The government has confirmed that its former plans for maternity safety investigations to be carried out by the Health Service Safety Investigations Body (HSSIB), the new statutory successor to the HSIB, have been removed from the Health Service Safety Investigations Bill.
The HSIB is expected to report on 300 of its current investigations early this year but will lose its maternity investigation remit by 2021.
At present, it is unclear how these important investigations will be managed but it is likely that they will be handled by a new body within the NHS.
The withdrawal of HSIB’s maternity safety investigation powers is the latest development in a series of unsuccessful attempts to achieve thorough investigation and open communication following serious injury to babies from failings in maternity care.
What is the Healthcare Safety Investigation Branch?
The Healthcare Safety Investigation Branch (HSIB) was established in 2017 to carry out independent investigations into patient safety concerns in the NHS in England. According to HSIB’s website, their purpose is to ‘improve patient safety through effective and independent investigations that do not apportion blame or liability.’
HSIB’s national investigations deal with a range of patient safety issues arising from NHS treatment in England after 1 April 2017 including concerns with medication, missed and delayed diagnoses of health conditions and the provision of mental health services.
Once HSIB has investigated a particular issue, HSIB’s investigation report is prepared and published on their website. This report may include ‘safety recommendations’, intended to prevent future similar events, to which the healthcare organisation must respond within three months. The report can also make ‘safety observations’ suggesting actions for wider learning and improvement within the healthcare organisation.
HSIB’s national investigations are independent and completely separate from NHS hospital trusts’ own complaints procedures and serious incident investigations. Where the incident concerns maternity care, HSIB’s investigation is currently carried out in place of any local, internal hospital investigations.
HSIB maternity investigations
In recent years a number of government/Department of Health and Social Care, NHS and professional initiatives have been working to reduce harmful maternity safety incidents and their resulting compensation claims by encouraging the NHS and its employees to learn from mistakes.
In 2015, The National Maternity Safety Ambition was launched which aimed to halve the rates of stillbirths, neonatal and maternal deaths and brain injuries occurring soon after birth by 2025. When this was updated in The Safer Maternity Care Plan in 2017, HSIB were tasked with carrying out maternity safety investigations.
In 2015, the Royal College of Obstetricians and Gynaecologists (RCOG) launched its own national quality programme designed to reduce the number of babies who die or are left with severe disabilities when something goes wrong during term labour by 50% by 2020. There are 1000 babies each year who fall within this category. RCOG recognised that many of these tragedies could have been avoided with better care and criticised the poor standard of local NHS trusts’ maternity safety investigations, two thirds of which excluded the injured child’s family from involvement in the investigation.
From 1 April 2018, HSIB became responsible for all patient safety investigations occurring in the NHS which met the criteria for the Each Baby Counts programme.
In 2018, the Parliamentary Joint Committee which reviewed the draft Health Service Safety Investigations Bill condemned the government’s attempt to place maternity safety investigations within the remit of the proposed independent statutory successor to the HSIB, the Health Service Safety Investigations Body (or HSSIB). At the time, we shared our support for the Parliamentary Joint Committee’s concerns. The government has now confirmed that under the new draft legislation, HSSIB will not carry out safety investigations relating to maternity care.
What happens next?
HSIB are expected to be permitted to continue with their investigations into NHS maternity services until 2021, when it is thought that a new body, possibly within the NHS, will take over this role.
By October 2019, HSIB had received 1,166 maternity incident referrals. It had 459 active maternity investigations and had completed 175 maternity investigations. HSIB expect to have their preliminary assessment of the first 300 cases completed by early 2020 which will lead to the publication of an annual review setting out key themes.
Failings during maternity care can have devastating consequences for the baby and their family, including the death of a baby or devastating injury with lifelong disability. When avoidable harm occurs as a result of failings in maternity care patients and their families have a right to be included in a thorough, fair and open investigation, and to receive answers and compensation. Avoidable injury will only be reduced if the NHS is willing to learn from its mistakes. To do so it must work harder to improve the quality and integrity of its serious incident and maternity safety investigations and act on their findings and recommendations.