NHS Resolution provides update on early notification

The notification scheme for brain injuries at birth has resulted in early admissions of liability being given to 24 families within 18 months of the birth, according to NHS Resolution.

Its progress report on the scheme, which was set up in 2017, makes six recommendations to support the clinical issues identified in the research, covering topics such as how families are treated when things go wrong, to monitoring in labour, and awareness of risk factors of brain injury at birth.

From 1 April 2017, all NHS trusts were required to report within 30 days maternity incidents of potentially severe brain injury, so that NHS Resolution could capture data, work to improve patient safety and disseminate outcomes on a national basis.

Previously, the average length of time between an incident occurring and an award for compensation being made was 11-and-a-half years, with claims often not passed to NHS Resolution until four to five years after the incident and compensation paid when the full extent of injuries were apparent.

A key ambition of the early notification scheme has been to shorten the time taken to report an incident from years to days, to enable learning to be identified quickly and support to be provided to families when they need it most.

As a result of the scheme, families have been provided with a detailed explanation, an apology and sign-posting to independent representation.

Where an entitlement to compensation has been identified, families have also been given prompt financial support for clinical and respite care, and psychological support where required.

According to the report, early admissions of liability have been given to 24 families within 18 months of the birth.

NHS Resolution is working in partnership with other national organisations, including the Royal College of Midwives, Royal College of Obstetricians and Gynaecologists, the National Maternity Safety Champions, and NHS England and NHS Improvement through the Maternity Transformation Programme to support the government’s target of halving the rates of stillbirths, neonatal/maternal deaths and brain injuries associated with birth by 2025.

Common themes in 96 cases were explored and included limited support to staff, a lack of family involvement, and confusion over duty of candour, as well as several contributory factors, such as issues with fetal monitoring.

The report’s six recommendations to support the clinical issues identified in the research are:

• 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
• An independent package of support should be offered to all NHS staff to manage the distress that can be associated with providing acute health services and in particular those involved in incidents
• There is an urgent need for an evidenced-based, standardised approach to fetal monitoring in England
• Increase awareness of impacted fetal head and difficult delivery of the fetal head at caesarean section, including the techniques required for care
• Work with existing national programmes to improve the detection of maternal deterioration in labour, including monitoring as well as the implementation of evidence-based guidance in all birth settings
• Awareness of the importance of high-quality resuscitation and immediate neonatal care on outcomes for newborn babies

Helen Vernon, chief executive at NHS Resolution said: “Avoidable brain injury at birth, whilst rare, carries a cost to the NHS of billions of pounds in compensation payments and has lasting consequences for families, and the NHS staff involved.”

“We owe it to them to learn from these cases to prevent the same things happening again and to provide support, right at the start when it can make a difference. This new approach is already delivering answers to families and recommendations for improvement to the NHS, cutting years out of the process and removing the prospect of litigation as a barrier to candour.”

Dr Samantha Steele, lead author and National Obstetric Clinical Fellow at NHS Resolution, said: “Having a baby should be a positive experience for families but sadly things do occasionally go wrong in maternity care with devastating effects. By carrying out early liability investigations, we can improve the experience for families and staff affected, provide early support and reduce formal litigation in the courts and the associated legal costs. Proximity to incidents also enables time relevant learning to be identified and shared at a national, regional and local level.”

Mark Dugdale