This fictional case illustrates the future role of NHS Resolution in relation to cases of serious neurological injury at birth as described in our five year strategy.

 

Just five days early, Julia arrived at hospital in labour. This was her first baby and like many new mums she was nervous, not knowing what to expect but so excited at the prospect of meeting her little boy. The labour was long and increasingly Julia’s midwife seemed concerned about progress. It was decided to deliver Alfie by forceps. The relief was overwhelming but quickly turned to fear when Julia realised Alfie wasn’t crying. The labour room suddenly seemed full of people and Alfie was whisked away.

Alfie was taken to the neonatal unit. Resuscitation had been difficult and the team decided he should be cooled – Julia was told his body temperature would be reduced to 33.5°C and maintained at this level, possibly for up to three days gradual re-warming. Julia felt lost but the team at the hospital helped her through, explaining why Alfie needed the care he was receiving but explaining what the future might hold.

Within the first couple of days the Consultant Obstetrician sat down with Julia and her partner and delivered some difficult news. It seemed that Alfie’s labour had been a bit too long and maybe steps could have been taken to deliver him earlier. He was genuinely upset. He was so sorry for what had happened and for what Julia, Alfie and the family were now going through.

Julia had so many questions. How could this have happened? Her midwife had been wonderful – how could it have gone so wrong?

The consultant explained that the Trust was committed to understanding what went wrong and using that to make improvements to stop anything similar happening again. There was a formal process for the Trust’s investigation but Julia and her partner would be involved all the way and they would get a report within two months. During this time, the Trust let NHS Resolution know about the incident. If the care Julia and Alfie received should have been better, NHS Resolution will work towards understanding the consequences of this.

Alfie came home after two weeks. Around six weeks after he was born, Julia went to the hospital and met with the Consultant again. Her midwife wasn’t there which surprised her. The Trust were finalising their report and it would be with her within two weeks.

The report arrived – there was still very little from her midwife and Julia felt that some details had been missed from the report.
What Julia didn’t realise was that the midwife had been so upset by the events surrounding Alfie’s birth she had had been unable to come to work.

NHS Resolution put the midwife in touch with a colleague at another Trust who had been through a similar experience. They talked through the process. Although very difficult, with some support the midwife felt more confident to speak with Julia about what had happened.

Julia had started to become frustrated with waiting for answers and wasn’t sure she was able to talk to the midwife or anyone at the Trust any longer. NHS Resolution helped the Trust arrange mediation. The midwife, Julia and her partner attended. It was tough and emotional, but by the end of the day both Julia and the midwife fully understood the others’ positions and agreed to work together to try and avoid something similar happening again. Julia volunteered to tell her story to team as a case study. She felt more able to speak with the Trust about services available to her to help look after Alfie.

When Alfie was around six months old, Julia got a letter from the Trust, prepared in conjunction with NHS Resolution, explaining in detail what had happened during Alfie’s delivery. It was accepted that the midwife should probably have asked for a doctor to come and examine earlier which would probably have led to Alfie being born earlier. The Trust apologised and advised that if a legal claim were to be brought, this would not be contested. Some further investigations would however need to be carried out to see whether Alfie might suffer any ongoing problems as a result.

Julia saw a solicitor. She wrote to NHS Resolution who responded with a formal admission of legal liability. By this time Alfie was becoming difficult for Julia to look after fully on her own. NHS Resolution agreed to make a payment to Julia at an early stage to allow her to get the help she needed.

Alfie has been diagnosed with cerebral palsy. It will take some years to fully understand how much help he will need in the future. Julia’s solicitor and NHS Resolution are working towards a settlement.