For patient safety and justice: a newsletter

For your information and interest.  Here is another organization fighting for justice with some relevant information for those of us working with maternity care as a human rights and justice issue.

The organization is looking for Trustees by the way.



In this edition:







One of the measures announced in the Government’s response to the Francis report on Mid Staffordshire was a statutory Duty of Candour on organisations – something which AvMA has campaigned for for years.  However, as things stand, the duty would be limited to fatal cases and those resulting in ‘severe’ harm only.  In our view, such an arrangement would actually make things worse rather than better – effectively legitimising the cover up of all incidents deemed less ‘severe’ than this.  As a direct result of intervention by AvMA, the Secretary of State, Jeremy Hunt, has agreed to review this arrangement and consider bringing all incidents suspected of having caused significant harm (‘moderate harm’ and worse as defined by the NHS) within the scope of the duty.  Mr Hunt has asked Norman Williams (President of the Royal College of Surgeons) and David Dalton (CEO of Salford NHS Foundation Trust) to report back to him before Christmas.  He is worried that an ‘unintended consequence’ of including all incidents of significant harm would be to over-burden healthcare providers with bureaucracy.  AvMA has pointed out that NHS bodies already have a contractual duty to disclose significant incidents of harm, and have been practising “Being Open” guidance which also covers these incidents for years.  The Duty of Candour will take the form of statutory ‘fundamental standards’ for registration with the CQC.  Read AvMA’s briefing for more information on how the Duty of Candour should be framed.


Jeremy Hunt delivered to Government response to the Francis report on 19th November.

AvMA is continuing to press for the statutory Duty of Candour on organisations to include all incidents of significant harm (see separate article).  We are also seeking to persuade Ministers that a creative drafting of the CQC regulations, which will encompass the new duty, could go a long way to meeting the objectives of Francis’s recommendations which have not been accepted.  For example, the recommendations for an individual duty of candour and offence of preventing others from complying with their duty were not accepted.  However, AvMA is calling for the organisational Duty of Candour to include a requirement to discipline or refer to regulators any individual who prevents the organisation from complying with its duty.  We are also asking for an explicit requirement on employers to support and train staff in complying with the duty.

Other recommendations which AvMA were disappointed not to see accepted include:

  • national guidance on minimum staffing levels (however we are assessing the Government’s alternative proposals, which Robert Francis QC himself seems quite content with)
  • regulation of healthcare assistants
  • ring-fenced funding and consistent national model for Healthwatch
  • regulation of managers.

The Government has made much of only having rejected 12 of the 290 recommendations.  However, a closer look reveals that many are only agreed ‘in principle’ or partly agreed.


The Department of Health has agreed to issue new clear guidance making it clear that NHS bodies must investigate complaints, notwithstanding any intended or actual legal action by the complainant.  This followed a threat of judicial review by AvMA.  AvMA has come across a number of examples of NHS bodies in England wrongly insisting complaints are put on hold purely because litigation is intended or taking place re clinical negligence.  The DH removed the bar on complaints being investigated whilst litigation was in train or intended, after lobbying by AvMA, when it revised the complaints regulations in 2009.  However, the lack of clear guidance has meant that some trusts are unaware of the change, whilst others have chosen to use the loophole to put complaints on hold simply because of litigation.  In a test case AvMA helped a claimant take to the Ombudsman, she could not intervene because under existing arrangements trusts had a right to do so.


AvMA is one of the charities chosen to benefit from the Big Give challenge this year.  By donating on line, on 5th, 6th and 7th December, you can help AvMA double the value of your donation by drawing on anonymous donors as part of the scheme.  Please donate whatever you can on 5th, 6th or 7th December and it will make a huge difference to our work.  For full details click here.


The Medway School of Pharmacy, University of Exeter Medical School and the Centre for Health and Social Studies at the University of Kent are undertaking a research project on patients’ experiences of a suspected adverse reaction to a medicine.

If you would be interested in taking part in their research project please click here


Due to recent retirement of trustees, AvMA is looking to recruit new trustees to join its board.  This is a voluntary position but all out-of-pocket expenses are paid.  In addition to a strong commitment to the aims of AvMA and relevant experience, we are looking for people who can add diversity to the board which is currently light on younger adults; people from ethnic minority backgrounds; and disabled people.  Click the following for more information:  Role Description.

If you are interested please write in with your CV and coverinjg letter explaining why you would like to be a trustee and how you think you could contribute:  Trustee Position, AvMA, Freedman House, Christopher Wren Yard, 117 High Street, Crokydon CR0 1QG.

Birth as a Human rights issue: Conference notes

The Midwifery Today Conference was a breath of fresh air, inspirational and challenging. 

 Here are some highlights from my notes.  First of all Birth as a Human Rights issue:

The discourse on human rights is relatively new ( as opposed to the rights of landowners, kings and oligarchies)

We are just catching on that Birth is human rights issues

19 years ago Maternal Mortality was included in the Millennium goals.

And since then the development of the understanding of preventable maternal mortality and morbidity as a pressing human rights issue.

The UN Human Rights commission is now saying re maternity:  No customs, traditions and practices can be involved that do violence to women.

There is a link between money (for instance, where birth is big business for doctors and hospitals) and fear of what may happen at birth.

Robbie Davis-Floyd: says: Birth is not something women just do, it is something we actively choose to do.

The force of law cannot be used to take away options [for how and where we give birth and with whom] sic

Several organizations now working on birth as a human rights issue:

Hospitals can work to achieve the 10 Steps as a means of providing optimal MotherBaby Childbirth Initiative (IMBCI) originated from the work of the International Committee of the Coalition for Improving Maternity Services (CIMS). The inspiration and foundation for the IMBCI is based on the philosophy and principles of CIMS, a coalition dedicated to promoting a wellness model of maternity care that will improve birth outcomes and substantially reduce costs, and to supporting new global efforts to improve the health of women and babies. CIMS is a life-long partner in support of the mission of IMBCO.

The International MotherBaby Childbirth Organization (IMBCO) was created in partnership with Childbirth Connection, a U.S. based not-for-profit organization dedicated to improving the quality of maternity care through research, education, advocacy and policy. Childbirth Connection promotes safe, effective and satisfying evidence-based maternity care for all women and their families.  See previous blog post for the mother/baby rights in full.

  • The White Ribbon Alliance campaigns against violence against women.  a whole arm of this campaign is about dignity and respect and good care in pregnancy and childbirth. cf their website for stories  and campaigns happening around the world.  Join the alliance to be part of change happening.  Some excellent videos and some shocking stories too.

 The talk ended with singing and dancing!

 Birth truly is a human rights issue!  And we can be part of making change happen.  These websites and organisations show that if we do, we join thousands of women and men around the world who are working towards the same goals.  We may feel that our part is small and parochial but be clear our actions are part of a global movement that we can also join and which makes our actions larger than the sum of the whole.  Inspirational and challenging!

Birth is a human rights issue

Dear friends,

I am typing up my notes from the amazing international Midwifery Today conference in Belgium, but as I did so I could not but share right away this declaration of mother/baby birth rights.  It is powerful stuff.  Sisters and brothers we must use it to ensure each woman and baby gets the care she needs.  Alongside the rights, is a 10 step strategic programme of implementation which every maternity service can use to apply these basic mother/baby rights.  For more information go to

MotherBaby Rights

  1. You and your baby have the right to be treated with respect and dignity.
  2. You have the right to be involved in and fully informed about care for yourself and your baby.
  3. You have the right to be communicated with in a language and in terminology that you understand.
  4. You have the right to informed consent and to informed refusal for any treatment, procedure or other aspect of care for yourself and your baby.
  5. You and your baby have the right to receive care that enhances and optimizes the normal processes of pregnancy, birth and postpartum under a model known as the midwifery (or motherbaby) model of care.
  6. You and your baby have the right to receive continuous support during labor and birth from those you choose.
  7. You have the right to be offered drug-free comfort and pain-relief measures during labor and to have the benefits of these measures and the means of their use explained to you and to your companions.
  8. You and your baby have the right to receive care consisting of evidence-based practices proven to be beneficial in supporting the normal physiology of labor, birth and postpartum.
  9. You and your baby have the right to receive care that seeks to avoid potentially harmful procedures and practices.
  10. You have the right to receive education concerning a healthy environment and disease prevention.
  11. You have the right to receive education regarding responsible sexuality, family planning and women’s reproductive rights, as well as access to family planning options.
  12. You have the right to receive supportive prenatal, intrapartum, postpartum and newborn care that addresses your physical and emotional health within the context of family relationships and your community environment.
  13. You and your baby have the right to evidenced-based emergency treatment for life-threatening complications.
  14. You and your baby have the right to be cared for by a small number of caregivers who collaborate across disciplinary, cultural and institutional boundaries and who provide consultations and facilitate transfers of care when necessary to appropriate institutions and specialists.
  15. You have the right to be made aware of and to be shown how to access available community services for yourself and your baby.
  16. You and your baby have the right to be cared for by practitioners with knowledge of and the skills to support breastfeeding.
  17. You have the right to be educated concerning the benefits and the management of breastfeeding and to be shown how to breastfeed and how to maintain lactation, even if you and your baby must be separated for medical reasons.
  18. You and your baby have the right to initiate breastfeeding within the first 30 minutes after birth, to remain together skin-to-skin for at least the first hour, to stay together 24 hours a day and to breastfeed on demand.
  19. Your baby has the right to be given no artificial teats or pacifiers and to receive no food or drink other then breast milk, unless medically indicated.
  20. You have the right to be referred to a breastfeeding support group, if available, upon discharge from the birthing facility.

Associated IMBCI Step

  1. Step 1   Treat every woman with respect and dignity.
  2. Step 1
  3. Step 1
  4. Step 1
  5. Step 2   Possess and routinely apply midwifery knowledge and skills that optimize the normal physiology of birth and breastfeeding.
  6. Step 3   Inform the mother of the benefits of continuous support during labour and birth, and affirm her right to receive such support from companions of her choice. 
  7. Step 4   Provide drug-free comfort and pain relief methods during labour, explaining their benefits for facilitating normal birth.
  8. Step 5   Provide evidence-based practices proven to be beneficial.
  9. Step 6   Avoid potentially harmful procedures and practices.
  10. Step 7   Implement measures that enhance wellness and prevent illness and emergencies.
  11. Step 7   Implement measures that enhance wellness and prevent illness and emergencies.
  12. Step 7   Implement measures that enhance wellness and prevent illness and emergencies.
  13.  Step 8   Provide access to evidence-based skilled emergency treatment.
  14. Step 9   Provide a continuum of collaborative care with all relevant health care providers, institutions, and organizations. 
  15. Step 9   Provide a continuum of collaborative care with all relevant health care providers, institutions, and organizations. 
  16. Step 10 Strive to achieve the BFHI 10 Steps to Successful Breastfeeding. 
  17. Step 10  
  18. Step 10  
  19. Step 10  
  20. Step 10  

Our thanks to Marcia Westmoreland, Robbie Davis-Floyd, and Rodolfo Gomez for their work on extrapolating these MotherBaby Rights from the text of the IMBCI.