***Parliamentary debate. Maternity Services. 25.02.25***
MPs to hold a debate on maternity services - Committees - UK Parliament
We have just sent a further letter to our local MP. Could you?
Dear Mr **********
"Further to our earlier correspondence. We understand a 90 minute parliamentary debate is scheduled on Tuesday 25th February 2025 concerning apparent maternity services failings.
We understand public participation is encouraged through local members of parliament. Please may we encourage you to attend.
As we outlined in our petition (https://www.change.org/Mollys_Missing_Heart_Views these are our significant areas of our concern. There is no transparency in pregnancy screening. Nobody will talk openly about why this is happening at a national level. National FASP guidance is not compatible with a range of professional guidance. Trusts are interpreting this guidance differently and operating with autonomy. National screening practice isn’t consistent as a result. Significant regional variation in CHD regional detection rates and differences in screening practice is not acceptable. We feel that there is evidence of a north/ south divide in fetal cardiac view retention practice. Medical records should always be retained.
1.There is national inconsistency in antenatal screening practice. We have submitted FOI requests to all NHS trusts in England. We have established national fetal cardiac view retention practice that was not previously known. Our figures suggest;
-11 trusts are retaining images and clips (9.3%)
-55 trusts are retaining images only (46.6%)
-48 trusts are not retaining anything (40.7%)
-2 trusts retain the situs view only (1.7%)
-2 trusts have hospital sites operating differently - sites that retain images only but also other sites that don’t retain anything (1.7%)
Trusts in the South predominantly retain fetal cardiac views. We reside in the north and our trust does not retain fetal cardiac views.
2.We do not feel that it is acceptable that NHSE, the ICBs and the regional CHD networks did not know of individual trust practice concerning fetal cardiac view retention practice. We were informed by NHSE this information was “granular”. We feel that there should have been an awareness and assessment of national majority practice. Trusts in England have been operating with complete autonomy.
3.The Fetal Anomaly Screening Programme Handbook Guidance (first published 2015, updated 2022) is outdated and no longer fit for purpose. It has remained consistent in respect of guidance on fetal cardiac view retention since first publication and no further national review has been undertaken since implementation. FASP guidance still suggests; ‘there is no requirement to archive images of the fetal cardiac protocol views’. This is ambiguous, non-prescriptive and has resulted in inconsistent national practice. The guidance is no longer compatible with a range of more recent professional guidelines – including that from SoR & BMUS:
’Images that accompany an ultrasound examination carried out by a competent ultrasound practitioner evidence the assumption that the necessary standard of care has been delivered’. (SoR)
4.Assessment of national detection rate data and suggestions to improve rates are being ignored. NICOR is funded by NHS England and has a national cardiac audit programme. In its 2023 national CHD audit NICOR advised;
‘to understand and improve rates of detection and reduce regional variation, several steps should be considered; storage of specific cardiac views to allow internal and external review to encourage a learning process and standardised pathways of feedback” (NICOR)
5.A minority of trusts are not delivering a competent standard of care. 57% of trusts retain images or clips of the fetal heart – whilst 43% do not retain. Trusts are interpreting and valuing FASP guidance and more recent professional guidance differently. This guidance is not compatible. National majority practice is significant: ‘The standard of care provided by a competent ultrasound practitioner is that which the majority of similar individuals would provide and/or which a significant body of similar individuals would provide in similar and contemporaneous circumstances’ (SoR)
6.Our care was not best practice. We have been privately supported by many within the NHS. We have been signposted to relevant content that has seemingly been disregarded by 43% of trusts that are not retaining views. The College of Radiographers (CoR) and The Royal College of Radiologists (RCR) have published ‘a minimum level of expectation’ on Quality Standard for Imaging (QSI). These ‘expectations’ concern CT, MRI, IR, NM and ultrasound imaging (US). This content is not compatible with FASP.
7.There is conflicting and incompatible guidance within the FASP programme itself.
8.These issues have now created a ‘postcode lottery’ for patient care during antenatal screening. NICOR suggests regional antenatal detection rates of CHD currently vary between 24% and 72%. Where you live will seemingly determine what is identified and what is recorded. In the 2024 NICOR Annual Summary Report it reported: ‘There is considerable variability on antenatal detection rates for these patients within the UK’ . This inconsistent national practice is unacceptable.
9.We feel that these issues are suppressing CHD detection rates. Average national statistics still show babies will only have a 50% chance of CHD being identified during the 20-week scan. In 2024 NICOR stated this 50% statistic has "plateaued" over the last six years. A change in guidance is required as per NICOR’s suggestion.
10.On 25.06.24 NHSE provided a final response to our complaint. They advised ‘we will consider a review of the [FASP] guidance, however at this point we are unable to specify what the timeframe for this review would be’.
11.Our trust did not disclose that they were not retaining our fetal cardiac views. We feel that they had a duty to do so as there is clearly clinical value in the retention of such records. We are confident that this non-disclosure practice is mirrored by the minority 43% of trusts nationally. This information, if disclosed, would have influenced where we elected to have our 20-week scan.
12.Our trust prevented us from ‘self-recording’ during our own 20-week scan without reasonable justification. This was directed by bold lettering on postal correspondence and departmental signage on our arrival. It is clear to us there is commentary from NICOR, a range of professional guidelines, the CHD CRG and seemingly 57% of trusts in England, that there is clinical value in fetal cardiac view retention. Whilst ultrasound is a diagnostic examination, patient recordings do not actually interfere with equipment. Our trust, like others nationally have cited non-prescriptive advisory professional guidance from SoR which discourages recording during ultrasound for personal reasons, such as social media posts.
13.Our daughter had 13 scans during pregnancy at our local hospital. It was a high-risk pregnancy. Due to reduced growth, reduced movement and low amniotic fluid we attended our hospital for ultrasound/ doppler and CTG scans frequently. A total of 96 images were saved. Images were saved on every occasion throughout 12 of her 13 antenatal scans. The only scan where images weren't saved was where her heart was assessed at 22 weeks during a repeat anomaly scan. Images were captured and retained on every other occasion before and after the 22-week repeat fetal heart scan. This 22-week scan was the only scan where her heart was assessed. Our local hospital advised that only the 22-week fetal heart images weren't saved and this was because of the FASP guidance. We feel this represents a total lack of transparency. In this context we feel that this is evidence of the deliberate obfuscation of records.
Many thanks
******* **********