NHS Resolution has published a report on the first year of its Early Notification (EN) scheme for potential severe brain injury following term labour. The EN scheme has been running since 1 April 2017 and requires NHS Trusts in England to report within 30 days, for investigation, all births which meet the qualifying criteria.

Background

The EN scheme aims to support the government’s priority to halve the rate of stillbirth, neonatal death and brain injury and improve the safety of maternity care. It is innovative and adopts a proactive approach, recognising the potential for early learning and the adverse effect on both families and staff which can be compounded by waiting to see if a claim is made. Early investigation also mitigates the impact of evidence no longer being available and the passage of time of the memories of those involved.

Claims analysis

A total of 746 cases were reported to the EN scheme between 1 April 2017 and 31 March 2018. The report contains an analysis of 96 of a total of 197 cases where NHS Resolution panel firms were instructed to investigate liability. Key themes amongst the clinical issues identified were: limited staff support; insufficient family involvement; confusion over the duty of candour; issues with fetal monitoring; issues with delivery of the head at caesarean section; concurrent maternal medical emergencies and the need for immediate neonatal care and resuscitation

Best practice and safer maternity care

The report makes 6 recommendations:

1. All families, whose baby meets the Early Notification criteria and requires treatment and separation from them for a potentially severe brain injury, should be offered a full and open conversation about their care.
2. An independent package of support should be offered to all NHS staff to manage the distress of incident.
3. There is an urgent need for an evidence-based standardised approach to fetal monitoring in England.
4. Increased awareness of impacted fetal head and difficulties with head delivery at caesarean section
5. Improvements in detection and monitoring of maternal deterioration in labour (within existing national programmes) and implementation of evidence-based guidance.
6. Increased awareness of importance for outcomes of high-quality resuscitation and immediate neonatal care.

Comment

The Early Notification scheme is a ground-breaking approach to investigating liability and delivering the right support to the right people at the right time. In 24 cases families have received an admission of liability, formal apology and in some cases financial assistance within 18 months of the incident. The EN scheme also has the potential to reduce the financial impact on the NHS of the rising cost of claims. It is already proving to be an integral part of the national focus on ‘safer, kinder and more personalised’ maternity care and demonstrates the value of early involvement to reduce future harm.

National Conference on Maternity Safety

The report will be considered at ‘Sharing best practice for safer births’, NHS Resolution’s national conference on 5 December 2019. 

How Capsticks can help

Capsticks is a market leader in healthcare and is ranked in the top tier for clinical negligence and inquest work by the Chambers Guide to the Legal Profession and the Legal 500. We have direct experience of working with the Early Notification team, advising Trusts and liaising with families where a birth meets the EN criteria. If you would like to discuss the Early Notification scheme or any other maternity initiatives, medico-legal or risk issues, please contact Majid Hassan, David Roberts, or Emily Senior.