Costs of litigation

THE RISK of lawsuits swallow up nearly every penny earned by one of the safest maternity units in the country – at Hinchingbrooke Hospital, in Huntingdon. Although the level of medical negligence claims against the unit is among the lowest in Britain, the

THE RISK of lawsuits swallow up nearly every penny earned by one of the safest maternity units in the country - at Hinchingbrooke Hospital, in Huntingdon.

Although the level of medical negligence claims against the unit is among the lowest in Britain, the hospital still has to pay £1.3million to year in premiums - in case something does go wrong.

The unit loses £2.2million a year, most of it because of the cost of insurance.

"The main problem is that the tariff is under-funded," the hospital's medical director for obstetrics and gynaecology, Suzanne Hamilton, who leads a team of 11 consultants and specialist registrars, told The Hunts Post.

Primary care trusts do not cover hospitals' costs - even Hinchingbrooke's, which is among the 10 per cent least expensive in the country.

NHS maternity units' insurance costs fall into three levels. Most hospitals pay premiums at level one. Hinchingbrooke is one of just 19 to qualify for level two's reduced costs. Just seven have achieved level three.

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If Hinchingbrooke carried its own indemnity, it would probably save nearly every penny because so little goes wrong.

But, when a single claim can cost as much as £4million, it cannot afford to take the risk. That is good news for insurance companies' shareholders, less good for the NHS and taxpayers.

"We saved money (on the premium) by achieving level two status, but the money received by the hospital for a normal delivery just about covers the premium and little else," Dr Hamilton said despairingly.

"We get paid more for a Caesarean section so, theoretically, it's in our interest to make childbirth more complex. But it's not in the patients' interest.

"We've actually reduced the number of Caesareans by about three per cent, and the number of home births is increasing.

"But, although home births save on hospital costs, we still need to have two midwives in attendance.

"So much of the financing makes no sense whatever, but we just have to get on and cope with it. There's no choice."

Dr Hamilton ridiculed suggestions that the district could manage with a midwife-led maternity unit. Of the 2,300 deliveries last year, barely one a day could have been handled by midwives without professional obstetric involvement, she said.

"A midwife-led unit doesn't make financial sense. You still need 24-hour cover, with at least six midwives a day.

"One third of women are high-risk from the start. Another third become high-risk during their pregnancy. And others become high-risk during the course of labour when moving them would be particularly risky.

"And many women simply choose to have their babies where they know specialist help is available should the need arise."

Midwives are not adequately trained to deal with many perinatal abnormalities, and qualified obstetric care is vital.

The hospital also plays host to the Cambridgeshire Primary Care Trust-funded special care baby unit, primarily for premature infants. It is part of an informal regional network of special units that includes Addenbrooke's, in Cambridge. Tiny babies are frequently moved from one to another to make use of available cots in units where specialist - and often intensive - care is available.

"The strategic health authority doesn't seem to have a strategic view of what's going on," Dr Hamilton said. "They are looking at Hinchingbrooke in isolation."

Uncertainty is starting to worry patients. "One of my ladies is now wondering whether to have a third child or not," Dr Hamilton said.

She acknowledges that 2,300 births is below critical mass for the unit, but there is no spare capacity in Addenbrooke's or Peterborough, so closing the unit, even though it spends more thana it receives, is not a serious option for the strategic health authority's review.

"If we had 3,500 births a year, we could wash our face financially - but we can't tell women to get pregnant."

Paradoxically, she believes her team's espousal of the latest techniques has worked against Hinchingbrooke. Nearly all gynaecological cases are dealt with by day surgery or as outpatients. Patients prefer it and the NHS saves money - but the hospital's income is reduced by that efficiency: it would get more money if it kept patients in hospital longer.

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