EWJ 60 April 2025 web - Journal - Page 17
The NHS Resolution Early Notification Scheme: A
Proactive Approach
In 2017, the NHS introduced the Early Notification
Scheme (ENS) as part of a broader effort to address
the growing concerns about medical negligence, particularly in the area of maternity care. The ENS is designed to facilitate a more proactive approach to
dealing with incidents of serious avoidable harm. The
scheme primarily focuses on incidents where serious
injury, especially in maternal and neonatal care, has
occurred.
Enhancing Legal and Medical Accountability
By incorporating the Bolam and Bolitho principles
into the framework of the ENS, the scheme ensures
that the standard of care is not only aligned with
widely accepted medical practice but also underpinned by logical and ethical reasoning. In this way,
both legal accountability and medical responsibility are
emphasised in the process of investigating and
addressing clinical negligence.
Expert witnesses involved in the ENS must carefully
assess whether the care provided aligns with both established practices and sound reasoning. Their conclusions are essential, as they determine whether the
care provided was acceptable and, if not, whether
negligence occurred.
The scheme works by identifying potential cases of
avoidable harm early, triggering an immediate investigation and initiating a process to understand what
went wrong, how it happened, and what measures can
be taken to prevent a recurrence. The ENS also aims
to streamline the reporting process to allow for
quicker resolutions and minimise the emotional, legal,
and financial burdens on affected families.
The Bolam and Bolitho principles create a robust legal
framework that prevents healthcare providers from
being held liable simply because they made a decision
that other practitioners might not have made. Instead,
they are held accountable based on whether their
actions align with rational, scientifically supported
practices.
One of the key benefits of the ENS is that it promotes
a shift from reactive to proactive medical practice, allowing for the identification of risks before they escalate into significant harm. By focusing on maternal
care, where the potential for harm is high, the ENS
has had a profound impact on preventing long-term
consequences for both mothers and babies.
Expert witness role in Early Notification Scheme
Expert witnesses in maternity care, typically
obstetricians, midwives, or other specialists, have indepth knowledge of clinical standards and practices
within the field. They help evaluate whether the care
provided met established guidelines and whether the
decisions made during pregnancy, labour, and delivery were appropriate. In the context of an early notification scheme, experts assess whether midwifery and
medical staff followed appropriate procedures, identifying any early signs of potential errors that could
lead to claims of negligence.
Key Elements of the NHS Resolution Early
Notification Scheme
1. Early Reporting: Healthcare providers are required
to notify the NHS Resolution within a specific time
frame (usually 30 days) when a serious incident occurs. This early intervention allows the NHS to take
immediate action in investigating the cause of the
harm and providing appropriate support to the
patient and family involved.
An in-depth assessment is required to establish
whether any harm or injury to the mother or baby occurred due to substandard care or whether it was an
unavoidable complication. Their professional opinion
can clarify whether there are grounds for a claim or
whether the issue may be attributed to a known
medical risk, rather than negligence.
2. Investigation and Root Cause Analysis: Once an
incident is reported, an investigation is conducted to
determine whether negligence or avoidable errors occurred. This investigation involves assessing whether
the care provided met the standard of care outlined in
legal precedents like Bolam and Bolitho. The investigation aims to identify systemic weaknesses, if any, and
implement strategies to address them.
The Duty of Candour: Transparency and Trust
An essential component of the ENS is the Duty of Candour, which requires healthcare providers to be open
and honest with patients when something goes wrong.
This legal obligation is part of the Health and Social
Care Act 2008 (Regulated Activities) Regulations and
demands that healthcare practitioners inform patients
when they suffer serious injury due to medical error.
3. Support for Families: The ENS ensures that
families affected by incidents of serious harm receive
adequate support, including access to counselling services and legal advice. This approach helps families
understand their rights and the process that will
unfold.
4. Learning from Incidents: Another key goal of the
ENS is the identification of systemic patterns of harm
within the NHS. By analysing the causes of incidents,
the NHS can implement preventative measures that
reduce the chances of similar events occurring in the
future.
The Duty of Candour requires healthcare professionals to:
• Disclose incidents of serious injury.
• Provide an accurate account of what happened.
• Apologise to the patient or their family.
• Explain what steps have been taken to prevent
recurrence.
5. Collaboration: The scheme emphasises collaboration between medical professionals, legal teams, and
affected families. This collaborative approach allows
for better communication, transparency, and a quicker
resolution of issues, ultimately leading to fewer adversarial legal disputes.
EXPERT WITNESS JOURNAL
The ENS aligns with this obligation, ensuring that
serious incidents are disclosed promptly within a 30day window. This approach encourages transparency,
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APRIL 2025
