The Health Secretary Jeremy Hunt yesterday announced proposals to bring about improvements in the standard of maternity care in this country. It remains a sad fact that despite advances in medical science and year on year increases in NHS spending, there are in excess of 500 serious injuries and 3,500 still births in the UK each year.
Any attempt to address the problem and reduce the numbers of injured children and bereaved families must be welcome. An £8 million training fund, an innovation fund and an Investigation Branch are all identified as components in the plan to bring about change. The success of the PROMPT programme pioneered by Professor Tim Draycott at Southmead in Bristol is cited as a means of bringing about a significant reduction in death and injury.
It cannot however be ignored that training based upon the excellent work carried out at Southmead has been available to all other Trusts for some time and whilst some have embraced it enthusiastically, a question must arise as to why it is only now that others may be compelled to learn from their mistakes. If lack of funding, which is often cited as a reason for failing to implement improvements, is a genuine issue, will a national fund of £8 million for training be sufficient to make a difference? At £40,000 per Trust, the impact will be limited and in reality, it is a change of mind set which is required to bring about change of outcomes.
Alongside the “safer maternity care action plan” the government proposes to introduce a “rapid resolution and redress” scheme as an alternative to applying for compensation through the courts. Again, any steps to alleviate the pressures on families who have suffered loss or are caring for a child injured at birth are to be applauded. The difficulty immediately apparent in this element of the proposal is that the NHS will decide if there is anything to be learned from an incident, whether a family should receive funds by way of compensation and how much they should receive. Since it is the NHS which currently denies liability in the majority of cases, to then concede that it was at fault in 76% of those cases only after court proceedings have been commenced, any expectation that the NHS will adopt a fair and open assessment of a claim under the scheme would appear unlikely.
The suggestion that adopting the “Swedish model” upon which the rapid resolution and redress scheme is based, will result in a 50% reduction in birth injuries seems wholly unsubstantiated and somewhat fanciful.
So a guarded welcome to proposals which are couched in good intentions but currently lack sufficient detail to be given unconditional approval.