NHS Childbirth – Time to cut the blame game amid another scandal – Rachel Sylvester (The Times)

NHS Childbirth
August 16, 2023 Michael 0 Comments

The following article about NHS Childbirth appeared in the Times on Tuesday August 15 2023, 6.00pm.

Families have to fight to get answers from a system that encourages cover-ups and is financially crippling for all sides

My first child was born on Christmas Day. The nurses were wearing angel wings but the experience of giving birth was far from heavenly. A midwife failed to notice the baby was upside down and so, after hours in labour, I was rushed into surgery for an emergency caesarean. I will never forget the doctors repeating, with increasing urgency: “The heartbeat’s decelerating.”

My son arrived safely — just as Santa Claus Is Coming To Town played on a badly tuned radio in the operating theatre — and is now about to go off to university. Many other families have not been so lucky.

Childbirth is messy, painful and often dangerous but there is something going seriously wrong with maternity care in the NHS. Already a litany of tragedies has swept through Morecambe Bay, East Kent and Shrewsbury. Now another scandal is emerging in Nottingham, where dozens of babies died or were injured at the hospital trust.

As many as 1,700 families are involved in what is set to be the largest review into maternity services ever conducted. Donna Ockenden, the senior midwife in charge of the inquiry, produced the scathing indictment of maternity care at Shrewsbury and Telford Hospital NHS Trust. Her investigation found that disastrous failings had contributed to the deaths of more than 200 babies. She told me that she is finding a similar culture of cover-up and lies in Nottingham. “Here we are again,” she said. “Families are having to fight to get answers.”

It is part of a pattern. The NHS is now spending more than twice as much on compensating families for clinical negligence in maternity services (£8 billion a year) as it is spending on maternity care itself (£3 billion). And, of course, these are not just statistics: every claim represents grieving or traumatised parents.

Theo Clarke, the Tory MP, has launched an all-party parliamentary group on birth trauma after a 40-hour labour that she described as the “most distressing” experience of her life. A Mumsnet survey for The Times Health Commission found that nearly a quarter of mothers said the maternity care they received left them or their baby in danger. Several said they had been diagnosed with post-traumatic stress disorder as a result of the birth and some reported terrifying flashbacks. Almost 60 per cent of respondents said they did not feel listened to by healthcare professionals.

Last year the Care Quality Commission, the NHS watchdog, warned that two out of five maternity units in England were providing substandard care: 39 per cent of those inspected “require improvement” or were “inadequate”, the highest proportion on record. In March, England’s health ombudsman concluded that mothers and babies were still being put at risk by unsafe provision because lessons had not been learnt from a series of critical reviews.

When I interviewed Sir Mike Richards, the former chief inspector of hospitals, recently he said it was often the maternity wards that gave him most concern. “I looked into a whole lot of cases of things that had gone wrong and they were heart-wrenching,” he recalled. “There was one woman who had had a locum midwife who really wasn’t up to the job, who didn’t call for help soon enough and, when they finally worked out that they needed to transfer the patient up one level into the obstetrics department, the lift was broken. It was just awful.” There are also appalling inequalities in maternity care, with black women four times more likely to die in childbirth than white mothers.

This is not only about individual error or incompetence, although those exist. There is a systemic problem in maternity care. The lines of accountability are unclear: the units are run by midwives but when something goes wrong they have to call in doctors. No other part of the health service has that dual power structure and there is a cultural clash between the two professions. Midwives prefer to preside over “natural” births, while clinicians are quicker to turn to medical interventions. It makes it hard for them to work as a team. The hierarchical nature of the NHS compounds the problem. The midwives resent the doctors and the doctors look down on the midwives, with patients too often caught in the middle.

A flawed compensation system also drives a cover-up culture. Clinical negligence claims for failings in maternity care can total millions of pounds. The stakes are therefore incredibly high and the legal nature of the process means the claimant has to prove negligence to get an award. That makes it very hard for doctors and midwives to admit to, and therefore learn from, mistakes or for the NHS to improve its processes.

If a baby is brain damaged at birth the financial damages are calculated on the basis of their potential lifetime earnings. In what seems like an increasingly anachronistic arrangement, the formula takes into account their parents’ salaries and education, which means the largest payouts typically go to the wealthiest families. One London hospital was required to pay £37 million but it is impossible to put a price on life. These heartbreaking cases can often take more than a decade to reach a conclusion, meaning parents have to struggle for years to look after profoundly disabled children without adequate financial support.

There is a solution. It would be much better for compensation to be offered automatically when something goes wrong, without families having to go through a lengthy legal battle to demonstrate who or what caused the harm. The focus, as in the airline industry, should be on learning lessons rather than apportioning blame.

New Zealand’s “no fault” compensation scheme is fairer and cheaper than the UK’s litigation-based system. Jeremy Hunt, the chancellor, supports such a reform and asked Treasury officials to produce a cost benefit analysis which reinforced the economic case for change.

For families, this is not about the money. James Titcombe, who lost his newborn son, Joshua, in Morecambe Bay in 2008, said that the current compensation system “retraumatises” parents while discouraging improvements in maternity care. “For families, the last thing on their mind is litigation,” he said. “They want the organisation to learn and they want to heal.”

If the NHS wants to make maternity services safer, kinder and more efficient it needs to put in place the incentives that drive rather than discourage teamwork and good care.

Rachel Sylvester is chairman of The Times Health Commission

Contact Michael, if you require  direct access barrister to represent you in an NHS Childbirth medical negligence case.

NHS Childbirth – Time to cut the blame game amid another scandal – Rachel Sylvester (The Times) was last modified: August 16th, 2023 by Michael

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