‘Deeply flawed’ watchdog fails to act in 182 cases

Bereaved parents have described maternity investigations carried out by a watchdog as “deeply flawed” after it failed to make recommendations to trusts in 182 cases of deaths and harm. 

The Maternity and Newborn Safety Investigations programme investigates certain cases of early neonatal deaths, stillbirths and severe brain injury in babies born at term following labour, alongside maternal deaths. Last year, it moved to the Care Quality Commission having previously been hosted by the Health Services Safety Investigation Branch.

Now a Freedom of Information request has revealed a third (182) of 556 MNSI reports completed between April 2023 and March 2024 did not contain recommendations.

Officials said in the 182 reports, none of the findings of the investigation contributed to the outcome for the mother or baby, and therefore no recommendations were made.

However, Emily Barley, whose daughter Beatrice died during labour in 2022, said it was “very concerning” to see that so many investigations result in no safety recommendations at all.

She added: “It is hard to believe that when a full-term baby dies or suffers a serious brain injury there is nothing for providers to learn. 

“I do not have any confidence in the MNSI, its investigations, or its conclusions. Having been through an MNSI investigation following the death of my daughter… it is clear to me the entire process is deeply flawed.”

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Source: HSJ, 25 November 2024