Contacted by the Maternity and Newborn Safety Investigations (MNSI)? Here’s what you need to know

The Maternity and Newborn Safety Investigations programme (MNSI) investigates some types of serious patient safety incidents which happen to mothers and babies during NHS maternity care in England. MNSI took over the maternity investigation programme from the Healthcare Safety Investigation Branch (HSIB) in October 2023.

The Maternity and Newborn Safety Investigations (MNSI) programme is part of a national strategy to improve maternity safety in the NHS. All NHS trusts must report certain maternity safety incidents to MNSI so that they can carry out an investigation.

Following each investigation, MNSI may make recommendations to the NHS trust involved and identify wider themes and learning points to improve maternity services across England.

MNSI investigates birth injuries which have taken place during NHS maternity care, where a full-term baby (born after 37 weeks of pregnancy):

• is diagnosed in the first seven days of life with severe brain injury, involving either:
  • grade III hypoxic ischaemic encephalopathy (HIE);
  • treatment with cooling;
  • or signs of hypoxic birth injury (decreased central tone/floppiness, loss of consciousness, fits or seizures);
• dies during labour but before birth (intrapartum stillbirth);
• is born alive but dies in the first week of life (early neonatal death).

MNSI also investigates maternal deaths, where a mother dies whilst pregnant or within six weeks (42 days) after the pregnancy ends (such as, by birth, miscarriage or termination) and where the death was directly or indirectly related to their maternity care. All NHS trusts which provide maternity services must tell MNSI whenever one of these incidents occur.

Cases MNSI does not usually investigate

MNSI does not investigate:

• HIE birth injuries where the baby’s MRI brain scans or neurological examinations show no obvious evidence of ongoing brain injury (such as after cooling), unless the family or the NHS trust request an investigation;
• brain injury to a baby which is caused by congenital conditions or health issues unrelated to the maternity care;
• neonatal death of a baby whose mother did not go into labour;
• maternal deaths caused by suicide.

If you have been contacted by MNSI, you can choose whether to allow MNSI to investigate your maternity and neonatal care.

Many families understandably want answers about what happened during the birth or neonatal care. An MNSI investigation may provide insight into the circumstances surrounding your child’s injury. However, it is important to understand that MNSI investigations are intended to improve patient safety and are not designed to determine negligence or attribute blame.

If MNSI carry out an investigation, they will produce a report which they will share with your family and the NHS trust which provided your maternity care. MNSI will also notify the NHS’s legal defence team at NHS Resolution, who will begin preparing to defend any potential birth injury compensation claim arising from your baby’s injury, via the Early Notification (EN) scheme.

If you decide not to consent to the investigation, MNSI will inform the NHS trust, which may instead carry out its own internal serious incident investigation.

Your decision about whether to participate does not affect your right to seek independent legal advice or pursue a compensation claim.

MNSI’s investigations are not intended to identify negligence or attribute blame, and NHS Resolution’s primary role is to defend the NHS against patients’ medical negligence compensation claims. Our specialist birth injury lawyers (and our medical experts) often disagree with NHS Resolution’s conclusions and go on to achieve substantial settlements for our birth-injured clients. The best way to find out whether your child or family is entitled to compensation is to talk to one of our experienced, claimant-specialist (for the patient) birth injury solicitors.

Step 1 – The hospital reports the incident

The NHS trust responsible for your birth or neonatal hospital care reports the incident to MNSI and asks for your consent to share your contact details.

Step 2 – MNSI contact you

If you agree to the hospital sharing your contact details with MNSI, an MNSI investigator will contact you within a few days and ask for your permission to access your family’s medical records. It is your choice as to whether you agree to let MNSI access your medical records and carry out an investigation. If you don’t want an MNSI investigation, or you do not want MNSI to access your family’s medical records, you can withhold your consent. If you do not agree to MNSI’s investigation, the NHS trust who manage your birth or neonatal hospital may carry out their own serious incident investigation.

Step 3 – You decide whether to consent

If you agree to the investigation, MNSI will arrange for you to meet with their investigator, so that they can explain the investigation process to you, discuss your involvement and answer any questions you may have. You will still be free to opt out of the investigation at any time, but if MNSI have already accessed your family’s medical records (with your consent) and begun their investigation, they will proceed with the investigation even if you no longer wish to be involved.

Step 4 — Interviews and evidence gathering

During the investigation, MNSI’s investigator will meet with you to interview you and your family to obtain your account of what happened during your pregnancy, birth and neonatal experience. The interviews may take place in person or by video call. You will not be allowed to have your own solicitor with you at these interviews. For this reason, we recommend that you speak to one of our solicitors before sharing your recollections of your birth experience with MNSI.

MNSI’s investigators will also interview the maternity and neonatal staff who were involved in your care. They will liaise with the NHS trust throughout the investigation and may encourage you to participate in meetings or communication with the NHS trust too.

Step 5 — Draft report

MNSI may obtain independent medical advice before preparing a draft investigation report. They will then share a copy of the investigation report with your family .If you believe that anything in the report is inaccurate, you should ask MNSI’s investigator to correct it.

Step 6 — Final report is issued

The final report will then be shared with you, the NHS trust and any healthcare staff involved in your care. MNSI will also notify the NHS’ defence team at NHS Resolution.

At the end of the investigation, you may be asked to attend a meeting with MNSI’s investigator and the NHS trust to discuss what happens next.

In most cases, MNSI expect their investigation to be completed within six months, but in some cases the investigation may take longer.

No. MNSI investigations are designed to improve maternity safety within the NHS and do not determine whether compensation should be paid.

The best way to find out whether your child can claim compensation after a birth injury is to seek advice from solicitors who are experienced in cerebral palsy and HIE birth injury claims for injured patients.

MNSI’s maternity safety investigations do not automatically lead to compensation for babies with birth injury, and MNSI doesn’t investigate birth injuries from a legal perspective. Their reports are designed to help NHS maternity services learn from maternity and neonatal safety incidents, and their recommendations are intended to help the healthcare system improve. However, at the end of the investigation, MNSI must notify NHS Resolution that they have completed their investigation. NHS Resolution are the NHS’ legal defence team, whose purpose is to reduce the amount of compensation that the NHS pays to injured patients, and to defend NHS organisations against patients’ medical negligence claims.

As parents, you may be encouraged to wait for NHS Resolution’s assessment of your child’s eligibility for compensation at the end of MNSI’s investigation. You may be led to believe that NHS Resolution’s assessment is final, or that you should agree to further investigations, such as genetic testing, before NHS Resolution will consider compensation. It is important that you understand that NHS Resolution cannot independently advise you about your child’s right to compensation, as NHS Resolution’s primary role is to oppose or reduce your child’s compensation claim.

In our experience, despite NHS Resolution’s suggestion that its Early Notification scheme leads to earlier financial compensation for families after birth injury, in practice, NHS Resolution very rarely gives unrepresented families a full admission of liability and substantial early compensation in these circumstances, but often uses the information they receive from the injured child’s family to support their legal defence of any potential claim.

For this reason, we strongly advise parents and families to seek free and confidential, legal advice and support from one of our experienced solicitors before responding to contact from NHS Resolution. Your child may be entitled to substantial compensation even if NHS Resolution denies that they are entitled to make a claim. You can email us at mednegclaims@boyesturner.com.