The Department of Health and the NHS LA have both recently been working hard to find alternative ways of dealing with maternity claims. What should be the happiest event in many people’s lives can cause so much heartache when things go wrong. There is also a wider financial cost, and payments made in relation to maternity claims represent a very large portion of the NHS LA’s annual financial budget both in damages and legal costs, currently running at around £1.6 billion.
Jeremy Hunt has recently announced two new measures to improve the safety of maternity care in the NHS, which will include maternity safety funding and maternity ratings for trusts. The first can be found in a document entitled 'Safer Maternity Care - Next Steps towards the National Maternity Ambition’. The second will be a consultation on an alternative system of compensation to court proceedings for high-value maternity claims, which will include elements from a system operating in Sweden which has led to a dramatic reduction in the number of tragic maternal events.
Safer Maternity Care
This document sets out the actions needed at both national and local level to help build on the progress already made to improve the safety of maternity services in the guidance document, Spotlight on Maternity, published via 'Sign up to Safety' in early 2016. The plan is for all those working in local maternity systems – the clinical staff who deliver the services as well as managers, leaders and commissioners - to provide the systems, tools and guidance to enable everyone caring for new and expectant mothers, their newborns and families to improve in the care they provide. The action plan should be used alongside Spotlight on Maternity and other useful resources and tools collated by the 'Sign up to Safety' team which can be found on the NHS England website.
What should maternity trusts be doing?
There are three actions that any trust with a maternity unit should now consider:
1. Appoint a board-level maternity champion to ensure a board-level focus on improving safety and that it remains a priority item at board meetings. The trust will be expected to appoint such a champion by January 2017 – that person will need to prepare a bespoke maternity safety improvement plan which will be made public.
2. Designate one obstetrician and one midwife to be jointly responsible for championing maternity safety ensuring links to the board, the local maternity clinical network and the Maternal and Neonatal Health Quality Improvement Programme in their region.
3. Work with staff to carry out a training and development self-assessment for their maternity team to ensure an accurate and agreed understanding of the gaps and develop and implement a learning and development plan for the entire multi-disciplinary team determining the appropriate training programme from the maternity safety training catalogue. From October 2016, trusts will be able to apply for a share of the £8 million Maternity Safety Training Fund to support them in training their staff which will be applied for from Health Education England using their self-assessment to ensure training is targeted to the needs of the individual teams.
Alternative system of compensation
The second major initiative is the expected consultation on an alternative system of compensation.
The name for this proposed new system is the Rapid Resolution and Redress (RRR) Scheme. This scheme is based on the immediate notification of serious maternity events, which means it could investigate and learn lessons from more than 500 incidents a year. In cases where harm was avoidable this would lead to timely access to financial support without the current obligation on the families to launch a formal legal process.
Eligible families will be given the option to join an alternative system of compensation that offers support and regular payments without the need to bring a claim through the courts and the scheme would ensure families receive personalised support including counselling, case management and legal advice. A similar scheme operating in Sweden has reduced serious avoidable birth injuries by around 50% in the last six to seven years.
We will have to await the consultation to see further detail but anything that can assist in hastening the investigation in to such tragic incidents is to be welcomed. Helen Vernon, chief executive of the NHS Litigation Authority, indicated at a recent conference that the notification of serious maternity events is likely to start from 1 April 2017.
We believe the NHS LA will benefit from being involved as early as possible to ensure that the right information and documentation is collated early before memories fade, documents are discarded or people move on to other positions. This will enable early investigation and lesson learning (if appropriate) and provide an opportunity to get to the heart of these cases much earlier. It will hopefully save damages and legal costs. We do not believe that early investigation will encourage people to make claims.
It is hoped that these joint initiatives will quickly provide the environment for safer care for the most natural event in the world and lead to reduced spending and increased learning for future births.