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Improve training on group B strep to 'save money and babies' lives'

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Maternity staff need more training on how to prevent, identify and treat group B streptococcus infections to stop babies needlessly dying or being left with life-changing disabilities, says a new report.

The report by the charity Group B Strep Support warns a failure to take basic steps to prevent or tackle infection is costing the NHS millions in negligence claims.

“The NHS must learn from these events and ensure they’re prevented in the future”

Jane Plumb

It analyses 32 settled or ongoing clinical negligence claims against the NHS where a group B strep infection was suspected or confirmed.

In nearly two thirds of these cases the harm caused was down to a “breach of duty of care”, according to the report, which is based on a survey of six law firms.

The most common reasons for a breach were “negligent failure” to give preventative antibiotics or “negligent failure” to spot the signs of infection.

The cases that have been settled or where liability was admitted represent a £40m cost to the NHS, increasing to £50m if all ongoing claims are successful, according to the six law firms that took part.

Group B strep, which is carried by around a quarter of women without symptoms or side effects, is the most common cause of life-threatening infection in newborn babies in the UK.

However, new and expectant mothers are rarely informed about group B strep as part of routine care, according to The Cost of Group B Strep Infection report (see PDF attached below).

“The first time many parents hear of it is when their baby is sick in hospital with meningitis, sepsis or pneumonia,” it stated.

This is despite the fact group B strep infections kill one baby each week in the UK while another will be left with a disability.

“In many cases nothing could have been done to change what happened to the baby,” said the report. “However, sometimes mistakes are made that result in babies developing group B strep infection unnecessarily, or that result in the infections not being identified or treated properly.”

To find out what prompted parents to take legal action and what lessons could be learned, the charity asked members of its expert legal panel to provide information on current and past negligence claims from 2006 to 2018.

Of the 32 cases identified, nine were settled with liability admitted while two were settled with no admission of liability. Meanwhile, five cases were unsuccessful and 16 are ongoing.

Out of the 32, 21 babies survived their infection but almost all were reported as having some kind of long-term health issue or disability including hearing loss, visual impairment, brain damage and cerebral palsy.

“We strongly support that NHS trusts offer an apology and work in partnership with families”

NHS Resolution 

In most cases where there was a “breach of duty of care” there were one or more failures to follow established guidelines, which would have led to more timely administration of antibiotics, said the report.

The most common care failings related to a failure to give antibiotics where a mother was known to carry group B strep or there were recognised risk factors.

In 13 cases the mother was not given antibiotics during labour – known as intrapartum antibiotic prophylaxis – including in five cases where she was known to carry group B strep.

In another four cases there was a delay in providing intrapartum antibiotic prophylaxis.

Examples of risk factors that were missed in the mother include fever and prolonged rupture of membranes.

In two cases a urine test detected the presence of group B strep but the message was not relayed to the mother and no treatment was given for group B strep or antibiotics offered during labour.

Meanwhile, there were nine cases where health professionals failed to identify infection in babies or where signs such as poor feeding, weight loss following birth or respiratory problems were not taken seriously enough.

“In two of these cases there was a failure of health professionals to respond appropriately to reports from parents after the baby had been discharged,” said the report.

One mum was not advised to take her baby for urgent assessment on the day after discharge despite the fact she reported her baby had a purple rash, was struggling to feed and had rigid arms.

There were four cases were meningitis and/or sepsis was missed including two where a diagnosis was eventually made but there was a severe delay in starting treatment.

The main reasons for taking legal action include parents’ dissatisfaction with the hospital’s investigation or handling of the complaint, clinical failings around the time of birth or issues that emerged later, and the need for financial support for the continuing care of a child.

“Sometimes mistakes are made that result in babies developing group B strep infection unnecessarily”

Report 

In two cases included in the report mothers wanted answers to questions because they felt responsible for the infection that had a life-changing effect on their child.

One of the report’s key recommendations is the need to overhaul the NHS’s complaints procedure to ensure parents are involved much earlier in investigations and throughout the process.

The report also calls for better staff training. “All NHS trusts should follow national guidelines on group B strep from the Royal College of Obstetricians and Gynaecologists (RCOG) and offer better training to staff involved in maternity and newborn care on preventing, spotting and treating group B strep infection,” it stated.

While other countries like the US, Germany and France routinely offer antenatal tests for Group Strep B, the UK does not.

However, in late 2017 RCOG updated its guidance and recommended women who tested positive in their first pregnancy should be tested for Group B Strep using the ECM (enriched culture medium) test.

Jane Plumb, chief executive of Group B Strep Support, said her organisation would continue to push for routine screening for group B strep.

“The NHS must learn from these events and ensure they’re prevented in the future,” she said.

“Too often parents are left with unanswered questions about what happened and why care has not met expected standards. Patient safety must be prioritised,” she added. 

A spokeswoman for NHS Resolution, which deals with litigation on behalf of the health service, said it was “committed” to working with system partners in reducing and preventing future harm.

She added: “We strongly support that NHS trusts offer an apology and work in partnership with families at the earliest opportunity during investigation processes.”

The report can also be viewed via the charity website. 

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