Sajid Javid announced in Parliament on 26 January 2022 plans to establish a new Special Health Authority to continue the Maternity Investigation Programme in England currently overseen by the Healthcare Safety Investigation Branch (HSIB).
The commitment to continue with independent maternity investigations under the new body is a positive development and should ensure that the significant learning that arises out of these investigations continues.
A new organisation, the Health Services Safety Investigation Body (HSSIB) will take up the role of HSIB, likely in 2023, except for maternity investigations for which a new Special Health Authority is to be created. This will separate the maternity function out to a new body.
The new Special Health Authority is intended to:
undertake independent, standardised family-centred investigations in maternity cases;
provide learning to the health system at local, regional and national level, via reports, to improve clinical and safety practices in NHS Trusts, to prevent similar incidents and deaths occurring;
analyse data from investigations to identify key trends, provide system-wide learning, identify where improvements are being made or where there is lack of improvement;
be a system expert in standards for maternity investigations;
support NHS Trusts to improve local investigations; and
collaborate with system partners to escalate safety concerns and share intelligence.
HSIB has undertaken investigations into intrapartum stillbirth, early neonatal death, severe brain injury diagnosed in the first seven days of life, and maternal deaths since April 2018, with concern that this important function should not be lost.
While the new HSSIB will conduct investigations within a statutory ‘safe space’, maternity investigations conducted by the new Special Health Authority will not be subject to this provision (continuing the present position, but with the separation of roles resolving a tension).
Further details of the new body are yet to emerge, such as whether their criteria and methodology will remain as it did under HSIB, and the correlation with the NHS Resolution Early Notification Scheme.
Maternity investigations are an important element in meeting the National Maternity Safety Ambition to halve the 2010 rates of stillbirths, brain injury and neonatal and maternal deaths by 2025.