East Kent Hospitals Trust has pleaded guilty to a charge of failing to discharge its duty to provide safe care and treatment, resulting in avoidable harm in relation to the death of seven day old Harry Richford and care of his mum Sarah at QEQM Hospital in 2017.
A hearing was held at Folkestone Magistrates’ Court today (April 19) for the prosecution brought by the Care Quality Commission.
Original charges were amended from ‘potentially’ to actually causing harm and the Trust admitted guilt. Harry’s parents Sarah and Tom and family members were in court for the hearing before District Judge Justin Barron.
Defence for East Kent Hospitals, Mr Spencer, said the Trust was “deeply sorry” and gave “unreserved apologies for the failure” to the Richford family.
A suggested sentencing date for October was rejected by Judge Barron who said this was too long to wait and he would prefer sentencing in June.
A date of June 18 at Folkestone Magistrates’ Court before Judge Barron has been set.
The Judge explained that as a summary offence it had to be dealt with within the magistrates court and the penalty available would be a fine which could be unlimited.
The decision to prosecute follows a coroner ruling that the death of Harry was avoidable.
The inquest had heard of the “panic” after Harry was born by emergency Caesarean section during which his heartbeat kept dropping. Harry died seven days after his delivery from a condition caused by a lack of oxygen. An independent report said he might have survived had there not been a delay in resuscitation at his birth that caused irreversible brain damage.
Coroner Christopher Sutton-Mattocks agreed with that conclusion and said Harry and his parents had been ‘failed.’
There was also criticism of the hospital trust which had said Harry’s death was expected, resulting in his parents, Tom and Sarah Richford, from Birchington, having to fight for an inquest.
The couple were supported at the time by North Thanet MP Sir Roger Gale, who commended them for their ‘courage and quiet dignity.’
Harry’s grandfather Derek has campaigned tirelessly to see the East Kent Hospitals Trust held accountable.
A statement issued by the Richford family says: “Today, the East Kent Hospitals Trust have submitted a plea of guilty on the two charges of unsafe care and treatment for Sarah and Harry Richford. This plea is welcomed as it will avoid all the awful details having to be replayed in public once more.
“For the period of 2020 following Harry’s inquest, neonatal deaths have fallen in the Trust by 55% and still births by 20% compared to the previous 7-year average. This proves that with the right level of focus, leadership and attention, baby’s lives can be saved. Harry’s life and our sacrifice has made a significant difference here in East Kent and it must be maintained.”
East Kent Hospitals Chief Executive, Susan Acott, said today: “We are deeply sorry that we failed Harry, Sarah and the Richford family and apologise unreservedly for our failures in their care.
“We are determined to learn when things go wrong. Our midwives, our doctors and every member of our staff constantly strive to give good care every day. We have already made significant changes following Harry’s death and we will continue to do everything we can to learn from this tragedy.
“We are working closely with national maternity experts to make sure we are doing everything we can to make rapid and sustainable improvements.
“We have welcomed the independent investigation into maternity services in east Kent and we are doing everything in our power to assist and support the investigation.”
An independent investigation launched in February 2020 in response to a concerning number of avoidable baby deaths at East Kent Hospitals Trust has progressed to the next stage.
NHS England and NHS Improvement commissioned Dr Bill Kirkup to carry out an independent review into the circumstances of the maternity deaths at QEQM and William Harvey hospitals.
The move came alongside a report by the Health and Safety Investigation Branch (HSIB) which found recurrent patient safety risks at the Trust maternity sites at QEQM and William Harvey Hospital.
Since Harry’s inquest a number of families have come forward over the preventable deaths of their babies.
It was also previously revealed that a critical report had been written after the trust asked the Royal College of Obstetricians and Gynaecologists to review the service in 2015.
Last year the Care Quality Commission confirmed it was bringing charges against the Trust in connection with Harry’s death. It is the first case of its kind against a Trust brought under powers the CQC was given in 2015.
The independent review was one of a series of actions to bring in urgent improvements to the service and examine what went wrong and why.
Dr Bill Kirkup (pictured) was appointed to lead the Independent Investigation. He has previously led a number of independent investigations, including into Morecambe Bay maternity services.
The investigation is to examine the management, delivery and outcomes of care provided by the maternity and neonatal services at East Kent University Hospitals NHS Foundation Trust during the period since 2009.
Initially the investigation team was calling for families to get in touch so the panel could look at individual cases where there has been a preventable or avoidable death; a concern that the death may have been preventable or avoidable; a damaging outcome for the baby or mother; or where there was reason to believe the circumstances shed light on how maternity services were provided or managed or how the Trust responded when things went wrong.
Last month the Terms of Reference for the investigation were published. These outline how the investigation will proceed and the main issues that will be covered. The Independent Investigation will aim to complete its Terms of Reference research by Autumn 2022. It is understood some 200 families have come forward.
The family were treated appallingly.
Absolutely appalling lack of care. How can this have happened given all the technological and training advantages that the NHS employs. Still, it will be OK in the end. Lessons will be learned – yes, of course they will – and deputy heads will roll.