The soaring cost of medical negligence is a major national financial liability which diverts resources from healthcare improvement. In 2018-2019 the NHS paid out £2.4bn in compensation with over £83bn set aside for future claims (NHS Resolution Annual Accounts 2019/20). High value obstetric claims related to neonatal brain injury account for over 50% of settlements with costs likely to exceed the budget for provision of maternity services.
Obstetricians look after at least two patients, automatically doubling the risk. But our demographic is young and human reproduction is a physiological and generally successful process. Training requires regular skills and drills updates, we have had national audits since the 1950s and extensive clinical guidelines ratified by our Royal College and NICE. Risk management operates in all maternity units with easy access to external review. With all these advantages one might expect near perfect outcomes and yet we find maternity units disproportionately represented in independent inquiries. But why?
After decades of perinatal meetings and expert witness reporting it saddens me to say the
