The ‘Maternity Scandal’. An inquest into Telford & Shrewsbury NHS Trusts.

1 April 2022

Alix Walker, Head of Clinical Negligence at TRUE, delves deeper into the inquest, identifying the fundamental mistakes made by both NHS Trusts:

Giving birth can be a stressful and worrying time for expectant mothers. In the vast majority of cases there is a positive outcome, but what happens when something goes wrong due to negligence?

This has been the focus of the inquiry into the “Shrewsbury Maternity Scandal” where an independent inquiry (which has taken place over 5 years) revealed the biggest maternity scandal in the history of the NHS.

The inquiry involved almost 1500 families and considered over 1500 clinical incidents. Hospitals operating under the Shrewsbury & Telford Hospital NHS Trust were at the centre of the investigation into care provided to mothers and their babies over many years.

There were an alarming number of tragic cases identified; ranging from babies suffering injuries, brain damage, cerebral palsy to stillbirths and deaths of babies during the neonatal period (shortly after their birth), as well as the unnecessary deaths of mothers during or shortly after giving birth. Many of the cases would involve mothers suffering psychological injury as a result of their experiences.

The 234 page report documented the failings which were ultimately far worse than had been initially expected, with the findings concluding that a staggering 201 babies and 9 mothers would have survived had they been provided with a better standard of care. Alarmingly the report also concluded that the opportunity to learn from mistakes made was missed by the Trust and that there were therefore missed opportunities to prevent further tragedies occurring.

There was a focus within the report that many mothers were ultimately forced to proceed with a natural birth, in spite of a Caesarean section being the better option for them. It was confirmed that over a 20-year period the rate for Caesarean sections was on average 10% below the English average. The Trust’s focus on the “natural birth” route meant that they were held in high regard nationally, as natural births were seen as the preferred route for delivery. When in fact behind the scenes focusing on natural births was actually having an adverse outcome, with many families being negatively impacted.

It also held that staff were “too confident” about managing complex pregnancies, and that there was a lack of collaborative working between midwives and obstetricians, putting unnecessary pressure on midwives who were ultimately too scared to involve consultants when required.

These failings were repeated year after year.

So why Shrewsbury & Telford?

This Trust was ultimately investigated after a campaign by two mothers who had been impacted, but it should not be considered that such events are isolated to only this Trust. The inquiry only serves to highlight many issues in maternity services in England. Certainly, the issues highlighted as part of this inquiry are the most severe but there have been other hospitals, including East Kent, Morecambe Bay and Nottingham Hospitals where poor maternity care has been identified in recent years.

What amounts to negligent maternity care?

Under English Law there is essentially a two-stage test adopted to consider whether negligence may have occurred. To bring a claim you need to be able to prove;

• that the standard of care provided fell below a reasonable standard of care that could be expected across England and Wales.
  If a breach of duty can be established, then you need to also be able to prove:
• That there was physical or mental harm caused as a direct result of any of the alleged breaches.
  In some cases it is possible for there to be a breach of duty, but that even with different care the outcome may still have been the same.

What types of maternity claims are there?

Claims may arise as a result of care received by both mother and baby, either during the pregnancy itself, during the process of labour or during delivery. In addition, claims can also arise following the birth with either the neonatal care of that baby or the postnatal care of the mother. More information on the types of maternity negligence, can be found here.

What can we do to help you?

If you think you may have suffered maternity negligence, speak to TRUE today. We have a team of highly experienced, compassionate specialists who can investigate a claim on your behalf.

To find out more, visit our Birth Injury information page. If you would like to speak to one of our specialists directly, please call us on 0344 854 7000 or email alix.walker@true.co.uk.