East Kent Hospitals University Trust pleading guilty

Last month, it was widely reported that East Kent Hospitals University Trust pleaded guilty to a criminal charge brought by the NHS regulator in that it failed to provide safe care and treatment which led to the sad, and in the words of the Coroner, “wholly avoidable” death of baby Harry Richford at just a week old in November 2017.

Harry was born at the Queen Elizabeth the Queen Mother hospital in Margate, Kent. They were also accused of exposing his mother, Sarah, to “a significant risk of avoidable harm”.

This was the first prosecution of its kind.

Civil proceedings and claims against Trusts relating to clinical care are common, but no criminal charges. There have been other criminal cases, but not on this issue. The Trust will be sentenced on 18 June and a large fine is likely.

There are those who will say that a fine will not undo the harm done and indeed it won’t and can’t.  But even Harry’s mother Sarah has said it brought “some level of justice” for baby Harry. She commented:

Although Harry’s life was short, hopefully it’s made a difference and that other babies won’t die

Susan Acott, the Chief Executive of the Trust, has apologised unreservedly and said that it had made “significant changes” and would “do everything we can to learn from this tragedy”.

Sometimes these comments can just seem to be just a stock response and nothing changes. But it is noticeable that since independent maternity care advisers were sent into the trust after Harry’s inquest in 2020, neonatal deaths at the East Kent had fallen by 55% and stillbirths by 22%.

The family say that this:

demonstrates clearly to us that, with the correct focus, leadership and procedures, babies’ lives can be saved

and that they can “take some comfort from that”

 

How did this happen?

The background to Harry’s case came out at the inquest. The coroner identified seven gross failings, including that although the level of Harry’s heartbeat showed that he needed to be delivered within half an hour, that did not happen for 92 minutes.

A consultant should have overseen the delivery, not the locum doctor (not an unusual situation by any means) on duty who was quite inexperienced. Harry also suffered a lack of oxygen to the brain when staff were trying to resuscitate him.

Justice for Harry was the focus of this case for his family, but it did not stop at findings of negligence contributing to his death. Harry’s family had to struggle for information for three and a half years to find out what really happened at Harry’s birth.  As if they didn’t have enough to cope with.

Harry’s grandfather, Derek Richford in particular made it a quest to find out. He ended up with over 5000 pages of evidence. He said the search for information was like peeling off the layers of an onion- the more layers he took off, the more he found underneath.

Another mother, Helen Gittos, who lost her baby, Harriet at 8 days old in 2014 said that she had found what seemed to be patterns of “blocking” behaviour when she was looking for evidence. She said it seemed to be routine to take months to respond to requests, or evidence being mislaid or even not kept. At one point, she was astonished to find a Serious Incident Report initially graded Harriet’s death as “severe harm”, but by the time it reached the Clinical Commission Group and the Trust board, it had been apparently been re-classified as “no harm done”.

 

What has the family said?

Mr Richford commented on his perception of the seeming lack of accountability and unwillingness to take responsibility on the part of often very well-paid management personnel at the Trusts. He feels that the two should go hand in hand.

We know that the NHS is in what seem to be perennial difficulties with finances and staffing issues. We know the pandemic hasn’t helped, to put it mildly. We know there are dedicated staff doing their best in almost impossible situations sometimes because they love their job. In fact, one of our own staff left recently to start her training as a midwife, a lifelong ambition.

But we also know that these are not new problems and that they have been flagged up time and time again. As lawyers, we see similar problems in investigating medical negligence claims. It is bad enough when someone is injured or is bereaved due to negligence, but they should not have to jump through so many hoops to get information on top. Some do just give up and the issues do not get exposed to the light of day for scrutiny. Thus the failings continue.

Civil medical negligence claims are not just about financial compensation.

They are also about finding out what happened and why something our clients often don’t get told. Trusts must know that they cannot be 100% perfect and get it right 100% of the time. The law knows this. It is a counsel of perfection and the law only requires the medical profession to act “reasonably”. Sometimes they will have got it wrong and if so, then there can be legal consequences. But that’s how it is.

Sometimes our investigations show that there is no claim as no legal wrongs have occurred. We are equally helped in that by Trusts being open and transparent. Many clients will fully accept what has happened and why there is no legal basis for a claim once they have an explanation.

The Compensation Act 2006 s2 expressly states that:

An apology, an offer of treatment or other redress, shall not of itself amount to an admission of negligence or breach of statutory duty

and this sometimes seems to get forgotten. A Trust can make a genuine apology that something hasn’t gone as expected without this constituting an admission of liability – there may be no liability to admit to anyway – and this can go a long way in averting potential claims, which must surely benefit the Trust?

 

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If the issues in this article have affected you or you have a negligent claim to make against the NHS, we can help.

Call 01522 561020 or email wecanhelp@ringroselaw.co.uk

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