Still questions to answer on transport of pregnant women from Caithness

13th June 2019

Labour MSP Rhoda Grant is still pushing for more to be done for pregnant women in Caithness.

An MSP is renewing her call for a full risk assessment to be carried out on the methods of transporting pregnant women to hospital from Caithness to Inverness after receiving an edited version of an investigation into the birth of twin babies, born 50 miles apart.

In February, Rhoda Grant, who represents the Highlands and Islands, asked the First Minister why the air ambulance was not initially called when a Caithness mother went into labour at 30 weeks with twins.

Mrs Grant has now received of ‘precis' of a report into a Significant Adverse Event Review of the case from the new NHS Highland Chief Executive, Iain Stewart.

In his letter, Mr Stewart says: "It is important to point out that the air ambulance helicopter is a highly unsuitable environment for the delivery of a baby."

Mrs Grant says: "His answer begs the question - what is a suitable environment for pregnant women to be airlifted to hospital in an emergency and why was the helicopter called twice in this case if it was so unsuitable?

"Also, Mr Stewart's letter only has a passing reference to Specialist Transport and Retrieval (SCOTSTAR), a national service that provides safe transfer for some of the sickest patients within NHS Scotland. The clinical teams are called in to transport patients, from babies through to children and adults by road and air. The expert teams include doctors, nurses and paramedics.

“Why was SCOTSTAR not called in? There are many questions unanswered in this edited version of the review and, while I see the need for patient confidentiality, it does not give me confidence that a similar incident will not happen again. There must be a full risk assessment carried out on what transport can be used and when and what craft is suitable for airlift in emergencies with pregnant women."

Mr Stewart stresses that the care teams involved in the birth “behaved appropriately and professionally and that the proper procedures were followed in the best interests of the mother and her babies".

Mrs Grant said: “I must congratulate all the staff working on the front-line in this case. They had a difficult job and did their very best for the mother and her babies.”

Previously, at First Minister's Questions, Mrs Grant told Nicola Sturgeon the woman had bravely shared her experience of giving birth under the current maternity provisions in Caithness.

After going to Caithness General Hospital, the mother was informed that she would have to go to Inverness by road ambulance, over a 100 miles away and two and half hour drive

Mrs Grant told the First Minister: “Half way into that journey they had to stop at a community hospital at Golspie when the first twin was born breech.

“The air ambulance was then tasked but because it would take two hours to arrive the first twin would be sent by road to Inverness.

“The helicopter could not land, another air ambulance was tasked but this would take too long therefore a second ambulance resumed the journey to Inverness where the second twin was born.

“Thankfully after prolonged stay in hospital all are now doing well.

“However, it begs the question why was the air ambulance or emergency retrieval team not tasked initially airlifting the mum from Caithness.

“Will the First Minister investigate this and will she make sure that the air ambulance treats situations like this as a priority?”

Nicola Sturgeon promised to investigate and conveyed her good wishes to the family. She said she could not answer immediately as to why the air ambulance was not initially tasked, and did not have information in the chamber, and but she asked the Health Secretary, Jeane Freeman, to look into this.

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Letter from Iain Stewart, Cheif Executive NHS Highland to Rhoda Grant 12 June 2019

Dear Ms Grant
You may remember that some concern was raised in Parliament recently about the circumstances
under which twins were born to a woman in labour whilst she was being transferred from Wick to
Raigmore. I write to advise you that NHS Highland has now undertaken a Significant Adverse
Event Review (SAER) and whilst the actual review itself is subject to patient confidentiality and
cannot be shared, I can share a precis of its main findings.
Firstly, NHS Highland is pleased to report that both babies were delivered safely. Nevertheless the
process on this occasion was unusually stressful for the mother and so it was important that the
event be reviewed to identify what, if any, lessons could be learned.
In summary the review concludes that the care teams involved in the births behaved appropriately
and professionally and that the proper procedures were followed in the best interests of the mother
and her babies. However I thought it would be helpful to highlight a few of the more salient points
identified within the review.
It is important to note that regarding the mode of transfer, all women are assessed on an individual
basis and there are many factors that inform the decision-making. These include the clinical
assessment at the time, weather conditions, availability of ambulance (road and air) and time of
day. Depending on the circumstances air transfer may not be the safest or quickest way to transfer
and this decision will be made in consultation with the lead clinician (obstetrician) and Scottish
Ambulance Service (SAS).
In this instance the review highlighted the good teamwork from all staff involved across NHS
Highland and the SAS with all staff acting in the best interests of their patient in what were difficult
circumstances. Given the assessment, the correct conclusion was reached.
The review also noted that it would not have been possible to send staff to Wick as there is no
service provision for making such a response and this would leave the main service at Raigmore
Hospital without obstetric and paediatric cover.
The conclusions of the review found that, while there were lessons that could be learned for the
future, it was unlikely that these would have changed the outcome and neither the mother nor
either twin suffered harm or required additional treatment as a result of this event.
NHS Highland and clinicians working in the maternity service put patient safety at the forefront of the care they provide and in clinical decision making. However due to the unpredictable nature of childbirth, there will always be a small percentage of cases where labouring women do not get to hospital in time and should this occur, they are advised to call 999 to seek immediate support. If inter-hospital ambulance transfer is required, the support of trained SAS crew and a midwife is provided. It is important to point out that the Air Ambulance helicopter is a highly unsuitable environment for the delivery of a baby.
Given all of the above and on the advice of clinical colleagues I am satisfied that the current arrangements for the transport of women in labour are adequate and I see no case for a further review.
Nevertheless, as with all SAERs there has been learning in this instance and recommendations have been made. These will be implemented and monitored through NHS Highland Clinical Governance reporting systems.
The recommendations included a protocol being put in place to support the clinical assessment of suspected early labour, local training events for all relevant clinical staff to be maintained and additionally an event for teams from NHS Highland, ambulance service and ScotSTAR, which will strengthen collaborative working in relation to information sharing and the communication pathway for maternity transfers.
NHS Highland recognises that unplanned occurrences such as this do occur and whilst they are stressful to all concerned the primary concern must always be the safety of the mother and her babies. NHS Highland is proud of the professionalism and dedication displayed by its staff and those of the SAS in supporting the birth of both babies. It also thanks the mother and her family for their help in undertaking the SAER.
I trust that this update satisfies any concerns that you may have had about the reported incident but should you wish to discuss this further please contact Jane McGirk or myself.
Yours sincerely
Iain Stewart
Chief Executive