Shropshire midwives found to have failed in care of newborn baby Pippa

The Nursing and Midwifery Council (NMC) hearing was looking at the conduct of Claire Roberts and Joanna Young in relation to the care of Pippa Griffiths, who died just one day old on April 27, 2016, from a Group B strep infection – the most common cause of meningitis in newborns.

Pippa's mother, Kayleigh, had given birth at the family home in Myddle and had spoken with the midwives, who at the time worked for Shrewsbury & Telford Hospital NHS Trust (SaTH), to raise concerns that her daughter was not feeding and had brought up brown mucus.

Both Pippa and her mother were eventually flown to Princess Royal Hospital in Telford, where she was confirmed dead.

The charges considered by the NMC related to two separate conversations the midwives had with Mrs Griffiths on April 27.

Both were found to have failed to recognise the urgency of a need for medical or midwifery attention for Pippa.

In the case of Ms Roberts the panel found she had effectively tried to cover up over her actions during a 2am call with Mrs Griffiths.

It concluded she had failed to make a record of her conversation with her at the time, and had then made an "inaccurate record".

The panel agreed that her conduct had been "dishonest in that you knowingly intended to create a misleading impression of Mrs Griffiths' concerns regarding Pippa during the telephone call."

The panel also said charges were proven relating to a failure to carry out a comprehensive triage assessment of Pippa's condition – by not asking about her breathing or temperature.

Charges of failing to refer to the newborn feeding guidelines or the midwifery post-natal notes were proven, as well as not advising Mrs Griffiths to attend the midwifery led unit "immediately" for a face-to-face assessment.

In the case of Ms Young the panel concluded she had not followed instructions from a senior midwife to visit Pippa in the morning – and to prioritise the visit as "extreme high importance" or call 999, as well as failing to refer Mrs Griffiths to the newborn feeding guidelines.

The panel also found that while talking to Mrs Griffiths she had failed to carry out a comprehensive triage assessment of Pippa's condition – not asking about her alertness, colour, breathing, or how she was feeding.

A charge of failing to make a contemporaneous note of the telephone call was proved, but four charges relating to dishonesty and attempting to cover up were not proven.

A hearing will take place on March 7 where the NMC will consider any possible sanction against both Ms Young and Ms Roberts – neither of whom still work for SaTH.

The tragedy is one of those that led to setting up of the Ockenden inquiry into maternity care at SaTH.

Mrs Griffiths and her husband Colin had written to the then Secretary of State for Health, Jeremy Hunt, jointly with fellow parents Rhiannon Davies and Richard Stanton whose baby Kate died avoidably while in the care of SaTH.

Speaking after the conclusion Mr Griffiths welcomed the findings, but said the family had endured a torturous five years to get to this point.

She said: "We wanted lessons learned and that is what we wanted from the start. It should have always just been an open, honest and transparent process to learn the lessons – it should not end five years down the line.

"We are happy with the result but nothing changes the fact we are still facing our fifth Christmas with an empty seat at the table."

Hayley Flavell, director of Nursing at The Shrewsbury and Telford Hospital NHS Trust said: “We note the panel’s findings at this stage of the process and again offer our sincere condolences to the family over the loss of their daughter.

“We recognise our previous failures in the standard of care offered to mothers and babies, for which we have apologised unreservedly, and we are committed to taking all of the steps necessary to improve the safety and quality of care that we provide to the women and families that we serve.”