October 6, 2017

NHS Resolution: working towards better obstetric care

NHS Resolution is continuing its focus on preventing harm and improving patient safety by turning its attention to cerebral palsy cases which, although limited in number, come at an extremely high cost. The recently published report “Five Years of Cerebral Palsy claims” produced in conjunction with The Royal College of Obstetricians, The Royal College of Midwives, NHS England and NHS Improvement, comprises a detailed review of 50 cases where liability was admitted in respect of a birth injury sustained between 2012 -2016. 

The report concluded that the incidence of such cases remained fairly static, with little improvement noted in crucial aspects of obstetric management. Two key areas for improvement were identified: future training for the clinical staff, and better quality serious incident investigations.

The quality of the internal investigations which were carried out into the cases at a local level was described as “poor”. As a consequence, the investigation not only failed the family and the staff involved in the case, but also, crucially, deprived the wider NHS of a learning opportunity thereby reducing the prospects of such cases occurring in the future. The poor quality of the root cause analysis was also identified as problematic, with the focus of many Serious Incident (SI) investigations being upon the performance of individuals, rather than upon a thorough analysis into why their performance had been inadequate.

As for the clinical themes identified, they will be only too familiar to those with some experience in such claims; fetal heart rate monitoring and breech deliveries were both highlighted as specific areas of concern, as were staff competency and training, with patient autonomy also identified as a common feature in the claims.

The report concludes with 4 key recommendations; the greater involvement of families in the SI investigation, the introduction of an accredited programme of training for those carrying out the SI investigations, independent peer review of all cases of birth related brain injury and adequate support of staff involved in the investigation.

 Given the enormous costs of these claims, both financial and emotional, it is to be hoped that the recommendations are implemented in full.

Authors: Sian Fisher