Labour in crisis: Staff shortage blamed for £665m payout in birth errors

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Childbirth is claimed to be safer than ever. Yet the price paid by the NHS for deliveries going catastrophically wrong has risen 59 per cent to £259m – enough to fund the consultants and midwives needed to save thousands of babies and mothers from harm

The dangers of childbirth in the modern health service are highlighted today by figures showing that £665m has been paid out over the past three years to settle medical negligence claims where obstetric deliveries have gone catastrophically wrong.

The size of the payout – enough to hire 1,000 extra consultants – reflects the enormous and growing burden of medical negligence on the health service, which is diverting scarce resources from patient care.

In a major report to be published today, the Royal College of Obstetricians will say that too little is being done to reduce the risks of childbirth and make it safer for mothers and babies. It will blame shortages of consultants and midwives, increasing pressure from a rising birth rate, and lack of training.

The report, Safer Childbirth: Minimum Standards for the Organisation and Delivery of Care in Labour, will highlight how a tiny error during labour can result in oxygen deprivation and brain damage to the baby, leading to lifelong disability and a compensation payment of millions of pounds.

Professor Sabaratnam Arulkumaran, the head of obstetrics at St George's Healthcare NHS Trust in Tooting, south London, and the vice-president of the Royal College of Obstetricians and Gynaecologists, said: "We are pressing the Government to increase the number of consultant obstetricians in busy units so that we can provide 24-hour cover.

"If there is a consultant present they are better able to deal with emergencies and prevent disasters. If you save 20 disasters costing £5m each that is £100m. Rather than have more [negligence] cases and pay out on more claims we should spend on more consultants and reduce the number of cases."

Childbirth is claimed to be safer than it has ever been, yet NHS trusts have to pay a £450 "insurance premium" for every baby that is born in case they are sued for negligence if things go catastrophically wrong with the birth.

The payments, totalling £280m for the 618,000 births in 2005-6, are collected by the NHS Litigation Authority, which handles negligence claims against NHS Trusts. The authority received 5,700 claims and paid out a record £560m in compensation in 2005-6, more than half of which (£259m) was for obstetric cases, up from £163m in 2003-4 – a rise of 59 per cent (£96m) in two years.

The figures were released to The Independent in response to a Freedom of Information request.

Last year, for the first time, the NHS Litigation Authority ranked maternity units in a league table according to their level of risk, based on a new standard for maternity care. Out of 154 maternity units in England, 18 are currently ranked Level 3 (the safest) and 54 are ranked Level 1 (least safe), with the remainder ranked Level 2.

Two poorly performing trusts, the Isle of Wight and the Royal Bournemouth, were upgraded earlier this year from the lowest Level 0 to Level 1.

NHS Trusts are not required to improve their risk rating but have a strong financial incentive to do so as it reduces their insurance premium – by 10 per cent for Level 1 rising to 30 per cent for Level 3. A trust delivering 5,000 babies a year and paying a £2.5m annual premium could save £750,000.

Steve Walker, the chief executive of the authority, said the high premiums charged to NHS trusts were necessary because of the "gold-plated" awards made by the courts.

"A judge may award £5m compensation if something goes wrong. I am not disputing that these kids need it – they are going to need teams of carers to look after them round the clock for life. But a minor shortcoming in their care can have the most devastating consequences for the child and the financial consequences for the NHS trust, if it is proved to be due to negligence, are astronomical."

He said the rising cost of compensation was due to legal changes that had inflated settlements and efforts to settle claims more quickly. "It doesn't mean obstetricians are more negligent. It means claims are becoming more expensive."

Compensation is a lottery, with the lucky minority who can prove negligence winning huge sums.

Efforts to reform the medical negligence scheme by the Government's chief medical officer, Sir Liam Donaldson, in a report in 2003, foundered after agreement could not be reached on how to implement his proposed no-fault scheme without massively increasing costs. The high cost of compensating some children diverts resources that could be used to reduce the risks for all.

The annual Confidential Inquiry into Stillbirths and Deaths in Infancy last year found that sub-standard care was to blame for more than 77 per cent of deaths during labour, and more than half might have had a different outcome with greater supervision and better management.

The Healthcare Commission, the Government's NHS watchdog, warned in its annual report in 2005 of poor standards in maternity units. It blamed "weak managerial or clinical leadership" and said some maternity services were "not as good or as safe as they could be".

The commission ordered all health trusts to review their maternity care.

The Royal College of Midwives said a poll carried out earlier this year of 102 maternity department heads (from a total of 216) found two-thirds thought their units were understaffed and one in five had lost staff in the past year.

Dame Karlene Davis, the chief executive, warned that the midwifery service was "heading for meltdown" as midwives struggled with staff shortages, service cuts and a rising birth rate.

She said: "We are looking to Alan Johnson [the Health Secretary] to put maternity issues at the top of his agenda, halt the decline in the service and deliver the first-class maternity care the Government promised."

'It is one of the most poignantly tragic cases' - Kerstin Parkin, dancer

Kerstin Parkin, an internationally known Latin American dancer, received one of the largest compensation settlements in the NHS's history when she was awarded £7m and £250,000 a year for life in 2002 for injuries sustained during the birth of her son, Dylan.

She suffered brain damage following a heart attack in labour brought on by pre-eclampsia, a condition linked to high blood pressure that can trigger convulsions.

The accident happened at what was then Farnborough hospital in Bromley, Kent, in November 1996. The High Court found that hospital staff had failed to take basic steps to prevent the damage and a cardiac emergency team was unable to reach her because they did not know the security code to enter the ward.

The judge, Mr Justice Buckley, said at the time: "It is one of the most poignantly tragic cases I have dealt with."

Today Mrs Parkin lives with her husband, Mark, and son, Dylan, now aged 10, in a large house near Godalming in Surrey, and is cared for round the clock by a team of staff.

Though profoundly disabled she is able to use her limited movements to control a computer and a wheelchair and to play games.

Mr Parkin, speaking earlier this year, said: "The compensation has made an enormous difference because it has enabled Kerstin to live at home with me and our son. It has allowed her to be cared for properly and to be provided with all the therapies and equipment that she needs."

Initially she was only able to move her head and eyes but constant care and therapy have helped her condition to improve.

Mrs Parkin and her husband became dance partners in 1989, the year of their marriage, and went on to international success in the Latin American dance world. They had planned to retire from dancing and concentrate on teaching and choreography when the accident happened.