Monday 1st February 2021
Failures to follow national guidelines to prevent group B Strep infections in newborn babies is leading to a postcode lottery of care and opportunities to stop deadly infections being missed, our new report has found. Nearly 90% of hospitals in the UK are not using the recommended test for GBS carriage – which costs around £11- despite clear guidance issued by the Royal College of Obstetricians and Gynaecologists (RCOG) and Public Health England (PHE) that the test can significantly decrease false-negative results.
Group B Strep is the UK’s most common cause of severe infection in newborn babies, causing sepsis, pneumonia, and meningitis. Approximately 800 babies a year in the UK develop group B Strep infection in their first 3 months of life, 50 babies will die, with another 70 survivors left with life-changing disabilities. Most of these infections could be prevented.
The RCOG has guidance on group B Strep infection in newborn babies, which was last updated in September 2017. A national learning published earlier in 2020 by the Healthcare Safety Investigation Branch (HSIB) highlighted that the RCOG guidance was not being followed. Our report reinforces these findings.
Only a tiny number of NHS Trusts are following the key new recommendations around giving pregnant women information on group B Strep, offering testing to some pregnant women, and following PHE guidelines on testing for group B Strep. As a result, pregnant women face a postcode lottery, potentially receiving significantly different care from recommended practice.
Key issues found by our report were:
- Around 20% of Trusts had not updated their local guidelines since the RCOG guidance was published in 2017.
- Over half (51%) of Trusts did not give all pregnant women information on GBS, contradicting RCOG guidance.
- Two-thirds (66%) of Trusts are using the wrong swab test to try and detect GBS in a pregnant woman, and only 13% of Trusts are following the right laboratory methodology for processing the tests.
Legal opinion from a leading clinical negligence QC, Chris Johnston QC of Serjeant’s Inn was that under current English law, it was very likely that hospitals using the wrong test or the wrong laboratory methodology would be leaving themselves open to expensive clinical negligence claim were a baby to develop GBS infection as a result.
In order to address the findings of the report, we recommend that:
- All NHS Trusts/Boards adopt and implement the Royal College of Obstetricians & Gynaecologists Green-top guideline on group B Strep promptly.
- All pregnant women are informed about group B Strep as a routine part of their antenatal care.
- Where pregnant women are offered testing for group B Strep carriage, the GBS-specific enriched culture medium (ECM) test is offered late in pregnancy.
- All new parents are informed about the key signs of group B Strep infection in babies to empower them to seek vital early treatment, which can save lives.
“There’s no point in expert bodies like the Royal College of Obstetricians and Gynaecologists producing clinical best practice guidelines if they’re not being adopted on the front line. Our research has found many Trusts and Boards are not giving pregnant women information on GBS, denying them an informed choice about their care. Equally worryingly, a majority are using the wrong test to look for GBS carriage, potentially leaving them vulnerable to expensive legal challenge if things go wrong.
I call on NHS Trusts and Boards across the UK to implement the RCOG guideline on GBS in full as soon as they possibly can.”Jane Plumb MBE, Group B strep Support Chief Executive
Using the Freedom of Information Act (FOIA), the charity requested information from NHS Trusts and Boards with maternity services throughout the United Kingdom. These requests asked 14 separate questions and asked for copies of the information materials given to pregnant women about GBS and the Trust/ Board’s local guideline on preventing early-onset group B Strep infection.
We received a response from all 151 organisations approached, a 100% response rate: 125 organisations in England, 15 in Scotland, six in Wales, and five in Northern Ireland.