The safety of maternity services and recommendations for change

Posted: 29/07/2021

The Health and Social Care Committee published a report in early July 2021 focusing on the safety of maternity services in England and making several recommendations.

The Committee had previously commissioned a panel of experts to assess the progress the Government had made against its own commitments in different areas of healthcare, with maternity services in England being addressed first. These commitments had been made over the preceding five years. The expert panel concentrated on four key commitments, namely improving maternity safety (reducing stillbirths, neonatal deaths, brain injury, maternal deaths and pre-term births); ensuring that the majority of women benefit from a ‘continuity of carer’ model during their pregnancies, labours and the post-natal period; ensuring that all women have a personalised care and support plan (PCSP) and ensuring that NHS providers are staffed with the appropriate number and mix of clinical professionals. Overall, although the expert panel found that progress had been made in relation to the reduction in stillbirths and neonatal deaths, it was felt that improvement was required across all four commitments, noting that insufficient resourcing was a factor.

The Committee’s report stresses that the vast majority of NHS births in England are safe but notes that there is a ‘worrying variation in the quality of maternity care’. Reference is made in the report to the maternity scandals at the University Hospitals of Morecambe Bay NHS Foundation Trust, the Shrewsbury and Telford Hospital NHS Trust and East Kent Hospitals University NHS Foundation Trust. These scandals and Donna Ockenden’s independent, interim review of maternity services at Shrewsbury and Telford have been covered in previous articles by Penningtons Manches Cooper’s specialist birth injury team (see panel below).

The report makes the point that it is “imperative that lessons are learnt from patient safety incidents”. It highlights the role of the Healthcare Safety Investigation Branch (HSIB), which conducts independent investigations for maternity safety incidents. These have now replaced local trust serious incident investigations for eligible maternity incidents.

A number of recommendations are made in the Health and Social Care Committee’s report, including:

• increasing the budget for maternity services by £200 – 350 million per annum, with consideration of how to deliver an adequate and sustainable level of obstetric training posts so that safe obstetric staffing is achieved, as well as ensuring that some of the maternity budget is ringfenced for training;
• continuing HSIB investigations but ensuring increased engagement with trusts to support local learning and development and the sharing of learning “in a more systematic and accessible manner”;
• reviewing the negligence system, with the implementation of a Rapid Redress and Resolution Scheme in full, (with the scope and timetable for the review of clinical negligence to be provided by September 2021), including a review of whether compensation should be awarded when an incident is avoidable, rather than it being necessary to prove clinical negligence, and with a change to the basis for compensation also proposed to remove the need to compensate on the basis of private healthcare provision, where appropriate NHS care is available, and with compensation for loss of earnings being pegged to the national average wage;
• supporting the principles of the ‘continuity of carer model’ but ensuring that it can be implemented in a sustainable way, with sufficient training being in place;
• focusing on ensuring that women are clearly informed about the safest options for their births and ending the use of total caesarean section percentages as a metric for maternity services, as some units appear to have been penalised for high caesarean section rates.

Alison Appelboam Meadows, a partner in the clinical negligence team at Penningtons Manches Cooper, comments: “The impact of poor maternity outcomes on families and clinicians cannot be underestimated and, therefore, any action which reduces such outcomes is welcome. The reduction of poor outcomes will not only reduce the heartache suffered but also the costs of compensating those involved. Where individuals are affected by such incidents, they should be properly compensated in accordance with the legal principles in place.”

Related articles on maternity care

• Interim report on maternity care at Shrewsbury and Telford NHS Trust: a summary of findings
• Shrewsbury and Telford Hospitals NHS Trust: Ockenden Review to release emerging findings report on maternity care
• The Shrewsbury and Telford Hospital Trust maternity review: a timeline of events leading to a police investigation into maternity care

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