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Maternity safety - Year 1 report on NHS Resolution’s Early Notification Scheme

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NHS Resolution has released a report on the first year of their innovative Early Notification Scheme for potential birth brain injuries. View the report.

The Scheme requires all births at NHS trusts in England from 1 April 2017 meeting qualifying criteria to be reported to NHS Resolution within 30 days for pro-active investigation. 

The approach breaks the traditional mould of waiting until a claim is received to investigate issues of liability, which is often many years after an injury, when evidence is no longer available and memories have faded. It also recognises that traditionally long timescales reduce the opportunity to learn lessons to improve care and avoid recurrence, while staff and families can be adversely affected by the complex and time-consuming formal litigation process.

The Scheme should be seen within a range of initiatives both to reduce the high cost of maternity claims to the NHS, which regularly hit the headlines, but also importantly to improve safety to reduce the tragedy of birth injury. The authors have been able to use information from the cases reported in order to identify areas where further research and clinical guidance would assist in the safe delivery of maternity care. 

Another notable initiative is a premium incentive for NHS trusts operating maternity units to meet 10 criteria agreed by national maternity champions under the CNST scheme, which has been running over the same period.

The report on the first year should be an interesting read for all involved in the organisation and delivery of maternity care, as well as incident investigation, safety and claims, providing a valuable overview of a large cohort of recent births. 

On process, the report identifies significantly reduced timescales to investigate, leading to unprecedentedly swift admissions. There will no doubt be other cases where failings were not identified but efforts made to secure evidence at an early stage will allow future claims to be defended. A particular innovation highlighted, successfully piloted by Hill Dickinson, is the holding of combined conferences at which several cases are considered consecutively, further streamlining the traditional claims process.

The report contains analysis of compliance with best practice in the investigative process and duty of candour, as well as support offered to staff.

On safety, there is a detailed breakdown of a large number of births by demographics and contributory care factors, from which themes for further investigation are drawn, with the report concluding with six concrete recommendations:

  • All families whose baby meets the EN criteria and requires treatment for a potentially severe brain injury should be offered a full and open conversation about their care
  • An independent package of support should be offered to all NHS staff to manage distress associated with incidents
  • There is an urgent need for an evidence-based, standardised approach to fetal monitoring
  • Increased awareness is needed of the risks of an impacted fetal head and difficult delivery of the head at caesarean section
  • To work with existing national programmes to improve the detection of maternal deterioration in labour, including monitoring and the implementation of evidence-based guidance in all birth settings
  • Increased awareness is needed of the importance of high-quality resuscitation and immediate neonatal care on outcomes

The report will be considered at an NHS Resolution national conference on maternity safety in Birmingham on 5 December 2019, ‘Sharing best practice for safer births’, open to all NHS trusts in England.  

If you would like to discuss the EN or CNST maternity incentive schemes, or any other initiatives on maternity care, please contact Andrew Leslie or Rebecca Hunt.

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