Hospitals to open 24/7 pregnancy hotlines to reduce harm and deaths
Hospitals have been ordered to open 24/7 hotlines that pregnant women can call with concerns in a bid to reduce avoidable deaths and harm.
NHS England said all hospitals must operate such a service by the end of this financial year, with the phones manned by dedicated midwives who are not distracted by other work on labour wards.
Women who still have anxieties after a phone consultation will be told to attend in-person, where they must be assessed within 15 minutes of arrival.
The diktat - part of a new 10 Point Plan for maternity and neonatal services - comes after NHS England chief executive Sir Jim Mackey summoned health leaders and top midwives to a meeting yesterday to discuss two major maternity reviews.
The damning reports highlighted serious concerns about maternity triage and potentially fatal delays when women phone for help or arrive at hospital for assessment.
The National Maternity and Neonatal Investigation, chaired by Baroness Valerie Amos, this week found the NHS continues to inflict harm, ignore women and cover-up mistakes despite years of reviews, inquiries and hundreds of previous recommendations.
Just days earlier, an inquiry into Nottingham University Hospitals NHS Trust, led by senior midwife Donna Ockenden, found more than 500 mothers and babies suffered avoidable harm or died due to ‘deeply embedded systemic failures’ at the ‘toxic’ hospital trust.
The Amos review says maternity triage ‘has become the Accident and Emergency service for pregnancy’ and is where concerns such as reduced baby movements, abdominal pain, bleeding, headaches, sickness or signs of labour often first present.
NHS England chief executive Sir Jim Mackey (pictured) summoned health leaders and top midwives to a meeting yesterday to discuss two major maternity reviews.
But the investigation ‘heard repeatedly’ about the consequences of triage ‘not functioning as it should’, often because there are too few staff, a lack of experienced senior decision-makers and not enough beds and cots.
This means early warning signs are missed and time-sensitive decisions not made, with ‘serious and irreversible consequences’.
It calls for a national overhaul of maternity triage, such as the dedicated phone lines.
Meanwhile, the Ockenden report highlights repeated concerns about telephone triage, women being discouraged from attending, delays after arrival, poor assessment, poor documentation, and delayed escalation.
It says there was ‘evidence of poor telephone risk assessment throughout the continuum of the Review’, and that when women called, ‘pain was minimised or ignored, and mothers were not invited in for review.’
Many women made several calls before being allowed to attend hospital and were left ‘scared and vulnerable at home’, it adds.
In a letter sent to attendees after the meeting, Sir Jim urged staff to work together to urgently ‘rebuild trust and confidence’ in maternity and neonatal care.
He added: ‘This must be a turning point for the NHS.
Senior midwife Donna Ockenden (pictured) led the inquiry into Nottingham University Hospitals NHS Trust
‘We cannot allow failures in care to persist and be followed by reviews that continuously highlight the same themes.’
The letter is accompanied by the 10 Point Plan that says: ’All trusts must commit to delivering safe and effective triage, starting by completing a board-level audit within 3 months, with a focus on ensuring that maternity triage services are consistently safe, responsive and appropriately resourced.
‘This will be supported by new NHS England guidance, which will be published this week.
‘This includes having dedicated midwifery staffing to answer calls and provide face-to-face assessments, separate from other services such as the labour ward.
‘Services should also have enough clinical, antenatal and bed capacity, with clear escalation routes in place at all times, including overnight and at weekends.’
Other elements of the 10 Point Plan include giving families the right to a second opinion if they believe their clinicians are not taking their concerns seriously, improved patient experience surveys and a review of how trusts respond to failings.
The Ockenden report gives one example where a mother rang the hospital three times after her waters broke and she was experiencing continuous pain.
The family said their concerns were dismissed, she was told to ‘calm down’ and take paracetamol, as it would ‘probably be another 24 hours before the baby was born’.
Baroness Valerie Amos (pictured) chaired the National Maternity and Neonatal Investigation
When she said she was coming in she was discouraged from doing so.
On arrival she was put in a waiting room while a bed was found and when she was finally examined she was nearly fully dilated and the fetal heartbeat was slow.
The baby was later born in poor condition via emergency c-section and sustained a serious brain injury resulting from a lack of blood and oxygen.
It gives another example where a ‘high risk’ mother phoned maternity triage twice and was told she was not in labour because she could hold an 18-minute conversation.
When she came in, the report records delay in escalation to an obstetrician; the baby was born in poor condition and later suffered seizures, although the cause was uncertain.
The report stresses: ‘A woman calling a maternity hospital at any point in labour and requesting to attend should be welcomed in for care, emotional support, assessment of their wellbeing, and fetal surveillance.’
Kate Brintworth, chief midwifery officer for England, said: ‘Too many women, babies and families have been harmed, bereaved or badly let down by maternity care, and too often women and families who raised concerns were not listened to.
‘That must change – starting by giving every pregnant woman and new parent in England the comfort of knowing they will always have a midwife on the end of a call to answer their concerns if they are experiencing an emergency.
‘This modernises maternity services so that pregnant women and parents who urgently need expert advice will no longer be left waiting for a call back or directed to a maternity unit voicemail – instead, they will get specialist advice straight away, helping them get the right care more quickly.
‘I also know midwives need the time and space to carry out thorough risk assessments. By creating dedicated teams away from busy labour wards, we can support staff to make faster, safer decisions and deliver better care for mothers and their babies.’
Is France the Best Team at This World Cup or Is It Yet to Be Properly Tested?
Is France the Best Team at This World Cup or Is It Yet to Be Properly Tested?
France has blown opponents away at this tournament, becoming the first team to score three or more goals in five straight World Cup matches.Conor Orr|
EAST RUTHERFORD, N.J. — Truly the stuff of fever dreams over here in section 225 along the stadium’s north side. Pass the man in the tight striped shirt wearing a red beret and holding a fake plastic baguette and you turn the corner to find a pair of men dressed as mimes. They are waving a French flag to fan a young supporter of Les Bleus who has overheated and is slumped down in a chair as security forms a wall around him to cool down.
Around the corner comes Max, an athletically built male of about 5’10” who is dripping sweat beneath what looks like a heavy, non-breathable blonde wig decorated in a kind of braided pigtail. He’s wearing a traditional Swedish dress for Midsommar atop shin guards, soccer socks and tennis shoes. Follow him through the concourse and onto the patio, and you’ve arrived at Camp Sweden.
The fan section of Swedish football—which also cleverly featured fans wearing yellow shirts with the word IKEA written on them—was paltry in size to the overwhelming number of French supporters here among the 83,000 attendants in New Jersey, but for the first 40 minutes, the chants of ‘Allez, Allez, Allez’ (‘Onward Sweden’) did not relent.
Max said Swedish fans took pride in their FIFA ranking for kindness, but when informed that France were heavy favorites, his eyes narrowed and he assumed a joking fighter’s posture. When asked if he believed, as Sweden seemed to escape one piercing attempt on goal after another (including a 19th-minute goal by Kylian Mbappe that was called back upon review) by the blistering French attack over the course of the first 40 minutes, he smiled.
“Of course I do,” he says. “I f—- flew here.”
France and Kylian Mbappé Take Charge
Of course, in rapid succession just before halftime, just after halftime and a third time at the 73rd minute, France eventually honed its eye for the goal and obliterated any chance of a stunning upset. Gone were the scattershot follows, the moments where Les Bleus’ incredible strikers were slapping their heads in frustration.
Kylian Mbappé sliced between two defenders and pounded the ball in the far side of the net. Bradley Barcola slipped between a pair of Swedish defenders, took a quick touch and scored again. Then Mbappé, one last time, punched the ball to the far corner of the net, just off the outstretched hand of Sweden's keeper, Jacob Widell Zetterström. After the last one Mbappé found an open swath of space and skied into the air, a bit like a toddler pretending he was a rocket ship blasting off to the moon.
Outside of the confidence that momentarily reverberated from Camp Sweden, though, the eventual 3-0 result was heavily expected. France became the first team in World Cup history to score three or more goals in five straight matches, though those matches were against some of the Cup’s lowliest opponents: A lukewarm Senegal, Iraq and a second-string Norway, none of which are in the FIFA top 15 World Rankings (Iraq hovers in the mid 60s). Sweden was in organizational tatters leading into the World Cup as well.
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Just How Good is This France Team?
It brings up the important question, as France advances to play Paraguay (another team outside of the Top 30 in FIFA World Rankings, though riding high after a stunning upset over Germany in the opening round) in the second stage of the knockout tournament: Are we responsible for believing what our eyes tell us to believe? Or, is it merely another victory over a small, bright-eyed, understaffed army like we saw in Camp Sweden?
“We knew we had to be perfect,” Graham Potter, Sweden’s manager said afterward, noting that, even if Sweden was perfect, it may not have been enough. “We needed a couple of miracles.”
When asked if he thought any team could beat France, he said: “Of course, it’s football, anything is possible, but I haven’t personally seen a better team.”
As Mbappé was subbed off in the 86th minute, France manager Didier Deschamps stretched out his arms and bowed several times, welcoming the 27-year-old star to the bench. Mbappé has now played in 18 World Cup games and has scored 18 goals. He is now the lone record holder, passing Ronaldo and Leonidas, for the most goals ever scored in the knockout stage of the World Cup (10).
What France Does to Opponents
French soccer, at this very moment, is the picture of versatility, with an amoebic attack that is grounded in a concept that is simple theoretically but almost impossible to achieve in real time: Make yourselves fluid enough to empower your goalscorers. France has dominated by mastering width, drawing double teams at both ends of the pitch and thinning out defenses that still cannot manage to bracket the team’s fleet of strikers. Even with quarterly hydration breaks, the tiring effect this has on defenders is debilitating.
They are also appropriately dominant. Before Mbappé’s first goal, he made a backward no-look pass to Ousmane Dembélé that looked more like a dance step (the pair have more mutual assists for one another than any tandem dating back more than 50 years). Every part of his facial expression suggested that he planned for the moment to go viral. France possessed the ball more than 60% of the game and had a shot advantage of 12-3.
Les Bleus appear comfortable enough, then, to sidestep the question of opponent quality. Deschamps admitted that “for us, it wasn’t that difficult” to reach the round of 16 but cautioned a reporter who mentioned the cementing confidence among French fans and journalists.
“Slow down, please,” he said. “There are issues, there’s always room for improvement.”
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Published 2 hours ago | Modified 17 minutes ago
CONOR ORRConor Orr is a Senior Writer for Sports Illustrated with more than 15 years of experience covering the NFL. His work has been cited in Best American Sportswriting and has won a PFWAA award. Prior to Sports Illustrated, he covered both the Giants and Jets for The Star-Ledger. Conor lives in New Jersey with his amazing wife and three children.
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