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Dyer's observation that Obstetrics accounts for 10% of the claims made against trusts, but 50% of the overall value of claims raises an interesting point. Intrapartum care in the UK involves a mixed Obstetric-midwifery model of care, providing care for both a low risk and high risk birthing population (1). Several of the Royal Colleges have advocated consultant led care on the labour ward to improve patient safety (2). However, a recent Cochrane review found that there is no reliable evidence of the effects of 24-hour resident consultant presence on the labour ward on to suggest improved intrapartum outcomes. This suggests a multidisciplinary approach is required to target care provision on the labour ward, which should be prioritised by trusts given these claims are the most expensive ones they face. A robust annual training programme should be in place in all trusts for all staff working on the labour ward as well as improving reporting mechanisms when things go wrong.
Standardising the layout of labour ward, facilities available and practical procedures across the UK may also go some way to minimising harm. Visibly involving staff members in risk management reporting and recommendations may also reduce adverse care outcomes for both mothers and babies. In short, unless a practical and proactive multidisciplinary approach to intrapartum care is taken urgently, the next decade will see trusts seriously question whether they are able to afford to deliver babies.
References
1 Birthplace in England Collaborative Group, Brocklehurst P, Hardy P, Hollowell J, Linsell L, Macfarlane A, et al. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ 2011;343:d7400.
2 Royal College of Obstetricians and Gynaecologists, Royal College of Midwives, Royal College of Anaesthetists, Royal College of Paediatrics and Child Health. Safer Childbirth: Minimum Standards for the Organisation and Delivery of Care in Labour. RCOG Press: London, 2007.
3 Resident Consultant Obstetrician Presence on the Labour Ward Versus Other Models of Consultant Cover: A Systematic Review of Intrapartum Outcomes J Henderson et al. BJOG 124 (9), 1311-1320. 2017 Feb 28
Re: New settlement procedures: changing the way the NHS resolves negligence claims
Dyer's observation that Obstetrics accounts for 10% of the claims made against trusts, but 50% of the overall value of claims raises an interesting point. Intrapartum care in the UK involves a mixed Obstetric-midwifery model of care, providing care for both a low risk and high risk birthing population (1). Several of the Royal Colleges have advocated consultant led care on the labour ward to improve patient safety (2). However, a recent Cochrane review found that there is no reliable evidence of the effects of 24-hour resident consultant presence on the labour ward on to suggest improved intrapartum outcomes. This suggests a multidisciplinary approach is required to target care provision on the labour ward, which should be prioritised by trusts given these claims are the most expensive ones they face. A robust annual training programme should be in place in all trusts for all staff working on the labour ward as well as improving reporting mechanisms when things go wrong.
Standardising the layout of labour ward, facilities available and practical procedures across the UK may also go some way to minimising harm. Visibly involving staff members in risk management reporting and recommendations may also reduce adverse care outcomes for both mothers and babies. In short, unless a practical and proactive multidisciplinary approach to intrapartum care is taken urgently, the next decade will see trusts seriously question whether they are able to afford to deliver babies.
References
1 Birthplace in England Collaborative Group, Brocklehurst P, Hardy P, Hollowell J, Linsell L, Macfarlane A, et al. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ 2011;343:d7400.
2 Royal College of Obstetricians and Gynaecologists, Royal College of Midwives, Royal College of Anaesthetists, Royal College of Paediatrics and Child Health. Safer Childbirth: Minimum Standards for the Organisation and Delivery of Care in Labour. RCOG Press: London, 2007.
3 Resident Consultant Obstetrician Presence on the Labour Ward Versus Other Models of Consultant Cover: A Systematic Review of Intrapartum Outcomes J Henderson et al. BJOG 124 (9), 1311-1320. 2017 Feb 28
Competing interests: No competing interests