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Health secretary aims to 'dismantle' maternity litigation culture in NHS

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Families who suffer harm after failings in maternity care could be given access to a new voluntary compensation scheme, health secretary Jeremy Hunt has announced today, as part of a new action plan that also includes funding for training and innovation.

In a statement, the government said the plans for a “rapid resolution and redress” scheme were the “first steps to dismantling the litigation culture”, which it said was a barrier to openness and transparency.

“We hope to achieve a dramatic reduction in the number of tragedies”

Jeremy Hunt

The scheme, which is one of a raft of measures outlined in a new maternity safety action plan – Safer maternity care: next steps towards the national maternity ambition – would be an alternative to families having to take legal action against NHS trusts that can take many years to reach a resolution.

Mr Hunt also announced a new mortality review tool to enable standardised recording and investigation of every stillbirth and neonatal death, so lessons can be learnt and shared across the system.

Other measures outlined by the health secretary included an £8m fund for multidisciplinary training, with at least £40,000 available to each NHS trust, as well as a national quality improvement programme for maternity services.

“It could have a significant and positive impact on the safety of England’s maternity services”

Cathy Warwick

The voluntary compensation scheme, to be consulted on, will provide families with an independent investigation of the incident and the option to join a compensation system that will offer regular payments to families without having to go to court.

According to the Department of Health a similar scheme in Sweden has been credited with contributing to a reduction in avoidable birth injuries by 50% in the last seven years.

There are up to 500 incidents a year of the type the scheme could investigate and it will also include counselling, case management and legal advice.

Mr Hunt said: “Our NHS maternity staff do a fantastic job under huge pressure. But even though we have made much progress, our stillbirth rates are still among the highest in western Europe and many on the frontline say there is still too much of a blame culture when things go wrong – often caused by fear of litigation or worry about damage to reputation and careers.

Jeremy Hunt

Jeremy Hunt

Source: Neil O’Connor

Jeremy Hunt

“These comprehensive measures will give practical support to help trusts improve their approach to safety – and help to foster an open and transparent culture so that the courts become a last resort not an automatic first step,” he said in a statement issued today.

“By learning from proven methods in countries like Sweden we hope to achieve a dramatic reduction in the number of tragedies where babies are lost or injured for life,” he added.

The government has previously announced an ambition to halve the rates of neonatal death, stillbirth, maternal death and brain injuries caused during or shortly after labour by 2030.

Other key actions highlighted by Mr Hunt included:

  • Consultation on “safe space” legislation to allow clinicians to talk openly about mistakes without fear of being sued or disciplined
  • Launch of the Healthcare Safety Investigation Branch from April 2017
  • The appointment of two national maternity safety champions: Matthew Jolly and Professor Jacqueline Dunkley-Bent
  • Maternity safety training fund of £8m administered by Health Education England
  • A £250,000 innovation fund for safety projects in maternity

Professor Cathy Warwick, chief executive of the Royal College of Midwives, said: “This is an ambitious plan that has the RCM’s full support. If implemented it could have a significant and positive impact on the safety of England’s maternity services, and contribute towards better and safer care.

“I really welcome the focus on public health, on reducing stillbirths and on improving services for pregnant women with maternal mental health problems,” she said. “These are areas that desperately need attention.


Cathy Warwick

“The plan’s focus on issues such as improving maternity service teamwork, sharing successful strategies, openness and transparency, and on learning when things go wrong is absolutely right,” she said. “These are areas where improvements can almost certainly be made without significant additional resources.

Professor Warwick noted that the intention to consult on a rapid resolution and redress scheme was “especially welcome”, as this could make a major difference to parents who experience a tragedy at birth.

“It is also excellent that part of this plan involves working directly with women to ensure they are aware of what can go wrong and can come forward quickly for help and advice,” she said.

She added that the plan “quite rightly” focused on the importance of training and skilling staff up to implement quality improvement. The £8m multi- disciplinary training fund is “very welcome and timely”, she said.

“I do, however have concerns about the ability of maternity services to fully implement the plan and achieve the ambitious targets in the current climate,” she said. “We are deeply worried about the pressures being reported to us from midwives working directly with women.”

“The devil will be in the detail of these proposals”

Peter Walsh

The charity Action against Medical Accidents gave a “cautious welcome” to the proposals for an alternative compensation scheme for maternity cases and improvements to patient safety.

However, it warned that the compensation scheme needed to be designed very carefully to protect the interests of injured babies and their families.

AvMA chief executive Peter Walsh said: “It is imperative that safety is improved to prevent these dreadful mistakes happening so often, so we welcome the added impetus to that. We also welcome the principle of compensating people more quickly without the stress and cost of litigation.


Peter Walsh

Peter Walsh

“However, the devil will be in the detail of these proposals,” he said. It is essential that any scheme compensates people fairly according to their individual needs rather than short changing them in return for a ‘quick’ settlement.

“The people investigating and making decisions about these cases need to be totally independent, and the families themselves need to be empowered in the process through the provision of specialist independent support and legal advice,” he said.

He added: “We are yet to see any real detail about how the proposed scheme will work. We do not want people to feel pressurised into accepting something less than they need and deserve just to save the NHS money. The main emphasis should be on prevention.”

Jonathan Ashworth, Labour’s new shadow health secretary, said: “Any measures to improve the quality and safety of maternity care is welcome.

“However, the government is offering no plans to address the serious financial crisis now facing the NHS and the shortage of midwives,” he said.

“It was the Tory government who promised us 3,000 more midwives but have actually presided over a shortage of 3,500 midwives in England,” he claimed.


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