Maternity failings in England: 1000 babies die preventable deaths every year
A report by MPs earlier this week revealed that 1000 babies die preventable deaths every year in England because a culture of shifting blame and keeping tight-lipped means lessons are not learned after mistakes occur on NHS maternity wards.
Two in five childbirth units unsafe
According to the health select committee’s report, almost two in five childbirth units still provide care that is unsafe to some extent. The cross-party group, chaired by former Health Secretary Jeremy Hunt, has applauded the NHS for the “impressive” 30% drop in neonatal deaths and 25% decrease in stillbirths that has taken place over the last decade, following several scandals. However, MPs said in the report:
“The improvement has come from a low base and if we had the same rate as Sweden approximately 1,000 more babies would survive every year.”
Mr Hunt has stressed that most births in the NHS were safe but added that there are some families who experience “a devastating outcome” when errors do occur.
“Despite a number of high-profile incidents, improvements in maternity safety are still not happening quickly enough. Although the NHS deserved credit for reducing baby deaths and stillbirths significantly, around 1,000 more babies would live every year if our maternity services were as safe as Sweden.”
The report highlights how Sweden halved the number of avoidable birth injuries in its hospitals after the introduction of a no-blame compensation scheme for injuries sustained because of medical treatment. Sweden’s scheme involves maternity staff being open and honest about why things went wrong that led to a baby, its mother or both suffering serious injury or dying. In the NHS, negligence must be proved for compensation to be paid out to those who have suffered due to maternity failings, whereas in Sweden, compensation is paid out purely on the basis that care was not good enough. The fact that negligence must be proved in the NHS contributes to what MPs describe as a damaging and persistent “blame game”. Experts credit the Swedish approach with encouraging health professionals to be upfront when mistakes happen, which in turn leads to a greater willingness to learn from failings.
‘We believe that adopting such an approach is an essential next step in shifting the culture in maternity services away from blame to one of learning,’ the report added.
Maternity claims costing NHS £2.3 billion
According to the report, failings in maternity care cost the NHS in England an extortionate amount, with NHS Resolution paying out around £2.3 billion in compensation and associated costs for maternity claims in 2019/20. This figure represented 40% of all NHS claim payments. The report also found that whilst stillbirths and neonatal deaths were falling, women from black, Asian and minority and poorer backgrounds were still more likely to experience such outcomes.
Dr Edward Morris is the president of the Royal College of Obstetricians and Gynaecologists, which represents maternity doctors. He said: “We acknowledge that stillbirth rates are still higher in the UK than many other high-income countries, with Sweden leading the way. While huge amounts of progress have been made and the number of stillbirths is going down, the death of any baby is a tragedy.”
The Care Quality Commission’s chief inspector of hospitals, Professor Ted Baker, told the committee’s inquiry that its inspections had found that 38% of NHS maternity services “require improvement for safety”. This is more than in any other medical speciality. He also said hospitals “still had not learned all the lessons” from maternity care scandals at the Morecambe Bay, East Kent, and Shrewsbury and Telford NHS trusts, in which hundreds of babies and mothers either sustained serious injuries or died. Persistent issues included “a defensive culture, dysfunctional teams and poor-quality investigations without learning taking place”.
According to MPs the main reason maternity care is unsafe is due to lack of staff, with units short of almost 2,000 midwives and around 500 senior doctors. Lack of staff is the main reason maternity care can prove unsafe, the MPs say. A recent survey only compounded this, with 80% of midwives telling the Royal College of Midwives they believed there was not enough staff to ensure safe care.
A 2015 report into the “serious and shocking” problems Dr Bill Kirkup uncovered in Morecambe Bay led ministers to pledge major improvements to maternity care, which included reducing the number of neonatal deaths, stillbirths, brain injuries and maternity deaths by half by the year 2025. Despite this pledge, a panel of experts asked by MPs to assess the government’s progress so far said that the speed at which key changes are being implemented – which include safe staffing and women having the same midwife throughout their pregnancy and labour – “requires improvement”.
Review of NHS Clinical Negligence system
The Commons Health and Social Care Committee has now called for the existing system of compensating victims by reference to private healthcare costs to be scrapped and replaced with appropriate NHS care where available. The committee has also called for action to deal with the ‘debilitating culture of blame’ which is created due to litigation hindering learning opportunities following a safety incident. Its report concluded that the present clinical negligence system is harmful to both the NHS and patients. It said:
"It is clear to us that in its current form the clinical negligence process is failing to meet its objectives for both families and the healthcare system. Too often families are not provided with the appropriate, timely and compassionate support they deserve."
MPs added that while providing appropriate financial redress to families after an incident was important, the rising costs of maternity claims ‘without sufficient learning and outdated mechanisms’ for calculating compensation was unsustainable. The report concluded it was ‘particularly unfair’ that wealthier families often receive more compensation for a severely disabled child than poorer families due to the fact that likely lost earnings are taken into account.
The government is currently reviewing the clinical negligence system, and it was recommended that a rapid redress and resolution scheme is implemented while that process is ongoing.