Patricia Wakeford, Clinical Negligence Legal Director, attended the Westminster Health Forum Event about Maternity Services in England – Patient Safety, Service Delivery and Policy Priorities.
This event took place at The Court House, St Andrews Street in London on 10 July 2019. It was well attended by representatives including Maternity Services NHS England, SANDS, NCT, NHS Resolution, the Family Nurse Partnership National Unit, NHS Digital, CQC and the RCM.
Unfortunately, there was too much information and too many ongoing projects to be able to detail them all in this article. Therefore, I have considered specific areas that impact on my job as a clinical negligence solicitor.
The initial session was chaired by Sharon Hodgson, Shadow Minister for Public Health, all-party Parliamentary Group on Baby Loss.
Claire Mathews, Deputy Head of Maternity Services NHS England; was the first speaker. She talked about tackling inequalities in maternity services; the Long Term Plan (LTP) and the Maternity Transformation Programme (MTP). There are 7 chapters in the LTP that cover various areas such as funding, tackling work force pressures, a service model where patients will get more options and joined-up care, health care inequalities and care and outcome improvement. Find out more information about the NHS Long Term Plan here.
Specifically for maternity services there was confirmation of the continuity of carer (COC). This was proposed in the 2016 Better Births which aimed to improve maternity services. More information is available on the National Maternity Review. This makes available a team of midwives that provide the support and care throughout pregnancy, labour, delivery and in the postnatal period. I know from my own midwifery practice that women are less anxious if they know the midwife who will be caring for them.
I asked if clinicians and midwives would receive more training about listening to women as many cases that I am involved in relate to staff assuming that the woman was exaggerating about her level of pain. This resulted in significant psychological harm including Post Traumatic Stress Disorder. Psychological input was not forthcoming early on for my clients; possibly because their mental health was not considered or assessed after a traumatic event. The impact on the mother and family was significant in all cases and caused issues with bonding with their baby in some cases. I hope that going forward this will change so support will be there pre-discharge or very soon afterwards. Taking a new baby home should be a wonderful experience and not daunting due to the mother having to deal with psychological symptoms.
The MTP considers 9 areas including digital records access, promoting good practice, improving access to perinatal mental health services and improving prevention. More information is available on the Royal College of Midwives website here.
There are many associated programmes including UNICEF’s Baby Friendly Initiative which aims to transform healthcare for mothers, babies and families Baby Friendly awards are given to those services that achieve certain standards. This is a good incentive for service providers.
Professor Heather O’Mahen talked about access to mental health care for mothers and families. She said that 1:5 mothers experience mental health issues. 50% of cases remain undetected and only 12-30% of mothers receive treatment. This compares with non-pregnancy where 50% of patients receive treatment. Dr O’Mahen said that anxiety is heightened at this time in any event. Mothers and fathers are worried about what might happen and concerns about their baby. Mental health issues will impact on the baby and family. The long term plan is to treat 24,000 more women.
Dr Clea Harmer from SANDS (Stillbirth and Neonatal Death Charity) said that 5,300 babies die each year. Apparently, 17 pregnancy and baby charities have come together to collaborate on how best to lower this number. I was stunned to hear that 60% of reviews into a baby death do not involve a parent. Dr Harmer rightly notes that the parents are the constant and are present from the start until their baby dies. Staff are being trained in using the right words to approach parents about being involved in a review. Each Baby Counts notes that only 25% of parents are actually aware that a review is taking place. Click here to view the Each Baby Counts key findings.
It is also important to ensure that a woman is on the correct care pathway and delivers her baby in the most appropriate place that can provide the care, treatment and support required. This means that her risks during the pregnancy and delivery are assessed early on. This will ensure the correct support and care pathway for mother and baby. This has been shown to reduce stillbirths.
Dr Nigel Acheson, Deputy Chief Inspector of Hospitals, CQC (Care Quality Commission) said that 2017 was the lowest stillbirth rate on record. This is the last figure available. The ambition is to reduce this by a further 50% by 2025.
I was intrigued to learn that a survey was carried out asking women about their experiences in maternity care. This involved 18,000 people and was published in January 2018. This demonstrated that women were generally more positive about their maternity care as compared with the 2015 survey. However, further improvements can be made.
Dr Denise Schaffer from NHS Resolution explained that the highest number of claims relate to emergency medicine; the most costly are the maternity/baby cases. The cost of clinical negligence claims runs in to billions of pounds. It is important to reduce these figures. NHSR provides support and expertise to NHS Trusts. An early notification scheme is running where trusts notify NHSR within 30 days of cases where a brain injury may result. This is meant to increase openness, reduce stress and avoid a long claim process. Staff are also supported to say if they believe something is wrong and are involved in any complaint process. The aim is to offer early, candid explanations and to learn and improve. I wish that I could say that my clients have had this experience. Some trusts are very good at explaining when things go wrong. I tend to hear from patients of trusts who are less forthcoming as my clients want answers and feel a claim is the only way to get them.
There is also a Maternity Incentive Scheme that rewards trusts that meet 10 safety criteria. In its first year 15% of trusts achieved all 10 criteria, with 132 trusts participating; which represents 100% of trusts providing maternity services. There is a monetary incentive with a refund of part of the fund paid to NHSR.
This was a fascinating morning where I did learn much about what is planned ahead and ongoing to improve maternity services. There are so many different incentives in place and thought has been given to how improvements can be made by various organisations collaborating in how best to achieve these goals. It is important that all involved are doing what is required and this is not always the case.
I look forward to the day when I see few women with PTSD and fewer babies with a brain injury due to errors made around the time of their birth. I think that there may be some time to go before that day arrives; however now I understand the steps that are being put in place to ensure that it does.
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