Leading article: Negligence and waste

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Most people would probably think of Britain as a pretty safe place in which to give birth to a child. But appearances can be misleading. This newspaper has unearthed figures which show the shocking extent of the financial burden that medical negligence in childbirth imposes on the National Health Service. The NHS paid out £560m in compensation in 2005-06. Half of that was related to obstetrics cases. Furthermore, the bill for medical negligence in childbirth has risen by almost 60 per cent in the past two years.

The NHS Litigation Authority, which is responsible for handling negligence claims made against the health service, argues that the rise in payments does not mean obstetricians are becoming less professional, but that compensation claims are becoming more expensive, and there are more of them, due to the recent rise in birth rates. But even allowing for the colossal size of the NHS and the rising birth rate, the number of medical errors in obstetrics is inexcusably high.

So what can explain it? As a report from the Royal College of Obstetricians makes clear today, there is a shortage of consultants and midwives. A poll carried out by the Royal College of Midwives found that two thirds of maternity unit heads felt they were understaffed.

Yet this is by no means simply a question of inadequate resources. A Department of Health inquiry found last year that more than 77 per cent of deaths during labour were a result of substandard care, and more than 50 per cent might have had a different outcome with better management. The Healthcare Commission, the NHS watchdog, warned in 2005 of inadequate standards in maternity units and blamed "weak managerial or clinical leadership".

It is a familiar story: old practices and ways of doing things have gone unchallenged in the NHS and patients are suffering needlessly as a result. Another aspect of this story is also depressingly familiar. These negligence payouts represent a ridiculous waste of financial resources. In 2005-06 the NHS funded an insurance payment of £280m to cover the 618,000 births in England. That works out at £450 insurance for every baby born on the NHS.

A huge amount of taxpayers' money has been poured into the NHS over the past seven years. But productivity gains have been disappointing. The improvement in the service has been less than would have been expected. It is now clear that is partly because so much money has gone out to cover negligence payments and insurance, both of which could easily be avoided through improved clinical and managerial practice. These figures offer one more reason why reform of the NHS cannot be delayed.

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