Reducing harm to newborn babies? Progress report on the first year of the Early Notification Scheme

The campaign group for improvements in patient safety Action against Medical Accidents (AvMA) held a meeting in London on 15 January 2020 to explore NHS Resolution’s Early Notification Scheme (ENS) first progress report. This was well attended by Claimant lawyers, amongst other professionals.

The Early Notification Scheme, in summary

From 1 April 2017 all NHSR member Trusts are required to report (within 30 days) all maternity incidents which result in a potentially severe brain injury diagnosed in the first seven days of life.

These are any babies that fall into the categories:

• Was diagnosed with grade III hypoxic ischaemic encephalopathy (HIE), or
• Was therapeutically cooled (active cooling only), or
• Had decreased central tone AND was comatose AND had seizures of any kind

By investigating these incidents early NHSR hope to identify those cases in which babies have suffered injury as a result of care that does not meet the expected standard, and in appropriate cases provide families with a written apology, offer financial support and practical advice on how to access support in caring for their child and provide support for the staff involved. This does not preclude families from seeking independent legal advice at any stage.

Further details of the ENS can be seen on the NHS Resolution (formerly NHS Litigation Authority) website.

Amongst other themes the ENS report identifies an “urgent need for a standard approach to fetal monitoring” (Theme 1).

To discuss this further consultant obstetrician and gynaecologist Mr Edwin Chandraharan was invited to speak about the current NICE guidelines on fetal monitoring and the fact that his unit (and others, including all units in Wales and Northern Ireland) no longer feel confident in relying on these as currently drafted.

It is clear that important work is currently underway involving all stakeholders including the Royal College of Obstetricians and Gynaecologists and Royal College of Midwives to consider the ENS report and the key themes identified, with the shared aim of reducing harm to mothers and babies and improving maternity care, in particular through a review of the use of fetal monitoring and the current NICE guidelines.

AvMA’s Chief Executive Peter Walsh also attended the meeting and raised the important issue of apparently failures within the ENS for involving parents, in line with the statutory Duty of Candour (a legal duty to be open and honest with patients about incidents that have caused or have the potential to result in significant harm). The experience reported by some parents is that they were unaware their case had even been referred to the scheme, and NHSR are seeking to address this.