NHS Resolution has published a report on the first year of its Early Notification Scheme for potential severe brain injury following term labour. The Scheme has been running since 1 April 2017 and requires NHS Trusts in England to report within 30 days, for investigation, all births which meet the qualifying criteria.

A total of 746 cases were reported to the scheme between 1 April 2017 and 31 March 2018. The report contains an analysis of 96 of a total of 197 cases where NHS Resolution panel firms were instructed to investigate liability. Key themes amongst the clinical issues identified were: limited staff support; insufficient family involvement; confusion over the duty of candour; issues with fetal monitoring; issues with delivery of the head at caesarean section; concurrent maternal medical emergencies and the need for immediate neonatal care and resuscitation

The report makes 6 key recommendations:

  1. All families whose baby meets the Early Notification criteria and requires treatment and separation from them for a potentially severe brain injury should be offered a full and open conversation about their care.
  2. An independent package of support should be offered to all NHS staff to manage the distress of incident.
  3. There is an urgent need for an evidence-based standardised approach to fetal monitoring in England.
  4. Increased awareness of impacted fetal head and difficulties with head delivery at caesarean section
  5. Improvements in detection and monitoring of maternal deterioration in labour (within existing national programmes) and implementation of evidence-based guidance.
  6. Increased awareness of importance for outcomes of high-quality resuscitation and immediate neonatal care.

As a result of the scheme, families have been provided with:

  • a detailed explanation;
  • an apology;
  • sign-posting to independent representation; and where an entitlement to compensation has been identified;
  • prompt financial support for clinical and respite care; and
  • psychological support where required.

Early admissions of liability have been given to 24 families within 18 months of the birth, a significant reduction on the average of 11.5 years between an incident occurring and an award for compensation being made.