TThe staggering rise in the cost of medical negligence cases to the NHS in England, and the sharp increase in maternal injuries during childbirth, are the latest warning signs of deeply disturbing failings in maternity services. The £60bn estimate of negligence liabilities from the National Audit Office represents a quadrupling in less than 20 years. While some medical specialties saw salaries decline, salaries in obstetrics rose. The reason payments are higher in these neglect cases is that when children are injured, grants must cover lifelong care needs.
It is widely recognized that there are serious deficiencies in maternity care, along with unfair disparities in outcomes for women of different socio-economic and ethnic groups. Preventable deaths and injuries at units in Morecambe Bay, Shrewsbury and Telford, and East Kent, have been among the most shocking patient safety scandals in recent years.
Investigations following these and other tragedies revealed a range of problems including poor collaboration between doctors, poor leadership, lack of openness and inability to learn from mistakes, inadequate staffing, and poor practices including lack of monitoring. But despite the long lists of recommendations, and some improvements, including in the use of data, it is impossible to be confident that the mistakes of the past cannot be repeated. Two years ago, the Care Quality Commission rated two-thirds of maternity units as inadequate or in need of improvement. Last year, the first parliamentary report on women’s birth trauma was published That’s it “Poor care is often tolerated as normal, and women are treated as a nuisance.”
Health Minister Wes Streeting said raising standards would be a litmus test for this government. But although his confirmation is welcome, and should prompt trust chiefs to pay greater attention to an area often overlooked, it is not clear how improvement will be achieved. A set of goals agreed in 2015, including halving maternal and newborn deaths, are on track to fail. And their bereaved families He slammed hard The remit for the rapid investigation is in specific units announced by Mr Streeting in the summer, which are due to report back next year.
The increasing number of severe vaginal tears, as well as the increase in maternal deaths, and the level of hospital readmissions of new mothers all point to issues that go beyond the relatively small number of cases in which a baby suffers brain damage as a result of medical errors.
Regarding maternal injuries, part of the recorded increase may be due to improved reporting and increased awareness of a topic that was not usually discussed at all. Experts say the changing demographics of mothers, with an increasing number of older and heavier women, is one factor in increasing the risks. The increasing proportion of cesarean deliveries presents challenges not because it is a problem in itself, but because it imposes different demands on the staff and the system. Unmanageable workloads are known to cause employee retention problems.
Given all this complexity, there can be no simple formula for developing a maternity care system. The concern here is that this latest review may produce another set of recommendations that are no more likely to succeed than those that came before it. But it is, at the very least, an opportunity to focus minds on the urgent need to improve birth outcomes and experiences.