North London Trust learns lessons of universal GBS testing
Screening for Group B Strep (GBS) is a prime example. At first glance, universal screening may appear prohibitively expensive given the relatively low incidence rate. However, as I will demonstrate below, a failure to implement universal screening can have catastrophic consequences, not just for the children and families affected, but for the public purse. This is a lesson that a North London Trust has already learned.
GBS is a bacterium that is regularly found on and in our bodies, and in adults usually causes no adverse effects. In new and unborn babies however, whose immune systems are much less developed, GBS can result in life threatening illness leading to brain damage and even death.
Universal antenatal screening for Group B Strep Carriage is not supported by The Royal College of Obstetricians and Gynaecologists (RCOG). Instead, the RCOG favours a ‘risk based’ approach. In other words, the RCOG only recommends giving women in labour antibiotics when certain risk factors emerge.
GBS Charity calling for increase in testing
The Group B Strep Support charity have long called for every pregnant woman to be informed about GBS and offered a sensitive test to see if they are a carrier, whilst the RCOG has historically maintained that there is not enough evidence to suggest such screening methods would improve incident rates sufficiently to justify the cost.
However, a recently published study has confirmed that universal screening is associated with a significant fall in neonatal GBS infections.
Between 2008 and 2013, one North West London NHS Trust was experiencing neonatal GBS infections at a rate equivalent to four times the national average. Some of these babies may have received life changing brain injuries due to GBS.
In an attempt to do something about the unacceptable levels of infection, this particular NHS Trust implemented an optional screening programme for all expectant mothers. The result was a marked reduction in infection levels. For some however, this change in policy may have come too late. Given the excellent results achieved, it is hoped that other hospital trusts will now adopt universal screening programmes.
The reality of a GBS infection
As specialist Clinical Negligence Lawyers, we see the human and financial cost of failing to prevent GBS infections all too often.
We recently settled a claim where a Trust failed to screen for Group B Strep even in the presence of the risk factors identified by the RCOG.
The Claimant suffered from infection related meningitis which caused injury to the brain and cerebral palsy. The child now suffers from motor problems, epilepsy, significant cognitive impairment and behavioural difficulties. He requires 24 hour care and is incapable of employment.
It was also found that his condition will not improve, and in fact will only worsen. It was found that he would lose the ability to walk independently by 15 years of age, by 20 years of age he would require the use of a wheelchair indoors when tired or unwell, he would be almost entirely dependent on a wheelchair indoors by the age of 45, and by 60 he would need a hoist intermittently in order to transfer.
The impact on the Claimant and his family has been significant to say the least.
The case settled for a lump sum of £3.25million, plus periodical payments of £86,000 per year to age 12, £120,000 per year between ages 12 and 19, and £208,000 from age 19 and for the remainder of his life.
When weighing up the costs and benefits of testing expectant mothers, some interesting numbers arise. The North West London study suggests that 1459 women would have to be screened to prevent a single case of GBS infection. At £11 per test this equates to £16,049 per avoided incident. As stated above, this may seem prohibitively expensive on the face of it. However, consider the cost to the tax payer of failing to prevent our client’s GBS infection. The cost of screening to prevent one incident is approximately 1/5th of one periodical payment during the first phase. Not every GBS incident gives rise to a clinical negligence claim of course, but the medical and nursing care, as well as the occupational and educational therapy needs of affected children will still need to be addressed - at significant cost to the tax payer.
Given that recent studies show a marked decrease in GBS infections where universal screening is in place, this surely tips the economic argument in favour of testing. Sticking with risk-based screening may save costs in the short term, but the financial strain of picking up the pieces in the medium to long term cannot be overstated.
Putting the financial argument to one side, there is also the human cost. We have to acknowledge that GBS infections, particularly those which result in a brain injury, can irreparably damage the lives of children and their families. Even if it is accepted that costs will be saved in the short term, can we live with the consequences of not doing enough?