FGH maternity civil actions

James Titcombe made this Freedom of Information request to University Hospitals of Morecambe Bay NHS Foundation Trust

This request has been closed to new correspondence from the public body. Contact us if you think it ought be re-opened.

The request was partially successful.

Dear University Hospitals of Morecambe Bay NHS Foundation Trust,

In a response to a recent FOI request, the trust confirmed that relating to maternity services at FGH only, between 2002 - 2011, 36 incidents occurred resulting in harm or death leading to civil action being instigated. From the years 2002 - 2006,  5 such incidents occurred, an average of one such  case per year. In 2007 however, the data shows a dramatic increase to 6 cases in a single year, a trend which continues, peaking at 8 cases in 2010.

Please can the trust answer the following questions:

1) Has the trust identified the reasons why the number of such cases increased so dramatically from 2006 to 2007 onwards?

2)Around this time, were any changes to working practices, policies and procedures in the maternity unit changed? For example, did the capacity of SCBU change and was the SCBU admissions protocol changed? Please provide details of all such changes that occurred.

3) Were all changes subject to thorough risk assessment in accordance with NHS guidelines? Are you able to provide copies of any such risk assessments carried out?

4) For the cases identified, for each year 2002 onwards, please confirm the following (please break down the answers into each year).

a) The number of LSA investigations carried out and if the LSA investigation was carried out in accordance with the statutory guidelines.

b) The number of cases which results in recommendations for changes in practice or additional training by the LSA.

c) The number of cases resulting in referral to the NMC.

d) The number of cases resulting in disciplinary action.

b) The number of cases treated by the trust as a formal SUI.

c) The number of cases which were subject to full RCA investigation.

d) The number of cases referred to the PHSO.

e) The number of cases reported to the CQC or Monitor (within 3 months of the event occurring).

f) The number of cases where the trust is aware that key medical records are known to have 'gone missing'? (for example cardiographs, observation charts, blood pressure readings etc...)

5. For years 2002 onwards, please can the trust confirm the following (relating to maternity services at FGH only).

a) The total number of midwives (please include band details).
b) The total number of obstetricians
c) The total number of paediatricians
d) The total number of cots (capacity for neonatal care) in SCBU.
e) The total number of specialist neonatal SCBU nurses.
f) The total planned budget for integrated maternity services at FGH for each year.
f) The trusts total actual expenditure on integrated maternity services at FGH for each year.

6. In the cases that resulted in death, please answer the following:

a) How many cases were reported to the Coroner?
b) How many cases were subject to an Inquest?
c) How many cases resulted on the trust being issued with a rule 43 letter?
d) How many of the 32 open civil claims is the trust aware of where an Inquest has been opened but has not yet been heard?

Yours faithfully,

James Titcombe

University Hospitals of Morecambe Bay NHS Foundation Trust

2 Attachments

[1]Description: UnI Hosp of Morecambe Bay col B

 

 

   

 

 

 

Trust Headquarters

Westmorland General Hospital

Burton Road

Kendal

LA9 7RG

 

Tel: 01539 716642

Fax: 01539 795313

Web: www.uhmb.nhs.uk

Reference Number: 2084

 

24 July 2012

 

James Titcombe

[2][FOI #122663 email]

 

Dear Mr Titcombe

 

RE: REQUEST FOR INFORMATION UNDER THE FREEDOM OF INFORMATION ACT (FOI Act)

I am writing to acknowledge receipt of your written request of 20 July
2012 regarding maternity services at FGH. This was received in this office
on 23 July 2012 via our electronic mail system. You can expect to receive
a written response within the statutory deadline.

 

Your request is currently being processed.  Should we require further
clarification of your information needs, we will contact you again within
the timeframe indicated above.

 

There are certain categories of information that are exempt from the
general right of access provided by the FOI Act.  These include, for
example, personal information protected by the Data Protection Act 1998
and where the release of information would not be in the public interest
as defined by the Act.  Should your request be deemed to relate to any
exempt information, you will be advised accordingly and a full explanation
given.

 

Public authorities may charge a fee for the information requested.  The
fees are worked out in accordance with the regulations issued under the
Act.  Should your request generate fee payment, you will be informed at
the earliest opportunity with an estimation of costs provided.

The officer handling your request can be contacted by telephone on 01539
716698 should you have any questions or concerns.

 

Yours sincerely

 

 

ERIC MORTON

INTERIM CHIEF EXECUTIVE

 

 

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Freedom of Information (UHMB), University Hospitals of Morecambe Bay NHS Foundation Trust

Dear Mr Titcombe

To enable the Trust to respond to the questions you have raised, please could you clarify what information you are requesting in relation to questions 1, 2 and 3?

Your request refers to "2006 to 2007 onwards" and "around this time". Please can you specify more precisely the period in respect of which you are requesting information. In particular, it would assist the Trust in dealing with your request if you could specify two reference dates. This would allow the Trust to search for relevant recorded information (e.g. policies, procedures, etc) in relation to each date and provide you with the information retrieved.

Regards
Rachael

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Dear Freedom of Information (UHMB),

Dear Rachael,

I had thought that my questions had been careful to detail the relevant dates. However, I will clarify again here now.

1)I asked if the trust has ‘identified the reasons why the number of such cases increased so dramatically from 2006 to 2007 onwards?’. To be more specific, have the trust identified why the number of civil cases (referring to the date the incident took place not the date the legal action was started), increased dramatically in 2007?

I really don’t think I can be any clearly than this but just to reiterate, the number of incidents resulting in legal actions averaged around 1 per year between 2002 to 2006. From 2007 – 2011 – this goes up by 5 or 6 times. I am asking you if the trust has understood the reasons why this happened and if so, to provide me with an explanation.

2)I asked ‘Around this time, were any changes to working practices, policies and procedures in the maternity unit changed? For example, did thecapacity of SCBU change and was the SCBU admissions protocol changed? Please provide details of all such changes that occurred.’

Again, I am surprised that this should require clarification, but if you require a more exactly defined question, please take ‘Around this time’ to mean ‘Between 1st January 2006 and 1st December 2007’.

I hope that my questions are now clear but please contact me if you require further clarification

Yours sincerely,

James Titcombe

Freedom of Information (UHMB), University Hospitals of Morecambe Bay NHS Foundation Trust

1 Attachment

Dear Mr Titcombe,

 

Please find attached the response to your FOI request.

 

Regards

Rachael

Freedom of Information (UHMB), University Hospitals of Morecambe Bay NHS Foundation Trust

17 Attachments

Dear Mr Titcombe

 

Please find attached our response with regards to your Freedom of
Information request, reference 2084.

 

Regards

 

 

 

Phil Woodford

Freedom of Information (UHMB), University Hospitals of Morecambe Bay NHS Foundation Trust

1 Attachment

Dear Mr Titcombe,

Please see attached response to your recent FOI request.

Kind regards,

Louise Fleming

Dear Ms Daniel,

Thank you for your response. For clarity, you have confirmed that of the 29 incidents at maternity services at Furness General Hospital (FGH) that have resulted in legal action since 2002 (that you are aware of to date) a search of the Trusts records has found that only 13 of these incidents were reported  as Serious Untoward Incidents or resulted in an RCA investigation/report.  

This means that more than half the cases above (55%) were not subject to an RCA investigation or treated as an SUI.  If the Trust was not properly investigating these incidents, how was it learning lessons or taking all 'reasonably practicable steps' to avoid exposing other mothers and babies to unnecessary risks? 

I note that you have invoked section 12 of the FOI Act in respect of the other information I have requested. I would therefore like to reduce the ambit of the outstanding aspects of my FOI request significantly and hope that you will now be able to provide the further information requested.

For the 13 cases which you have confirmed you have electronic records for only; please can you confirm:

1) How many cases resulted in an LSA investigation.
2) How many cases were reported to the CQC (at the time).
3) How many cases were reported to the PHSO
4) How many cases resulted in disciplinary action.

I note that you have stated that the Trust does not hold any records which indicate a change in the SCBU admissions policy in the time frame specified. This is information that I shall keep on record for future reference.

Yours sincerely,

James Titcombe

Freedom of Information (UHMB), University Hospitals of Morecambe Bay NHS Foundation Trust

Dear Mr Titcome,

Thank you for your email. The FOI team will respond to your below comments and will be in touch shortly.

Regards
Rachael

show quoted sections

Freedom of Information (UHMB), University Hospitals of Morecambe Bay NHS Foundation Trust

2 Attachments

[1]Description: UnI Hosp of Morecambe Bay col B

 

 

   

Trust Headquarters

Westmorland General Hospital

Burton Road

Kendal

LA9 7RG

 

Tel: 01539 716642

Fax: 01539 795313

Web: www.uhmb.nhs.uk

Reference Number: 3017

 

14 September 2012

 

James Titcombe

[2][FOI #122663 email]

 

Dear Mr Titcombe

 

RE: REQUEST FOR INFORMATION UNDER THE FREEDOM OF INFORMATION ACT (FOI Act)

 

Thank you for your email dated 9 September 2012.  Your request is being
dealt with as a new request for information under the Freedom of
Information Act 2000 (‘the FOIA’).

 

In relation to the first point raised in your email, I confirm that the
Trust’s response to your earlier request (FOI 2084) only indicates that:

 

·         Of the 37 cases originally thought to relate to maternity
services at FGH, the Trust holds electronic data on its Safeguard in
respect of 21 of those cases.

·         Of those 21 cases, the recorded information held on the
Safeguard system indicates that 13 were formally treated as a SUI and or
resulted in a RCA investigation.

 

Due to the known inaccuracies in the list of 37 cases originally thought
to relate to maternity services at FGH, it is not correct to assume from
the above that the 13 cases identified as involving a SUI or RCA
investigation all actually relate to maternity services at FGH.  Some of
those 13 cases may relate to another location and/or service provided by
the Trust.

 

The Trust does appreciate the rather confusing position that has arisen as
a result of the original list of 37 cases being identified as inaccurate
during the Trust’s handling of your previous FOI request (FOI 2084).

 

In order to ensure that information provided in future is relevant (i.e.
applies to cases relating to maternity services at FGH only), we would
suggest that you may wish to amend your recent request so it reads as
follows:

 

 1. In the Trust’s response to FOI 2078 dated 15 August 2012, the Trust
identified 29 cases which related to maternity services at FGH.  How
many of those 29 cases involved the designation of a serious untoward
incident or a RCA investigation?

 

2.    Of those cases which did involve the designation of a serious
untoward incident or a RCA investigation:

a.    How many cases resulted in a LSA investigation?

b.    How many cases were reported to the CQC within 3 months of the
relevant incident occurring?

c.    How many cases were reported to the PHSO?

 d. How many cases resulted in disciplinary action?

 

Of course, if you would rather not amend your request, the Trust would be
happy to respond to it in its current form but you should be aware that
the information returned may not, in fact, relate to maternity services at
FGH due to known inaccuracies in the original list of 37 cases.

 

I look forward to hearing from you in due course with your views on the
above.

 

 

Yours sincerely

 

 

 

 

TIM BENNETT

DEPUTY CHIEF EXECUTIVE

 

References

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2. mailto:[FOI #122663 email]

Dear Mr Bennett,

Many thanks for this clarification. I am happy with the proposal you have made and look forward to receiving your response in due course.

Yours sincerely,

James Titcombe

Freedom of Information (UHMB), University Hospitals of Morecambe Bay NHS Foundation Trust

1 Attachment

Dear Mr Titcombe,

 

Please find attached the response to your FOI request.

 

Regards

Rachael