[DEV] Support for NHS trusts or member organisations

NHS Resolution’s Early Notification Scheme

Welcome to NHS Resolution, Early Notification (EN) Scheme’s support page for NHS Trusts and member organisations.

We have included links so you can find out everything you need to know, from what the EN scheme is, as well as useful information, FAQ’s and where you can find further information and support.

The EN Scheme is a key initiative towards achieving the delivery of safer maternity care, providing a more rapid, caring response to families in cases of severe harm, supporting a learning culture.

The scheme proactively investigates specific brain injuries at birth for the purposes of determining if negligence has caused the harm. We do this by requiring our Clinical Negligence Scheme for Trusts (CNST) members to notify us of maternity incidents which meet a certain clinical definition.

In the videos below, Sangita Bodalia, solicitor and former head of Early Notification for the legal team at NHS Resolution, and Annette Anderson, midwife and head of the Early Notification clinical team at NHS Resolution, explain NHS Resolution’s role and function and the Early Notification Scheme.

Early Notification criteria

Babies who meet the criteria to be reported to us by NHS Trusts include term babies born following labour (at least 37 completed weeks of gestation) who have had a potential severe hypoxic brain injury confirmed on an MRI scan. Babies who are born by elective caesarean section, and babies who have sadly died within the first week of life (0-6 days) will not be eligible for review under the EN scheme.

A potential severe brain injury is diagnosed in the first seven days of a baby’s life, and is when the baby:

Was therapeutically cooled (active cooling only), or
Has been diagnosed with moderate to severe encephalopathy, consisting of altered state of consciousness (lethargy, stupor or coma) and at least one of the following:
– hypotonia;
– abnormal reflexes including oculomotor or pupillary abnormalities;
– absent or weak suck;
– clinical seizures

(We have amended the wording on our family pages to give a simplified version of the above criteria).

These babies are reported to the Maternity and Newborn Safety Investigations (MNSI) programme.  

Reporting requirements

Key actions for trusts:

Trusts’ legal teams to report incidents to NHS Resolution via the Claims Reporting Wizard of qualifying EN cases once they have been confirmed by MNSI as under investigation. Trusts need not report cases which are being investigated by MNSI due to parental or Trusts concerns only.
When reporting incidents to NHS Resolution, please include the MNSI reference in the ‘any other comments’ box
In the Claims Reporting Wizard, for ‘Team Leader’ please select Beth Dickinson, interim Head of Early Notification at NHS Resolution
Undertake statutory duty of candour conversations and inform families of the EN process.
Please upload the final MNSI report to the corresponding CMS file when you have received this via DTS
During the transition to SPEN, Early Notification Scheme eligible cases should continue to be referred via NHS Resolution’s claims reporting wizard, until your Trust has been onboarded to the SPEN portal. When onboarded, your Trust should no longer report cases to the Early Notification Scheme via the claims reporting wizard.

Communication with families

The statutory duty of candour requires Trusts to inform families of all investigations into their care. It is vital that families involved in MNSI and EN investigations are fully informed by NHS Trusts of all processes underway and of the outcome reached.

For births from 1 April 2021 onwards Trusts are responsible for advising families that their case has been reported to NHS Resolution for consideration of inclusion in the EN Scheme. Ongoing communication regarding inclusion into the scheme, the progress on the investigation and outcome will be provided by NHS Resolution. If the family contact the Trust directly, the Trust should positively engage with them and signpost to NHS Resolution and the EN Family Liaison and Mediation Lead.

Trusts are encouraged to continue with their initial 72-hour reviews to ensure that any learning is identified and actioned in a timely manner. 72-hour reports and investigations can be shared with NHS Resolution should a liability investigation take place.

The flowchart on our support for families and carers page illustrates when we make contact throughout the investigation process.

Contact

If you would like to get in touch with the EN team, please contact NHS Resolution directly on nhsr.enteam@nhs.net call us on 0207 811 6263.

Learning resources

Maternity Incentive Scheme
The Maternity Incentive Scheme (MIS) supports the delivery of safer maternity care through an incentive element to trust contributions to the CNST.

eLearning module
eLearning module that focuses on learning from the significant avoidable harm that can occur during the antenatal, intrapartum and postnatal care of mothers and their babies and is seen in the cases notified to its Early Notification Scheme.

EN case stories
Our EN case stories are illustrative and based on recurring themes from real life events. These experiences have been highlighted and shared with you, to help identify potential risks in your clinical area, promote learning and prevent fewer incidents like these occurring in the future.

Report form
Within 30 days of receipt of the final MNSI report Trusts must ensure that the following documents are uploaded to the corresponding CMS file via DTS:

A copy of the final MNSI report;
A copy MRI report (if available);
An updated EN report form (if there were any outstanding fields of information).

Once these items are received, the EN team will triage the case and acknowledge whether the matter will be taken forward for further investigation. At this point medical records and/or other documentation may be requested.

Reporting guide
To be considered alongside wider Claims Reporting guidelines and to establish whether a maternity incident should be reported to the Early Notification (EN) scheme please answer the questions and follow the instructions set out in steps one to four of our reporting guide.

Published reports
The second Early Notification report
Published on 29 September 2022, the report provides an overview of progress made since the first report in 2018.

It updates on the progress of the key recommendations which were made in the first report and reflects on modifications and improvements made to the scheme since its launch in 2018. It also provides an analysis of the main clinical themes, based on a small cohort of cases, and makes recommendations to further improve outcomes for affected families.

Head over to our dedicated page for the second report where you can also find a webinar which gives a detailed overview of the report, as well as an infographic with the key messages.

The first Early Notification report
Published September 2019, our Early Notification scheme progress report: collaboration and improved experience for families is available providing an overview of the scheme alongside a thematic analysis of a cohort of cases from year one of the scheme (2017/2018).