Francesca Beach looks at the thematic review of cerebral palsy clinical negligence claims published by NHS Resolution in September 2017.
NHS Resolution are responsible for resolving the majority of clinical negligence claims made against the NHS. They are therefore in a unique position to provide insight into the medical treatment of patients during pregnancy and labour and offer their own recommendations for improvement of care and the reduction of claims.
This report looks at 50 civil litigation claims brought between 2012 and 2016 where the NHS admitted that had it not been for the negligent care the children in question would have been born without cerebral palsy.
Cerebral palsy is the commonest cause of physical disability in early childhood affecting 2 babies in every 1,000 births. It is a permanent neurological disorder that can be caused before, during or after birth. The condition ranges in severity but most commonly involves problems with communication, feeding and movement.
NHS Resolution’s review has two main areas of focus.
The first looks at the quality of the serious incident investigation reports that are compiled following negligence which result in a baby being born with cerebral palsy.
The report concluded the serious investigation reports undertaken were deficient in three main areas:
- a lack of family involvement and staff support through the investigation process;
- poor quality root cause analysis and too great a focus on individuals; and
- ineffective recommendations resulting from the reports.
In addition it showed that the serious incident reports undertaken in these 50 claims were generally of poor quality; only 40% of the investigations involved patients and their families, only 32% had a review that involved a obstetrician, midwife and neonatologist and a mere 4% went to external review. NHS Resolution’s review also highlighted that the incident reports focused too greatly on individual errors of medical staff and recommended that they take a wider view looking at NHS practice and procedure as a whole.
The second part of NHS Resolution’s review analysed the negligent treatment that results in babies being born with cerebral palsy.
In particular there were four common causal areas found in the 50 individual cases;
- Fetal heart rate monitoring; of the 32 claims that involved errors in fetal heart rate monitoring, 91% of those involved a CTG. This includes 11 cases where CTG’s were misinterpreted and 8 where the CTG was not started when it should have been. Recommendations stemming from the review include the advice that CTG interpretation should not occur in isolation and should be part of a holistic assessment of fetal and maternal wellbeing and that there should be CTG training incorporating risk stratification, timely escalation of concerns and detection and treatment of the deteriorating mother and baby.
- Breech birth; 6 claims out of the 50 were related to breech presentation where vaginal delivery was attempted but delivery by caesarean section was needed. The review comments that it is likely that current obstetric trainees have less experience of vaginal breech birth than in the past which may have contributed to recent birthing complications. The Royal College of Obstetricians and Gynaecologists now recommend that simulation equipment should be used to rehearse the skills needed during vaginal breech birth by all doctors and midwives.
- Staff competency and training; in 29 out of the 50 cases the serious incident reports that followed recommended staff have extra training. This review states, however, that it is not new training that is needed but reinforcement of existing training, either in ensuring that what is offered is taken up by staff or by refreshing previous training. NHS Resolution comments that clinicians have a duty to be competent in all aspects of their work; keep professional knowledge and skills up to date and regularly take part in activities that maintain and develop their competence.
- Patient autonomy; evidence of a lack of informed consent was evident throughout the 50 claims. The review reiterates the importance of providing appropriate information quickly to enable the mother to make an informed decision and states that respect for a patient’s autonomy is the cornerstone of good medical practice.
Other important topics that were raised as factors in cerebral palsy cases were the use of Syntocinon, vaginal birth after caesarean section and shoulder dystocia.
The full NHS Resolution report can be located here: https://resolution.nhs.uk/five-years-of-cerebral-palsy-claims/
Francesca Beach, Solicitor at Fairweathers Solicitors LLP, commented:-
‘Cerebral palsy has a devastating, long lasting effect on both the child and their family. This review produced by NHS Resolution has highlighted some key areas of concern both with regards to the negligent cause of cerebral palsy and the consequent investigations. It is vital that all NHS bodies continue to analyse their practices in order to provide a better standard of medical care and minimise the number of cerebral palsy cases in the future.’
If you or a member of your family has suffered as a result of negligence on the part of a health professional then please do not hesitate to phone us free on 0800 999 5585, request a call back or submit your case details.