MP slams maternity insurance spend
A fifth of maternity services funding is spent on insurance against malpractice, a report suggests.
Public Accounts Committee chairwoman Margaret Hodge said that it is "absolutely scandalous" that £482 million was spent on clinical negligence cover last year.
The MP's comments come as a National Audit Office (NAO) report shows that the NHS in England forks out the equivalent of £700 per birth on such cover.
The most common reasons for maternity claims are mistakes in the management of labour or Caesarean sections and errors resulting in cerebral palsy, the NAO report states.
The report also highlights a "wide unexplained variation" in complication rates between hospitals.
In some hospitals up to 1.6% of women are readmitted as an emergency after having a baby compared to 0.5% in others.
Infection rates in newborns range from 0.6% of babies born in some hospitals compared to 4.2% of babies born in others.
The report also highlights a shortage of midwives and consultants on labour wards.
During 2012 there was a shortfall of around 2,300 midwives, the authors said.
More than half of units were not meeting the levels of consultant presence recommended by the Royal College of Obstetricians and Gynaecologists.
Between April and September 2012, more than a quarter (28%) of maternity units were forced to close their doors to patients for at least half a day because of a lack of space or a shortage of midwives. Of these units, 11% closed for the equivalent of a fortnight or more, the report found.
The authors also said that m ore needs to be done to address the number of stillbirths in England.
The report points out that in 2011, one in 133 babies was stillborn or died within several days of birth. The mortality rate has fallen over time, but comparisons with the other UK nations suggest scope for further improvement.
" While I am pleased that the number of midwives has increased, I am very concerned that the NHS still has over 2,000 fewer midwives than needed," said Ms Hodge.
"I was also shocked to discover that England has a much higher perinatal mortality rate than the rest of the United Kingdom.
" I find it absolutely scandalous that one fifth of all funding for maternity services, equivalent to around £700 per birth, is spent on clinical negligence cover.
"The current system is not working as it should. The Department of Health needs to buck up and take responsibility for this. It needs to review its monitoring and reporting process to ensure that all relevant bodies can work effectively together to deliver maternity services that are value for money and fit for purpose."
Cathy Warwick, chief executive of the Royal College of Midwives, said: " We are many thousands of midwives short of the number needed to deliver safe, high quality care. Births are at a 40-year high and other figures out this week show that this is set to continue. As the report states, births are also becoming increasingly complex putting even more demands on midwives and maternity services.
"We know that maternity units are closing because they simply do not have enough staff to deliver care safely. This reduces or removes choice for women, yet ensuring choice was a pledge by the Government. When units close it leaves this pledge in tatters and women upset, stressed and deeply disappointed.
"We recognise that there has been an increase in the number of midwives in training, but it is not enough. We also know that when midwives do finish their training they are struggling to find jobs.
"The cost of litigation payments in maternity can be enormous. What this shows is that you cannot get safe, high quality maternity services on the cheap because it will cost much more in the long run. Most importantly there are the terrible consequences for mothers, babies and their families if mistakes are made. Money invested in maternity is also money invested in the future health of the country."
Minister for health and maternity Dr Dan Poulter said: "We have always recognised the need for greater investment in midwives and maternity units. The NHS now has over 1,300 more midwives since May 2010 and there are a record 5,000 more in training. The number of midwives working in our NHS is increasing twice as quickly as the birthrate, and the presence of consultant doctors on maternity wards has increased significantly too.
"Maternity services are unable to plan the exact time and place of birth and unfortunately there are occasions when a unit cannot safely accept more women into their care.
"Very occasionally, women may have to be directed to other maternity units. The NHS must make sure this is a carefully managed process and the best interests of mum and baby are taken into account."
On the number of stillbirths in England, he said: "The death of a child is always a tragedy and has a devastating impact on the whole family. Although latest statistics show the rate of stillbirths and perinatal mortality have decreased, there is still much more to be done.
"We are working closely with the charity Sands and the NHS on ways to raise awareness about stillbirth with women and NHS staff. This will help reduce the chances of stillbirth and make sure every mother gets the best possible care. We are also funding a range of research to help us better understand the causes of stillbirth and find new ways to reduce the rate even further."
Labour's shadow health secretary Andy Burnham said: " David Cameron promised thousands more midwives, but he's failing to deliver them.
"Across England, too many maternity units are operating without enough staff - unable to keep up with demand - whilst others are facing closure or downgrading.
"Experts have warned the Government on the importance of safe staffing levels, but ministers continue to ignore the advice. Meanwhile, hospitals are struggling without enough midwives and nurses."
Dr David Richmond, president of the Royal College of Obstetricians and Gynaecologists, added: "Although the UK is generally a safe place for women to give birth, we have known for some time that pressure on maternity services is growing in some areas particularly inner city conurbations placing stress on clinicians, managers and patients alike.
"More consultants are needed to deal with not only the rapidly increasing birth rate but the rise in complex pregnancies, with older mothers, maternal obesity and multiple pregnancies at the fore."