Billy Wilson

Dear Mr Hinchcliff Your ref: DH/ST/893/15 re Baby Karpovich DH/KLA/3156/13 re Billy Wilson Thank vou for writing to me on 22 February and & March 2017 regarding the inquest of the deaths of Maxim Karpovich and Billy Wilson_ responded t on 17 March 2017 after meeting discussing with the RCOG Officers and seeking input and advice from the new Vice Presidents of Education and Clinical Quality: apologised to_ ifor the delay in my response explaining that needed to consult with the Curriculum Review team in some detail before address his concerns appropriately: The consensus from the RCOG Officers and the Curriculum Review team was that a theoretical course in itself _ particularly a course taking place over many weeks a5 was suggested ~was unrealistic for ail trainees, many of whom are struggling to obtain study leave from their Trusts and are also complaining bitterly about the mandatory training modules that they are expected to complete: There is also the question of whether a course is the most appropriate method of training as the problems that can arise in clinical practice are generally when the whole picture is not considered and the issue is not escalated appropriately: Cardiotocograph (CTG) training Is part of the current RCOG curriculum: In summary it is part of module 10 'Management of labour' and by the end of Specialist Training year 1 (ST1), all trainees must produce evidence of having completed a course demonstrating CTG interpretation skills (see Module 10 attached with relevant sections highlighted) before they can progress to become an ST2_ As you will see this is usually an e-learning course and the resources which most trainees use are either the KZMS" PTP (Perinatal Training Program) package or the e-learing for Healthcare Electronic Fetal Monitoring chapter: You may be aware that the K2 training requires hospitals to have a site licence and trainees can then be registered: The e-learning for Healthcare requires doctors to have a NHS email address and then they can register for free; but this precludes those working out with the NHS. However should mention here that, as the official host, the RCOG has put a significant amount of resource into supporting the eFM package, working with the Roval College of Midwives and Health Education England. Royal of Obstetricians and Gynaecologists 27 Sussex Place; Regents Park London NWI 4RG Telephone: +44 (0J20 7772 6200 Facsimile: +44 (0)20 7723 0575 Website: wwwrcogorguk Registered chanty no, 2/3280 May ` and could being College "

Royal College of Obstetricians & Gynaecologists CTG training is additionally included in the basic practical skills course which all trainees have to take to progress to ST3. One ofthe 10 practical stations is on interpretation of CTG and fetal blood sampling: All delegates are expected to complete the on-line tutorials in electronic fetal monitoring and fetal blood sampling during the pre-course preparation and should basic understanding the fetal monitoring principles_ In terms of the new curriculum; the pressure of completing modules does not allow us to increase the emphasis on CTG interpretation but it will remain an important that trainees evidence this skill; The RCOG opinion on CTG interpretation is that the problems arise in clinical practice when the whole picture is not considered, and this is why trainees are encouraged to demonstrate clinical competence within teams as part of workplace based assessments. In addition senior trainees who are likely to be in of such teams can register for our Advanced Training Skills Module (ATSM) in advanced antenatal practice or advanced labour ward practice, both of which contain curricula that deliver additional training in the teamwork around CTG interpretation which includes the running of team meetings and reviews of decision making Further details of our ATSM programme can be found at https LLWWW rcg org uklen/careers-training/specialty-training-curriculumlatsmsl: Whilst we fully understand the concerns around this case we would like to reassure you that the College is committed to ensure that safety is at the heart of anything we do. We have discussed whether one additional course such as that proposed by Professor Steer for all our trainees would enhance safety We believe that it would not and that we should therefore concentrate on ensuring consistency of our curriculum and also engaging with NHS England and the 'Safer Maternity Care' programme; launched by Jeremy Hunt at the RCOG in October 2016. This important national programme has come with a very strong bias towards team work and leadership, supported by a new funding stream for multi-professional training programmes. As am sure you are aware; the Secretary of State announced E8m of funding for maternity safety training last Autumn 2016, with at least E4Ok to each NHS Trust In England: This has allowed some units to fund training in subjects such as team working in intrapartum care and CTG interpretation via courses that have already been established: Lastly should mention that in my reply tol reminded him that the RCOG currently offer an "intrapartum fetal surveillance course" which is run over one at the RCOG and is aimed at obstetric team working: suggested to that he could Iiaise with our Convenor of Meetings to help us design a pilot programme alng the lines that Professor Steer proposes, that have charge fully day -

Royal College of Obstetricians & Gynaecologists could then be trialled at the RCOG: offered to give this my full support if he wished to pursue the proposal and believe that he has already started to do so Ifyou would like to discuss this further with me please do not hesitate to contact me