Healthcare Safety Investigation Branch (HSIB) and your obstetric or midwifery negligence claim with Fieldfisher

What is HSIB?

HSIB is an independent body set up in 2017, funded by the government and hosted by NHS England, tasked with investigating serious incidents involving patient safety in NHS-funded care in England. 

One of its main programmes specifically involves maternity care as part of national action plan to improve safety and reduce the number of stillbirths, neonatal and maternal deaths, and brain injuries. 

Anyone can request an investigation via HSIB's website, although criteria are strict. Each investigation is subject to clear guidelines. A hospital trust may refer itself to HSIB where it is concerned about its own safety behaviour in a case.

HSIB's key objective in its maternity investigation programme is to concentrate on systemic problems and common themes and to use findings to improve maternity safety by determining the causes behind the incidents. 

It is not intended to apportion blame or liability at organisations or individuals.  

Who is involved in a report?

HSIB has the freedom to interview anyone relevant to a case, which will generally include the patient, their family and NHS staff and clinicians, and appoint an independent panel.  A written report is made available to those involved.

Your obstetric or midwifery negligence claim

An HSIB investigation is different from a hospital's internal Serious Incident Report (SUI) in that it is run externally. 

A family who has suffered negligent care during maternity and birth does not have to wait for a completed HSIB report to instruct a solicitor. Safety recommendations are not necessarily indicative of medical negligence. 

Partner Jane Weakley says: 'Although an HSIB report does not apportion blame, discussions will generally include the provision of care, and findings can positively impact an ongoing claim. It should also speed up a case because a hospital trust may not be able to dispute the findings  of an HSIB report, which can be used as the basis of a Letter of Claim, without the need to wait for expert evidence.' 

Examples from a Fieldfisher case:

In a current birth injury case following failure to deliver a baby following a ruptured placenta, HSIB, findings relevant to the case included:

• Failure to provide an interpreter in line with local guidelines.
• As a result of the mother's previous caesarean section, there should have been a mid-trimester scan (32-34 weeks) which may have diagnosed placenta accreta and an elective caesarean section may have been carried out at 38 weeks.
• Vaginal delivery after caesarean section (VBAC) should have been discussed and a consideration of placenta accreta should have been made. 
• Staff were reassured by a successful vaginal delivery previously and they felt the pain was associated with labour and SPD (symphysis pubic dysfunction). There was no consideration that the pain was another cause other than contractions in labour.
• Rupture of the uterus should be considered in any situation where there is an acute change in presentation.
• Concerns about the baby's heart rate could have been identified quicker and the emergency bell pulled sooner.
• The risk of uterine rupture did not appear to be considered timely and this delayed the escalation which could have delivered the baby earlier.

For advice about pursuing a maternity claim or an HSIB report, please contact any member of the medical negligence team.