The County Durham and Darlington NHS Trust's maternity ward experienced over 450 'red flag events' in 2022.

According to the National Institute for Health and Care Excellence (NICE) guidelines, a midwifery "red flag event" is a warning sign that something may be wrong with midwifery staffing.

A Freedom of Information request found 474 red flag events and contributing factors were recorded for the whole of last year, which included 234 at Darlington Memorial Hospital and 240 at the University Hospital North Durham.

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But the Trust has maintained that a "short wait does not pose a clinical risk," while it also confirmed that it was recruiting people in roles to support women requiring induction.

According to NHS England, some of the red flag events can be categorised as delays, both in commencing the induction of labour and transferring to the labour suite to continue the induction of labour.

The Northern Echo: Darlington Memorial HospitalDarlington Memorial Hospital (Image: NORTHERN ECHO)

It was explained that, in these cases, processes may be paused temporarily if they are unable to provide one-to-one care during labour in line with NICE recommended standards.

The Northern Echo:  University Hospital North Durham University Hospital North Durham (Image: NORTHERN ECHO)

If a midwifery red flag event occurs, the midwife in charge of the service should be notified and should determine whether midwifery staffing is the cause, and the action that is needed, according to NHS England.

Here's a full list of reasons for 'red flag events' in relation to midwifery:

  • Delayed or cancelled time-critical activity
  • Missed or delayed care (e.g. delay of 60 minutes or more in washing and suturing)
  • Missed medication during an admission to hospital or midwifery-led unit (e.g. diabetes medication)
  • Delay of more than 30 minutes in providing pain relief
  • Delay of 30 minutes or more between presentation and triage
  • Full clinical examination not carried out when presenting in labour
  • Delay of two hours or more between admission for induction and start of the process
  • Delayed recognition of and action on abnormal vital signs (e.g. sepsis or urine output)
  • Any occasion when one midwife is unable to provide continuous one-to-one care 
  • Support to a woman during established labour.

A spokesperson for County Durham and Darlington NHS Foundation Trust, said: 

“These figures relate to situations where labour requires induction and the induction process has not begun for at least two hours after admission. 

“As most inductions are planned and a short wait does not pose a clinical risk, the process is only started once one to one care is in place.  Once the induction process has begun one to one care is continued throughout the labour.   

The Northern Echo: South Tees Hospital NHS TrustSouth Tees Hospital NHS Trust (Image: NORTHERN ECHO)

“We are in the process of recruiting to new roles dedicated to supporting women requiring induction, to improve their experience. 

“Every year at County Durham and Darlington NHS Foundation Trust, we welcome over 4,000 new babies and our teams are committed to providing a safe, compassionate and supported experience to each and every delivery.”

In contrast to the figures for County Durham and Darlington NHS Trust, another FOI submitted to South Tees Hospital Trust revealed that there were 132 red flags recorded during 22, with 128 relating to delays in the induction of labour, and four relating to the team leader not able to maintain supernumerary status.

In response, chief nurse Hilary Lloyd, from the South Tees NHS Trust, said:

“South Tees Hospitals NHS Foundation Trust has a number of supportive safer staffing processes in place to ensure we deliver safe, quality, personal, effective and timely care across all our services.

“Midwifery red flags are part of a NICE recommended staffing tool.

"They act as a proactive flagging system to prompt the midwife in charge to check staffing levels and organise appropriate cover if required.

“The majority of red flags recorded in midwifery during 2022 were related to potential delays in starting the induction process after women had been admitted.

"Midwives were moved to provide support following safer staffing discussions with ward managers and matrons. “In line with national guidance all women have a dedicated midwife throughout their labour.”

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Here is the other data for the North East and North Yorkshire:

North Cumbria Integrated Care NHS: 27 staffing incidents for the whole of maternity for 2022 inclusive of Community staffing.

Harrogate and District NHS: There were 11 red flags in 2022.

South Tyneside and Sunderland NHS: The data was not held in response to the FOI.

*North Tees and Hartlepool NHS and Newcastle Hospitals NHS Foundation Trust not included within the FOI data*