Are shortages of maternity staff at weekends leading to higher risk levels for mothers and babies?
A report by the National Audit Office, published in November 2013, reviewed in detail the figures relating to maternal care services in England. One of their findings was that there were poorer outcomes for mothers and babies during the weekends. The report noted that: “the chance of injury to the baby varied from 1 in 68 on weekdays to 1 in 60 at weekends. These differences remain after adjusting for maternal characteristics and the type of cases.” So why are outcome worse at weekends?
The report noted that; “The provision of high-quality, safe maternity care requires the presence of appropriately skilled staff.” It goes on to comment that unfortunately it is usually only trainee doctors, rather than consultants, who are in most hospital obstetric units at night and weekends. If consultants are needed then they are called in from home or need to give advice over the telephone, which clearly could lead to a delay in emergency treatment.
The report suggested that: “Increasing routine consultant presence on the labour ward to support, teach and supervise junior staff may result in better decision making and fewer unnecessary interventions.” It was noted that 53% of obstetric units did not meet the recommended consultant presence level as recommended by the Royal College of Obstetricians and Gynaecologists.
The National Audit Office report noted that: “Over the last decade, the most common reasons for maternity claims have consistently been mistakes in the management of labour and relating to caesarean sections, and errors resulting in cerebral palsy.” The report goes on to state that: “The scale of litigation highlights the importance of improving risk management and safety of care.”
As a specialist medical negligence solicitor specialising in obstetric care I have investigated a large number of cerebral palsy cases where parents of injured children have pursued claims because their child has suffered catastrophic injuries due to poor care, and these cases have included care provided at weekends. No one undertakes such a step lightly, but NHS and social care provisions for catastrophically disabled children goes no where to meeting their high level of needs.
It is hoped that this report will reinforce the need for improved staffing levels, particularly at weekends where there is a noticeable issue nationwide. With improved funding and training of staff the standard of care for mothers should increase and the number of children suffering avoidable cerebral palsy and therefore the level of medical negligence cerebral palsy cases will decrease. It is of course particularly hard for the NHS to strive for full consultant led cover 7 days a week due to significant restriction on NHS budgets, however the cost to the NHS and more importantly families, will be much more without implementing such measures.