Essential insight into England’s biggest health economy, by Ben Clover

A very sad and worrying story from St George’s in south London.

The trust, which has a good reputation in maternity, saw a stillbirth last year to which contributory factors were insufficient midwives, and a locum registrar who walked out after a contract dispute.

The incident report has more details but the case raises a disturbing possibility.

A locum registrar who arrived for the day shift left after a dispute about whether they were to be employed as a senior or junior registrar.

The trust’s report said the individual did not inform anyone else they were leaving, which sounds unhelpful at best.

St George’s press team would not confirm which agency had supplied the locum, whether the company accepted the blame for the confusion over how much the registrar was going to be paid for their shift or whether it still uses that agency.

But it doesn’t sound like it was the agency’s fault.

The serious incident report said: “The panel questioned why the locum was not aware that the position was for a junior registrar, not a senior registrar” – but does not record who the question was asked of and what their answer was.

It added: “The panel recommended the general management team ensure that locum staff are made fully aware of the position and responsibilities that they are expected to provide cover for” – which suggests in this case the locum was not made fully aware.

It added: “The on-call consultant had wanted to negotiate with the locum registrar but when they arrived the locum had already left.”

The consultant had then felt the unit was potentially unsafe and “shortly after managed to arrange for suitable senior registrar cover”.

The report’s recommendations said the general manager for women’s services “must ensure that the correct information is given to all locum staff”.

How could a trust that books so many locum shifts allow this kind of confusion to arise over whether a medic was going to be paid at a higher or lower rate?

It might not have expected the locum to walk out (the on-call consultant clearly expected they would be able to “negotiate”), but they were within their rights to do so.

The report does not spell this out exactly but we can see, nonetheless, that a dispute over the money to be paid for an agency shift contributed to a clinical situation that resulted in a stillbirth.

In what other safety critical situations does St George’s leave it unclear what rate a temporary worker is to be employed at, trusting to the on-call consultant to negotiate with the worker if they feel they have been misled?

St George’s is looking at a deficit of £80m this year. Like all trusts, it has a cap from NHS Improvement on its agency spend.

The communications team told London Eye that the serious incident report had “identified a number of contributory factors in this case – neither cost cutting nor the agency cap were among them”.

The case is currently being settled with the NHS Litigation Authority

Full credit to the London Evening Standard for bringing this case to light last week.

The paper also reported that St George’s had saved the life of the father of this child a short while later when he suffered a stroke.

Hospitals are complicated places and I sometimes wonder whether it is possible to form reliable pictures of how safe they are, even at a department level.

London Eye features a look at what’s going on in England’s biggest health economy. London has the best and worst regarded hospital trusts in the country. It has excellence and dysfunction in commissioning and primary care. I will cover all of this.

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