One Fifth Of Spending On Maternity Now Set Aside For Medical Negligence

25 April 2014

One Fifth Of Spending On Maternity Now Set Aside For Medical Negligence

Article originally seen in Family Health Guide

It is appalling that £480 million per year is spent by NHS trusts on medical negligence cover for errors in maternity services. The figure represents nearly a fifth of all maternity spending and is equivalent to £700 per birth.

But while it is shocking, it is sadly not surprising given that the country’s long-standing midwife shortage has still not been solved despite an ongoing baby boom.

In data collated by medical negligence specialists, it is shown that births in England and Wales have been steadily increasing in recent years with latest figures showing an 18 per cent increase in a decade since births hit a 25-year low in 2001.

High birth rates among migrant women born abroad and improvements in fertility treatment helping people to have children later in life are among the key factors behind the trend.

However, while the number of midwives has begun to rise, it is happening far too slowly given the unprecedented demand and a recent Public Accounts Committee (PAC) report said 2,300 more midwives are still needed to meet current birth rates.

Last year the Royal College of Midwives (RCM) said it will be the middle of the 2020s before the shortage is eliminated given current birth and recruitment rates.

That is simply not good enough.

Midwives undertake professional education at degree level in order to ensure they can give mothers the expert care required at all stages of pregnancy, labour and the early postnatal period.

The Department of Health should be working to ensure that all women who give birth in its hospitals or birth centres can expect the same, high standard of care.

But despite the baby boom, half of English regions cut their spending on maternity services in 2012-13, according to figures obtained by Liberal Democrat MP Andrew George through a parliamentary question.

Only one region (the North East) was found to meet the recommended minimum staffing level of one midwife for every 28 births per year, while the average in England is one for every 33.2 births.

These figures are worrying enough in themselves but become doubly so when consideration is given to a number of other factors:

  • First, birth rates among older mothers continue to rise far more quickly than for other age groups and these women tend to require more care and time from midwives. Births among women aged 40 to 44 were 85 per cent higher in England in 2012 compared with 2001. Similarly, growing obesity levels among expectant mothers also add to the likelihood of complications, including miscarriage, gestational diabetes and pre-eclampsia.

  • Second, one of the consequences of our ageing society will be an ageing workforce. In future midwives will be expected to carry on working longer despite the physical demands of their work. RCM has warned that many midwives are “very worried that that they will not be able to keep up with the pace of a busy maternity unit”. Ultimately, mothers going into labour and their babies may suffer as a result, in addition to the midwives themselves.

  • Third, funding cuts are not only damaging maternity services for women in labour but also mean antenatal and postnatal care suffer. These services play a vital role in helping women feel prepared for the unique challenges of motherhood and ensuring both they and their baby remains healthy.

  • Fourth, the pressure created by staff shortages along with resentment over pay and conditions can leave midwives deeply demoralised and considering whether to get out. Nearly a third of midwives with less than 10 years’ work experience intend to leave the profession within a year, said the PAC.

  • Fifth, returning to the point about medical negligence, it should be remembered that funding cuts now are likely to cost the country more in the long run. Cathy Warwick, general secretary of the RCM, has rightly warned that the “exceptionally high cost” of maternity litigation payments proves that high quality maternity care cannot be achieved on the cheap.

To expand on this final point, maternity cases account for a third of total medical negligence payments and have risen by 80 per cent in the last five years.

Stillbirths and deaths of newborn babies in England compare unfavourably with the other UK nations and many other countries. For others mistakes in maternity care can lead to life-changing problems, such as brain damage or spinal injuries.

The PAC called for an investigation into variations in performance between health trusts to highlight how the number of tragic mistakes could be cut.

But the committee also lambasted the Department of Health and NHS England for being unable to even explain who is ultimately accountable for ensuring the NHS has enough midwives.

With management failings of that nature and continued population growth, you could be forgiven for concluding that the mid-2020s is an overly ambitious timescale for putting maternity care back on track.

A spokesperson from added:

“Addressing the key challenges and difficulties that maternity services and midwives face, both now and in the future, is absolutely imperative if the NHS as a whole wants to foster the best possible care for expectant and new mothers. The pressures on existing systems are as a result of a wide ranging number of issues, but reducing avoidable harm is a primary objective all health professionals must aspire to. Sometimes things do go wrong and avoidable complications can arise. In those instances, a deeper understanding of the issues at hand is needed and the right support, guidance and advice is absolutely necessary for those women who have been impacted in order to improve maternity services for both them and their loved ones far beyond the mid-2020s.”