State Claims Agency releases Report on Maternity & Gynaecological Services
The State Claims Agency released its report on clinical incidents and reports relating to maternity and gynaecological Services in Ireland on the 20th October 2015. The hope is to highlight any trends or patterns which may aid patient safety and efficiency in the system. Critically it will also help in identifying problem areas in the maternity services in Ireland. In this regard the report also provides recommendations for improvements in safety measures and an improvement in the reporting of such incidents.
One of the most important observations of the report is a major variation in the reporting of patient safety incidents across different maternity services throughout the country. There exists a lack of harmony in relation to the systems of reporting of incidents and in particular the reporting of the severity of injuries sustained by patients. In this regard the newly implemented National Incident Management System (NIMS) seeks to provide a more consistent and standardised system across maternity services nationwide. NIMS was launched in 2014 and has been fully implemented.
In relation to the number of claims, reported incidents and the costs thereof the report found that generally the rates of claims and reported incidents in maternity services in Ireland are roughly equal to that of counterparts internationally. The report found that a total of 9,787 incidents were reported to NIMS by maternity services and of those 75 were categorised as extreme in severity.
The report also found that frequency of claims has remained static since 2012 and the 10 most common of claims between 2010 and 2014 were as follows
|3.||Perineal tear (3rd & 4th degree) (incl. breakdown of perineum)||43|
|6.||Unexpected neonatal death||25|
|7.||Cerebral irritability/neo-natal seizure||22|
|8.||Birth Injury (incl. Instrument Injury)||20|
|10.||Apgar <5@1, 7@5, cord BE <12, PH||16|
It is abundantly clear from the report that the total expenditure on maternity claims has risen quite dramatically between 2010 and 2014. The cost of claims has risen by 54% overall. The cost of claims in maternity services has increased by a massive 80% increasing from €32 million in 2010 to €58 million in 2014. The cost of cerebral palsy claims increased by 77% over a 4 year period where the cost in 2014 amounted to €47 million. However the report did make it clear that that some of the reported increases in expenditure were as a result of an increase in payments of lump sums as opposed to the previous use of Periodic Payment Orders (PPOs).
The report found that there is still a large disparity between patient safety services across the 19 different maternity services in Ireland.
In relation to gynaecological services the most common claims between 2010 -2014 were as follows:
|3.||Health care records missing/misplaced||310|
|4.||Patient fall moving without supervision||230|
|5.||Failure/faulty medical device/equipment||213|
|10.||Unexpected complications following operation/procedure||137|
Expenditure on gynaecological claims amounted to €4.2 million in 2014.
The report also focused on closed claims regarding retained foreign bodies following surgery. According to this report, between the years of 2004 and 2014, there were 30 such claims for retained foreign bodies in maternity services and 14 for gynaecological services. The report also suggested some best practice guidelines and specifically highlighted some preventative measures which can and should be implemented by maternity services in this regard. They included the implementation of a counting protocol for any objects or materials used pre and post vaginal delivery. This would mirror a similar protocol which exists in respect of surgical procedures in theatre. It also suggests a rigorous investigative process where a case of retained foreign bodies is reported.
Finally the report took a look at systems and patterns of incident reporting over time in order to establish a national picture which may assist in improving the accuracy of and frequency of reporting where necessary. The report found that only 18% of hospitals notify the State Claims Agency of 50% of incidents reported to them. The report also found that in more than half of acute hospitals there were backlogs of incidents to be reported to the State Claims Agency. It found that in 68% of acute hospitals there was a delay of 1 month before an incident was notified to the State Claims Agency. Overall the report’s findings are that there is a large disparity between the different acute hospitals regarding the reporting of incidents to the State Claims Agency.
It is hoped the report will help improve patient safety and prevent avoidable clinical incidents from occurring. It aims to do this by providing an overall picture of the most common incidents and also by highlighting the best performing maternity services with the most effective patient safety so that others can use this as a benchmark with the aim of improving their own and help prevent clinical incidents occurring.
The Minister for Health, Leo Varadkar, has just announced Government approval in relation to certain measures aimed at improving patient safety. Among the measures to be enforced is the establishment of a National Patient Safety Office, an extension of the powers granted to the Ombudsman and the Health Information and Quality Authority (HIQA) and a simplification of the complaints process currently in force. The new measures will allow the Ombudsman and the HIQA to deal with medical as well as management complaints. Minister Varadkar has stated that the government plans to introduce legal reforms in cases of medical negligence, the hope is to reduce the length of court cases and to award compensation for sufferers of long-term injuries on an annual payment basis (Periodic Payment Orders) and not in one lump sum. This legislation will aim to support the principle of open disclosure where doctors will be required to be more transparent with patients who have suffered injury as a result of medical negligence.
If you require further information please contact Rachael Liston, Partner in our medical negligence department on