NHS Litigation Authority sets aside £235.4m to settle 60 cases in which hospital staff failed to spot hypoglycaemia in newborns
Blunders by hospital staff which leave newborn babies brain-damaged in the first few days of their lives are set to cost the NHS more than £235m, official figures reveal.
NHS lawyers have set aside £235.4m to settle 60 claims in which babies allegedly suffered brain damage and other complications after maternity staff failed to notice they had dangerously low blood sugar levels. In two of the cases the hypoglycaemia was so serious the baby died, according to the lawsuits.
NHS Litigation Authority (NHSLA) figures obtained by the Guardian show that in England in the past decade, it has received 79 claims for damages of harm to babies relating to undetected or untreated hypoglycaemia. Of those, 19 were closed with no compensation. It has paid damages of between £300,000 and more than £7m in 19 other cases and is defending 41 other similar actions. Seven of the 19 settled cases have each involved damages of more than £6m.
Neonatal hypoglycaemia is a rare complication of childbirth affecting between one and three of every 1,000 babies. If untreated it can have devastating consequences. In March 2011 the family of Louis Peers received a settlement worth more than £7m – the largest so far in such a case – after claiming midwives at Birmingham Heartlands hospital failed to intervene for the first three days of his life, even though he was not feeding.
The £235.4m is the NHSLA's estimate of the total cost of settling the 60 claims, including damages and legal fees. Of that, £69.3m has been spent on the 19 cases which have been concluded and the other £166.1m is the potential cost of settling the other 41. But the figure is likely to rise once annual sums to cover damaged babies' lifelong care needs have been made, the authority admits.
Relatives, lawyers and patient safety campaigners said the figures, and hypoglycaemia's terrible consequences, underline the fact that midwives and doctors need to be better in monitoring babies' feeding and blood sugar level just after birth.
Peter Walsh, chief executive of the patient safety group Action Against Medical Accidents, said: "Whilst these cases are relatively small in number, the fact the effects are so catastrophic and they are so preventable should make them a 'never' event in the NHS. It's absolutely essential the NHS stops these kinds of accidents happening.
"The NHS should ensure the lessons from these cases are learned and midwives are properly trained and there are enough midwives and consultants on duty to ensure babies are monitored … The human cost of these cases is incalculable."
While midwives can make mistakes, the NHS's shortage of midwives is "the biggest factor in these recurring problems of undiagnosed hypoglycaemia," he added.
Angela Kirtley, a medical negligence specialist with lawyers Irwin Mitchell, who has handled several cases of hypoglycaemia, said: "We have been approached for help by families whose babies have suffered life-changing injuries after medical professionals have failed to recognise babies are being slow to feed.
"All too often we are told that concerns about a lack of feeding are not taken seriously by medical staff."
In some cases, babies are discharged from hospital too early before they have started to feed properly, she added.
Maternity staff need support and training to help them spot the warning signs that a baby is becoming hypoglycaemic. "It is heartbreaking for families to learn that their baby has suffered an horrific injury that may have been prevented by more careful monitoring of feeding and by carrying out a simple blood test to check blood sugar levels", she said.
Professor Cathy Warwick, general secretary of the Royal College of Midwives, said: "Hypoglycaemia is something that in the majority of cases we should be detecting and preventing." New mothers should be educated so they can spot the signs of it developing, and be able to see a midwife any time they need to, when they are still in hospital or back at home, to ensure the condition is spotted and treated quickly, she said.
A shortage of midwives may be a factor, Warwick added. "It's incredibly important that women are getting enough care in the postnatal period to ensure they have the information they need and that babies are getting screened and seeing midwives enough to pick up these problems, and that women are getting enough support with breastfeeding", she said.
Some babies are at higher risk than others of hypoglycaemia, particularly those born early or small, and big babies, including those with diabetic mothers. Such newborns should have a blood test on a heel prick sample every few hours after birth until their blood sugar level is stable, according to the Department of Health. Babies with low blood sugar levels are either given extra feeds or sugar through an intravenous drip. Where blood sugar levels are kept normal, the baby's outlook is good, it says.
A Department of Health spokesman said of the NHSLA figures: "Neonatal hypoglycaemia should never go undetected in a baby who is at risk.
"Where there are failures in care, these should be fully investigated to ensure lessons are learned to prevent mistakes happening again."
'Staff failed to investigate for three days'
Christine Peers's 12-year-old son Louis was left brain damaged when he developed hypoglycaemia while still in hospital soon after his birth.
He has cerebral palsy and physical problems and attends a special school in Bromsgrove, Worcestershire, near his home. In March last year the 42-year-old mother of four won more than £7m in damages against the NHS for its poor care of Louis, to pay for his lifetime care needs.
"Louis was born on Monday 6 December 1999 at Heartlands hospital in Birmingham. It was an emergency caesarean because although I was 39 weeks pregnant, checks showed he hadn't grown for a few weeks. He weighed just 5lb 6oz.
"For the first three days he wouldn't breastfeed properly. On the Tuesday the midwives said that some babies didn't feed for the first 24 hours, especially after a caesarean birth.
"I began to get concerned on the Wednesday evening because Louis changed from being a vocal, screamy baby to being lethargic and unresponsive. On Thursday morning I got tearful and asked a midwife: 'Can you help?' She was very reassuring and said it was just the baby blues kicking in.
"But a few hours later someone must have realised Louis was struggling. They tested some blood from his heel and found that his blood sugar level was low. He had hypoglycaemia. They took him straight to a neonatal intensive care ward.
"They kept asking me what his name was. We hadn't named him by then but I said Louis Alber. I didn't want him to die without a name. He was put on a glucose drip but by then he had suffered irreversible brain damage.
"He has cerebral palsy and epilepsy and wears splints to support his lower legs and ankles. He can walk, but after 15-20 minutes we have to put him in a wheelchair. He can run too, but he's very clumsy and falls and bumps into things because his vision is affected.
"He's probably functioning intellectually at the level of a four or five-year-old. His twin sisters, who are five, are now overtaking him in things like reading."I feel really let down by the care that we received and by the midwives in the hospital who were supposed to take care of him. I trusted them and their mistakes are something which my son now has to live with for the rest of his life. All of this was preventable.
"A simple glucose test would have quickly revealed why Louis was so unresponsive but instead his condition was left to deteriorate until things became critical and the damage to his brain became irreversible. Staff failed for three days to investigate and instead told me there was nothing wrong."Cases of hypoglycaemia are very unusual but can be very damaging. The NHS should ensure there's more routine testing of babies."
Interview by Denis Campbell