliveries will be managed at James Cook Hospital.

“We appreciate this may be further to travel for some families, however it will mean access to specialist skills on one site including the specialist neo-natal service should it be required."

Darlington MP Jenny Chapman, who has continually campaigned to retain services at the town’s hospital, said the development will do nothing to allay fears that the hospital is being downgraded.

She said: “I am sure that this is temporary but we know from experience that temporary arrangements can become permanent and we must make sure that women who are expecting twins or more babies can have their children in Darlington.”

THE report into maternity services in County Durham and Darlington found the behaviour of senior staff is threatening the safety net protecting mothers and babies at units run by the County Durham and Darlington NHS Foundation Trust.

The recent external review uncovered a number of concerns over maternity provision at Darlington Memorial Hospital (DMH) and the University Hospital of North Durham (UHND).

While maternity services were found to be safe overall, inspectors widely criticised a troubling working environment and the behaviour of staff.

The report – compiled by Elizabeth Ross, head of midwifery, and James Dwyer, consultant obstetrician and gynaecologist at the York Teaching Hospitals NHS Foundation Trust – considered the views of 82 members of staff, meetings with focus groups of staff and anonymous comments.

Inspectors also reviewed 15 incident reports – including six serious incidents – and found concerns around communication, documentation, clinical care and interpretation of medical tests.

Concerns regarding neonatal resuscitation skills and competence were also mentioned by inspectors.

In general, incident reporting was found to be good but lower at DMH, a problem said to be reflective of staff feedback about behaviours and culture at DMH.

Staff were said to be reluctant to escalate concerns and risk issues because of “finger pointing and criticism”.

The report said: “At DMH staff reported feeling fearful and unsupported when discussing and reporting incidents.

“A blame culture was described by a number of staff from different groups, having a negative effect on individuals.”

Bullying was also highlighted, with relationships between staff members at DMH said by many to impact negatively on the service, “very heated disagreements” taking place and consultants overriding each other’s decisions and care plans, something “which has the potential to impact on patient safety”.

The poor behaviour of consultants was mentioned repeatedly through the report, which described interaction between consultants as unproductive and senior staff as unapproachable.

Staff, especially consultants, were blamed for persistently refusing to follow guidelines as “they don’t agree with them” – another issue more prevalent at DMH.

The report went on to say: “Difficult behaviours seem to have been tolerated and not addressed for years, mainly at Darlington.

“The impact of this type of behaviour and culture poses a risk to patient care.

“Describing individuals as passionate and strong characters is not an excuse for poor behaviour.”

Staff also criticised a lack of staff room, important handovers taking place in a kitchen area and an inability to easily access equipment.

Uncertainty surrounding a potential merger of the two units is highlighted.

Inspectors said: “We were of the opinion that overall, the maternity service is safe and many of the potential risk areas have already been identified.

“However, it is important to recognise that senior staff behaviours have the ability to erode this safety net and could lead to a serious risk of poor clinical outcomes if they are not formally addressed.”

The matter is expected to be discussed at a meeting of the Darlington Clinical Commissioning Group taking place today (June 14) at Darlington Fire Station’s community rooms.