Health and Social Care Committee's Report on maternity safety says rate of improvement too slow

A report by the Parliamentary Health and Social Care Committee inquiry into maternity services in England, chaired by Rt Hon Jeremy Hunt, has condemned the rate of improvement in NHS maternity care as too slow.

The committee’s conclusions are based on evidence gathered from witnesses at the inquiry, and from a panel of independent experts commissioned to evaluate the government’s progress in meeting its own maternity safety goals. The expert panel used a CQC-style scoring system which rated the progress on reduction in neonatal deaths and stillbirths as ‘good’. However, three key areas of maternity safety, safe staffing and continuity of carer were rated as ‘requires improvement’, with an ‘inadequate’ rating for improvements towards women receiving personalised care. 

Staffing shortages must be addressed so that maternity staff can deliver safe maternity care

The report emphasised that appropriate staffing levels are a prerequisite for safe maternity care. However, progress in this key area was rated as ‘requires improvement’.  The inquiry heard evidence which suggested that:

• 8 out of 10 midwives believed that there were not enough staff on their shifts to be able to provide a safe maternity service;
• every maternity unit has gaps in its rotas for doctors;
• the NHS needs, as a minimum, 496 more obstetricians (childbirth doctors) and 1,932 more midwives;
• maternity team staffing includes anaesthetists to provide timely pain relief, which is a key component of safe, personalised care.

Staffing shortages are also preventing staff from taking part in essential training needed to deliver safe care, with only 8% of units meeting the highest standards of training set out in the Saving Babies’ Lives Care Bundle. The report recommended that funding should be ring-fenced and targets set for training. 

Whilst acknowledging that the Department of Health and Social Care (DHSC) has agreed funding for RCOG to develop a tool to help trusts calculate required workforce levels, they recommended that the government urgently commits more funding to provide safe care to all mothers and babies.

NHS still not learning from patient safety incidents in maternity care

The report reflected on how little had changed at the time of the Ockenden Report in 2021 since the findings of the  Morecambe Bay Investigation in 2015. Evidence from the CQC’s Chief Inspector of Hospitals suggested that a defensive culture, dysfunctional teams and failure to learn safety lessons is commonplace in many of England’s maternity units.

The inquiry raised concerns that families are still not receiving the support they deserve after a maternity safety incident. The report acknowledged HSIB’s role in following up failings in maternity safety with independent investigations but found their effectiveness limited by lengthy waits for their reports and trusts’ failure to implement recommendations made by HSIB.  The report recommended that:

• before qualifying, all types of clinicians should be trained in how to respond and accept their own fallibility when they are found to have made mistakes;
• HSIB investigations should continue, but HSIB should review how it works with trusts to investigate in a timely and collaborative way, involving multi-disciplinary healthcare professionals at all levels, including junior doctors and midwives;
• HSIB should systematically share the learning from maternity investigations rapidly across the NHS in an accessible way.

The inquiry found that women and babies are still suffering harm as a result of a midwifery culture which promotes ‘normal birth at any cost’ and are made to feel that they have failed by having a caesarean section. They urged those working in maternity leadership positions, including within NHS England and Improvement (NHS E &I) and professional organisations such as the RCM and RCOG,  to ‘stamp out’ this damaging ideological focus on, and use of the phrase, ‘normal birth’.

The report calls for an immediate end to penalising maternity services for high caesarean rates and asks NHS E&I to write to all maternity units to make them aware of this change. They urged NHS E&I to ensure that every woman is fully informed about her birthing and pain relief options, and the safety risks for her and her baby. They recommend wider work take place to reduce the pressure on women to have an unassisted birth or vaginal delivery, including from society, the media and social media.

Despite the poorer outcomes for mothers and babies from BAME groups having been documented for many years, the inquiry found that there has been little progress in closing the gap. Given the wide range of complex issues which contribute to inequalities in maternal and neonatal treatment and outcomes between those from BAME and white backgrounds, the report recommends that the government sets a target to end the disparity in outcomes together with a clear timeframe for achieving that target.

Inquiry urges immediate implementation of Rapid Resolution and Redress Scheme (RRR) and cuts to maternity compensation

It seems that any report into the NHS’s inability to reduce the shocking scale of avoidable harm or learn from its mistakes inevitably turns the spotlight of blame onto the families who seek their severely injured child’s legal entitlement to compensation. It comes as no surprise that this report does the same. The report blames the adversarial nature of litigation, in which patients must prove that their injury was caused by negligent care, for promoting a culture of blame within the maternity unit where the tragic injury took place, instead of a culture which is open to learning.  

Back in 2017, the DHSC consulted on a Rapid Resolution and Redress Scheme (RRR). Since then, progress towards RRR has been limited to NHS Resolution’s Early Notification Scheme (ENS), which in its first year provided just 24 families out of 746 reported cases with an admission of liability, apology and, in some cases, financial assistance.

The inquiry report now says that whilst ‘providing appropriate financial redress to families after an incident is important’, the rising costs of maternity claims without sufficient learning and, based on what it calls ‘outdated mechanisms for calculating compensation’ is unsustainable. It recommends:

• rapid implementation by DHSC of the Rapid Redress and Resolution Scheme in full whilst the government reviews (and considers reforming) the existing negligence claims system;
• DHSC produces its plan and timetable for reviewing the clinical negligence system by September 2021;
• after that review, DHSC should make proposals to bring in reforms which:
  • compensate people injured by maternity mistakes based on whether an incident was avoidable rather than caused by clinical negligence;
  • cut compensation for private care costs where appropriate care is available on the NHS;
  • cut compensation for a brain damaged child’s loss of earnings by basing their claim on national average wages instead of the range of earnings that the child would probably have achieved;  

• the GMC (which disciplines doctors) and the NMC (which disciplines nurses and midwives) must review the changes they must make to reduce fear amongst clinicians, to allow them to be more open about their mistakes.

Boyes Turner remains committed to helping families claim compensation for severe birth injury

Overall, the panel of experts rated the government’s progress on improving maternity safety outcomes as ‘Requires Improvement’. Put simply, the NHS is still failing to learn from maternity mistakes when it could, and should, do better. Until it learns and the harm stops happening, our birth injury specialists remain committed to helping severely injured children, women and their families rebuild their devastated lives through their legal right to compensation.

If you or your child has been severely injured as a result of maternity mistakes, you can find out more about your right to make a claim for compensation by speaking, free and confidentially, to one of our specialist solicitors by contacting us here.