'Grading' the safety of maternity services in England
The Health and Social Care Select Committee of the UK Parliament has today published a progress report regarding the safety of maternity services in England. Attached to the report was the assessment of Government performance made by the committee's expert panel, which is made up of healthcare practitioners, legal professionals and academics.
The expert panel's review included a rating system, evaluating progress made by the Government against its commitments in different areas of healthcare policy. The possible ratings echoed those of the Care Quality Commission (CQC) which monitors and inspects hospitals and other healthcare providers. The Government's performance could be rated 'outstanding', 'good', 'requires improvement' or 'inadequate'.
How has the Government been rated?
The expert panel's conclusion was that overall the Government's performance against its commitments on maternity safety 'requires improvement'. More worryingly, the expert panel rated the Government's performance against its target on maternal deaths as 'inadequate'.
In 2015 the Government announced the National Ambition, which was updated in 2017 to reflect the following commitments in relation to safety in maternity services:
- to halve the rates of stillbirths, neonatal deaths, maternal deaths and brain injuries that occur during or soon after birth by 2025
- to achieve a 20% reduction in these rates by 2020
- to reduce the pre-term birth rate from 8% to 6% by 2025
An improving picture (in some respects)
The first MBRRACE-UK report on perinatal deaths in 2013 gave the UK a poor review in relation to stillbirth and neonatal mortality rates, in comparison to other European countries. The expert panel now says that there is evidence of significant progress being made in reducing these rates (with reductions of 25% in relation to stillbirths and 30% in relation to neonatal deaths since 2010).
However, the expert panel expects progress to have been hindered, or even for there to have been some regression, as a result of the COVID-19 pandemic. It also found that there is little evidence that the target on reducing brain injuries occurring during or soon after birth is on course to be met. Tragically, the same applies to the Government’s target on reducing maternal deaths.
What should be done?
Any death or serious injury during childbirth is a tragedy. Troublingly, it appears to be a tragedy that disproportionately affects some groups. For example, the expert panel found that babies from ‘minority ethnic or socio-economically deprived backgrounds’ are at significantly greater risk of perinatal death.
The expert panel flagged up several issues that need to be addressed:
- It has consistently been informed that insufficient resources and staffing numbers within the NHS preclude the training opportunities required to learn and implement recommended guidance.
- Greater efforts, resources and funding are required to reduce the disparity in outcomes between women and babies from different backgrounds.
- The importance of avoidable harm needs to be recognised. In 2020 Each Baby Counts found that 75% of stillbirths and deaths at term were potentially avoidable with different care.
Identifying when and why things go wrong
Whilst not all incidents in maternity services are preventable, some are and any missed opportunity to avoid harm should be recognised and learned from. Unfortunately, our clients who have suffered such harm often report that the NHS trusts involved have failed to carry out any investigation which could identify how or why this happened.
Improving that system is one of the aims of the Healthcare Safety and Investigation Branch (HSIB) maternity investigation programme. That body, funded by the Health and Social Care department, undertakes investigations in the hope of identifying common themes and helping to influence improvements in maternity services.
However, not all incidences of harm to babies and mothers during or around childbirth fall within the remit of the HSIB. There will therefore be cases involving (potentially avoidable) serious injuries or deaths which will either be investigated internally by the NHS trusts involved, or not at all.
The expert panel suggests that reviewing unexpected perinatal and maternal death rates should become a "performance metric" for NHS trusts, rather than simply relying on the trusts to self-detect and report on these. This should help to identify poorly performing trusts and guide them in addressing the problems found.
Our experiences of acting for bereaved families confirm that this is often what they want, more than financial compensation. Unfortunately, compensation is all that a court will be empowered to grant if a clinical negligence claim succeeds in relation to a child’s or mother’s death or injury. However, it is to be hoped that the nature and numbers of such successful claims against particular NHS trusts may also feed into any system of recognising and addressing systemic problems in maternity services.