Thread by @JamesTitcombe

In the interests of transparency, I’m sharing the response from MNSI to this letter. A short 🧵1/11

https://twitter.com/jamestitcombe/status/1769440838558285984

2/11

The full response is here:-

The letter doesn’t correct the assertion that a ‘…professional bias towards the normalisation of pregnancy and childbirth’ is a finding ‘frequently seen’ in MNSI (formerly HSIB) maternity investigations. That’s because it’s unequivocally true.

Why does it matter?

3/11

It matters because the HSIB/MNSI investigation programme was set up to identify systemic issues affecting maternity safety & to drive national learning & change….

4/11

Yet more than 4 years into the programme, the issue of ‘normal birth’ ideology & its impact on maternity safety (raised repeatedly by independent inquires & widely known to be a factor in avoidable harm & death) - hasn’t been so much as whispered by HSIB/MNSI.

5/11

This might be understandable if they genuinely don’t see this issue in the 1000’s of investigations they have carried out, but is it acceptable if internally (behind closed doors), the issue is referred to by maternity investigations & senior team as a ‘frequent finding’?

6/11

I strongly feel it isn’t - not least because the silence from MNSI/HSIB on this issue gives weight & credibility to the false argument that this isn’t a national problem & that the inquires that found this issue were therefore ‘isolated’ - ‘one offs’.

7/11

That narrative has been strongly pushed by the ‘normal birth’ lobby that still (sadly), has influence on UK maternity policy, education & practice. In my view, MNSI/HSIB’s silence on this issue (despite them holding a wealth of evidence) is unacceptable - negligent even.

8/11

The HSIB/MNSI maternity programme was established, in part, as a response to Joshua’s death & the Morecambe Bay Inquiry. I’ve always been a voice that has championed it. But sadly, if Joshua was a recent case, I wouldn’t allow MNSI (in its current form) anywhere near it.

9/11

Trying to raise these issues with HSIB/NMSI’s maternity team has been a massive uphill struggle -very much a case of feeling like I’m a ‘problem to be managed’ rather than someone raising genuine concerns for no other reason than wanting to see maternity safety improve.

10/11

In my view, the programme needs a proper independent review & overhaul including:

- strengthening the investigative methodology
- readdressing the professional balance within investigation teams (currently overwhelmingly midwife dominated)
- a commitment to publish anonymised learning from individual reports - rapidly and shared via an online platform
- much more focus on thematic analysis with stronger links to a more cohesive national improvement system
- a more transparent system of evaluation - with independence and open publication

But I won’t hold my breath.

11/11