Black and Asian families have told a review into maternity care at Nottingham hospitals they have a “deepened mistrust” of the service.
Maternity departments at the Queen’s Medical Centre and City Hospital are currently rated ‘inadequate’ by the healthcare watchdog. The services are also subject to an ongoing independent review by midwife and healthcare expert Donna Ockenden.
Black and Asian families, who have been described as “hard to reach” groups by the city’s hospitals trust, Nottingham University Hospitals ( NUH ), have instead told the Ockenden review that they feel “easy to ignore”.
The review began in September last year and comes after dozens of babies were injured or died while in the care of NUH.
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Now, Ms Ockenden has sent a letter to NUH Chief Executive Anthony May, explaining her concerns with the way the trust treats black and Asian women within its maternity services. The letter, seen by the Local Democracy Reporting Service, says the trust has failed to communicate properly with black and Asian women and failed to appreciate cultural sensitivities.
The letter was sent after Ms Ockenden met the trust to raise concerns about the “deteriorating relationship” with the trust reported to her by patients. Ms Ockenden wrote that the review’s work is taking place against a “very difficult background” because some families are deterred from contacting it due to a distrust of NUH.
In response, NUH says a new task force, made up of midwives, doctors, researchers, advocates and black and Asian staff and families has been set up to specifically address the feedback raised by Ms Ockenden.
“The feedback that I received from local Black and Asian women is that mistrust of the Trust has deepened and that your communication and relationships with them have progressively worsened rather than improved”, the letter states.
It adds: “Local women have told me of a repeated issue of male sonographers being allocated to the care of Muslim women, even when they have specifically asked for a female sonographer.
“Women have apparently been told, ‘there is no choice and you can go home if you don’t like it’.
“I know of three women who were repeatedly sent away as there was no female staff member to assist them. This has led to significant delays in important ultrasound scans for these women.”
Women have also reported that in the Urdu clinics, it is common for a different midwife to appear each time with “women having to repeat their accounts and concerns weekly”.
Ms Ockenden writes that maternity staff have told of a proposal to reduce Urdu language appointments accompanied by an interpreter from 30 minutes to 20 minutes in a bid to “free up more midwives”.
The letter, which was written on April 20, stated that the Chief Nurse was not aware of the proposals to reduce the length of appointments, which have since been cancelled. Women also told Ms Ockenden’s review that face-to-face interpreting services are “frequently not available” and the telephone system often disconnects.
The letter added: “One very recent example is of a mother for whom Urdu was her spoken language. She experienced fetal distress in labour.
“The woman was unable to communicate with staff caring for her in labour as they spoke only English. The only solution was for the woman to phone her mother in Pakistan who then got hold of a relative who was not in Nottingham who begged her to agree to a caesarean section.
“All that the relative could translate was ‘baby danger zone’. This case happened within the last fortnight.”
Ms Ockenden also raised concerns that engagement with the ‘open book’ part of the review is “very low”, especially among black and Asian women.
The letter added: “Local community leaders tell us that the level of distrust for the Trust within communities is deterring Black and Asian women from affected families from engaging with and participating in the review.
“We will continue in our efforts to ensure all women and family voices are heard but you will appreciate our work is taking place against a very difficult background.”
The issue was discussed during a board meeting at NUH on May 10.
Michelle Rhodes, Chief Nurse, said during the meeting: “Donna Ockenden came to us with a whole host of examples that we knew were happening but we haven’t got right.
“Listening to some of this feedback is really hard to know that the teams aren’t always doing the right thing for this group of families.
“We’ve got to sort that out and we are absolutely committed to doing that. It’s an exciting piece of work for us to get our teeth into.”
Serbjit Kaur, a non-executive director, said: “I am mildly surprised that it took the independent review for us to realise that interpretation services were not where they should be.
“That’s been a requirement since time dot in the NHS.
“Sometimes it isn’t possible to have female sonographers and that’s understandable but it’s about giving ladies the choice to reschedule if there isn’t a female available.”
Responding to the letter, Ms Rhodes added that listening to women and families is “crucial to making improvements”.
She said: “We know that more must be done to ensure that the voices of women from all the communities we serve are heard and we welcome the feedback from Donna Ockenden and her team.
“Women and families can be assured that the feedback and learning that is shared with us throughout the review will be used to make changes to our maternity services immediately.”
NUH added they have taken “immediate action” to ensure that community clinic appointments have enough time for women using interpreting services.
They said information is available in many languages on the Trust’s website. It is also “reviewing the information provided to women about scans and choice of gender specific sonographers”.
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