Daily Insight: Double the trouble in maternity care

It’s unusual for Daily Insight to focus on two maternity stories, so today’s newsletter probably says something about the sorry state of the services in England.

First up, a story about delays to inductions of labour. We know these are widespread — they come up in Care Quality Commission reports frequently — but trying to quantify them is another matter. Freedom of Information Act requests from HSJ found nearly 5,000 “red flag” incidents relating to delays of two hours or more in 2022-23 and nearly 2,000 Datix reports mentioning induction of labour in the same year.

But this is still a partial picture. Many trusts could not give us this data and others said they did not use the red flag system, which is meant to prompt a review of the staffing levels at the time. NHS England is collecting some additional data on very long delays — over 24 hours — but declined to share it.

Are women and babies being harmed as a result of these delays? It’s impossible to be certain but the lack of easily available data at some trusts may make any systemic problems harder to identify and rectify.

Second, HSJ revealed that families whose babies died and whose mothers were harmed – in some cases dying – in the East Kent maternity scandal were still having to prove legal liability to get any compensation. This is despite Bill Kirkup’s report, published around 18 months ago, having already looked at their cases in detail and reached conclusions on whether better care could have led to different outcomes.

But NHS Resolution, which handles the NHS’s clinical negligence claims, says causation and a breach of duty of care will need to be proved in each case. This may mean families have to engage not just lawyers but also experts in midwifery, obstetrics and neonatal care.

Baby deaths usually lead to relatively small payouts and the cost of obtaining such expert advice may well put some families off making a claim. HSJ has also been told the psychological assessments women have had to go through as part of the claims process are gruelling and causing considerable distress.

Dr Kirkup has called for a “more compassionate approach” and pointed to the “robust clinical assessment” which had already been made of cases. But the Department of Health and Social Care says it is important a “proper investigation” is undertaken on each case.