Hospital Dr News

“Time to clarify maternity services policy”

A committee of MPs has been highly critical of maternity services in the NHS slamming midwife shortages, a lack of choice for patients and spiralling negligence claims.

The chair of the Public Accounts Committee called on the government to clarify its policy for maternity services, what it wants to achieve and who is accountable for delivery.

The Rt Hon Margaret Hodge MP, chair of the Committee of Public Accounts, said: “Despite an overall increase in the number of midwives there is still a shortage of 2,300 that are required to meet current birth rates – a truly worrying figure.

“We know that many women do not want to give birth in hospital, with care led by consultants, and this is also more expensive. However, 87% of women still gave birth in this setting in 2012. Women who have a low risk pregnancy should be able to choose where to give birth, such as in a midwife-led unit. More could be delivered for less money with better results if there were more midwife-led birth centres available.”

The committee recommended that the Department of Health needs to set out its objectives for maternity care, explicitly stating who is accountable for their implementation and how success against its objectives will be measured.

High attrition rates among midwives is contributing to the shortages, says the committee, and the problem is compounded by more than half of obstetric units being unable to ensure appropriate consultant cover at all times. “All those who use the NHS will be alarmed to hear that evidence suggests the quality of care is worse at weekends,” said Hodge.

The committee also called on the DoH and NHS England to improve research examining the main causes of maternity clinical negligence claims and to stop so many claims coming forward. They should also investigate the variations in performance between trusts to see how services can be improved so that fewer tragic mistakes occur.

Hodge said: “The clinical negligence bill for maternity services is too high. Clearly victims of poor care need to be properly compensated, but clinical negligence costs have spiralled and reduce the money available for frontline care.

“Maternity cases account for a third of total clinical negligence payments and the number of maternity claims has risen by 80% over the last five years. The rate of babies who are stillborn or die within seven days of birth in England compares poorly with the other UK nations and some European countries. Some £480 million, nearly a fifth of trusts’ spending on maternity services, is for clinical negligence cover, equivalent to £700 per birth.”

The NHS Litigation Authority has produced research on the causes of maternity claims, such as mistakes in the management of labour.

Commenting on this aspect, Dr Christine Tomkins, MDU chief executive said: “We cannot afford to continue to pay claims escalating in this way, only radical legal reform will reduce the NHS clinical negligence bill. It is a matter of urgency that policy-makers take this issue seriously and act now.

“Improved patient safety might reduce future claims but even if it were possible to prevent every single adverse incident from now on, this would not tackle existing claims or those arising from incidents that have already happened but where the claim may not be reported for many years into the future.

“Ultimately we are all paying for the ever-increasing rise in NHS compensation costs and it is in all our interests that something is done to address claims costs urgently.”

The MDU is calling for a package of reforms including Repeal of the Law Reform (Personal Injury) Act 1948 which means that the cost of future care must be calculated on the basis that it will be provided privately, and that NHS care must be disregarded. Providing a package of medical and social care through the public sector could save billions and would allow money to be paid into the NHS by insurers and other bodies paying compensation as well as allowing the NHS to retain the funds for the claims it pays on behalf of the NHS.

In 2012, there were nearly 700,000 live births, a number that has risen by almost a quarter in the last decade. There has also been an increase in the proportion of ‘complex’ births, such as multiple births or those involving women over 40. Maternity care cost the NHS around £2.6 billion in 2012-13.

The committee also said women should be given more choice about where to give birth. The number of midwifery-led units, where midwives take primary responsibility for care, increased from 87 in 2007 to 152 in 2013, but only 11% of women gave birth in these units in 2012.

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