We hope we are able to answer any questions you have here about different review and investigation processes, both inside and outside the NHS. We update this information regularly in the light of any changes or questions that come through our helpline services.
Thinking about taking legal action or making a complaint
We are so sorry that you find yourself thinking about legal action following the death of your baby. The following information could help you decide whether and how to go ahead with this action, and the organisations and services who will be able to support you through this difficult time. In the first instance you should be told that the hospital will undertake a review into your baby’s deaths. The review should include your questions and concerns about your care that should then be addressed by the review team at the hospital. In some cases an independent body (such as the coroner or the Health Safety Investigation Branch in England) will conduct a separate investigation about what happened, but this is usually when a baby dies during labour at term (more than 37 weeks of pregnancy). You'll see more information about different review and investigation processes on our pages here.
If you want to make a complaint about any aspect of your care (including the review process itself) you can make complaints via the PALS (Patient Advisory Liaison) service where your baby was born (or died, if this is not the same hospital). Every Trust or Health Board has details of the PALS service on their website.
If you do decide you would like to explore legal action, we recommend that you contact the charity AvMA (Action Against Medical Accidents) https://www.avma.org.uk/?download_protected_attachment=How-AvMA-can-help-you.pdf.
AvMA can provide help and advice via their helpline, can help you find a solicitor and can advise on compensation claims. Free, impartial advice from a trained solicitor is available, who can sign post you on to further services. AvMA produces self-help guidance for parents seeking information and support. This can be found at www.avma.org.uk/guides. These guides give advice on finding a solicitor.
FAQs for families about review and investigation
A hospital-based review and the PMRT
What is a hospital-based review? A hospital-based review is part of standard NHS care. It is when a team of health care professionals at the hospital where your baby was born and/or died review the care mother and baby received to understand as much as possible about what happened and why your baby died. They will use the Perinatal Mortality Review Tool (PMRT) to guide them in assessing your care against national and relevant local guidelines. This will help them reach a consensus on what happened in a review meeting, the results of which will be reported back to you.
What is the Perinatal Mortality Review Tool (PMRT*) and how does it work? The PMRT is a web-based process for conducting a hospital review into a baby’s death to understand what happened and why the baby might have died. It is not the same as a post mortem
How does the PMRT work? The on-line tool is designed to bring as much information about you, your pregnancy, birth and any other information about your baby from medical notes into one place. Your care and your baby’s care are assessed against national (set out by National Institute for Clinical Guidance NICE), and any local hospital, guidelines relevant to every aspect of your care, from your pregnancy booking right through to postnatal care. Once all the information (and any more they may have such as a post mortem), is put into the on-line tool a team of health professionals will use it to discuss your care at a hospital-based review meeting.
Why do hospitals do reviews of babies who die? Hospitals review the deaths of babies to understand more about why a baby died. A review will evaluate whether appropriate care was given to a pregnant woman and her family, in line with relevant national and local guidelines. It may be a review will find that good care was given; there are cases where a review may find care did not follow guidelines, and action needs to be taken to improve care for future families. It’s important to understand that a review is not the same as a post mortem, which is a clinical investigation to understand the cause of death. Information from a post mortem, if there is one, may add to the review in understanding why a baby died.
Will my baby’s death definitely be reviewed by the PMRT team? A hospital-based PMRT review is undertaken for all babies, weighing more than 500 grammes, whether they die during pregnancy or during their first four weeks of life. Babies who die later having received care in a neonatal care unit will also be reviewed using the PMRT. A baby who dies outside the hospital will also be notified to the coroner/procurator fiscal (Scotland), who will open an investigation and possibly an inquest to understand the cause of death.
My baby died some time ago – will a hospital review have been done?
Some hospitals started using the PMRT to review deaths in early 2018 but it wasn’t used more widely until 2019. Even if the PMRT was not used, some kind of review should have taken place to understand as much as possible about your baby’s death. NHS Resolution in England has been encouraging hospitals to use the PMRT for all baby deaths specifically since December 2018.
Is the PMRT the same as a Serious Incident Investigation (SII)? A Serious Incident Investigation occurs when the hospital is concerned that something may have gone wrong with NHS care. The PMRT tool itself can be used to review a serious incident in maternity or neonatal care, but not all baby deaths will trigger an SII. In England, most SIIs are now being undertaken by the Healthcare Safety Investigation Branch(HSIB) which is independent of the NHS. If your baby died in an English hospital unit at term (37 weeks’ gestation or more) due to an event in labour, this may be the case.
If my baby was born in one hospital but died in another, who will do the review? The hospital where your baby died is likely to lead the review of your baby’s death. The hospitals where your baby was born and died should work together to share information, however. It is important as part of the review to understand your care in pregnancy as well as during labour and birth and any care your baby had after he or she was born.
What if my baby died at home, after he/she was born in hospital, will the hospital still review their care? If your baby died at home, the coroner/procurator fiscal (Scotland) will be notified. They may open an investigation and will decide whether to hold an inquest or not. If your baby died within 4 weeks of being born or having received care in a neonatal unit at a later stage, then the hospital should also undertake a hospital review. They may not do this until the coroner has completed the report from their inquest. Ask your hospital what is likely to happen.
Is the information about me that’s put into the PMRT for the review confidential? The information about you and your baby will only be used for the PMRT review. Information from the PMRT is linked to a data system already run on behalf of all UK governments and which is kept in a secure way at the University of Oxford. This data system collects brief information about every pregnancy and birth which ends in the late fetal loss, stillbirth or the death of a baby. This is in order to monitor what is happening between different hospitals, regions of the UK and countries in the UK, and to understand what factors contribute to baby deaths. The collaboration commissioned to do this work, MBRRACE-UK, then makes recommendations to prevent future deaths, wherever possible. You can find out about what information is stored in the PMRT data system here. You can choose to opt out of the PMRT being used to review your and your baby’s care; since reviewing your care is part of standard NHS care, hospitals will find another way to review your care.
How will I know that a review is taking place? Staff at the hospital where your baby died should tell you about the review soon after your baby has died. They should give you some written information explaining what the review is and what you should expect. Sands has played a key role in developing resources to help professionals in supporting parents through a review. These resources were launched in July 2019.
Who is part of the review team? Health professionals representing all the areas of care you and your baby received will be on the review team. All review teams include midwives and an obstetrician but if your baby was on a neonatal care unit then a neonatologist should be present too.
Will the people involved in my care be on the review team?Sometimes they are but not always. This may depend on work shifts and what staff are working in the hospital the day the review is taking place.
What if I have questions or my own views/concerns about what happened and why my baby died? The hospital should let parents know the review is taking place and ask parents if they have any questions or issues they want the review team to address. This doesn’t mean you’ll be asked to attend the review meeting itself, but that a member of staff at the hospital will support you in recording your questions and concerns to ensure they are answered at the review meeting. If you haven’t been offered this opportunity but want to be involved, get in touch with your hospital as soon as possible to ask them.
What if I don’t have any questions about what happened? Some parents do not have questions or concerns they want to share with the review team. Every parent and every situation is unique. The review report should still be shared with you regardless, if you wish, whether you have specific questions or not.
*The PMRT stands for Perinatal Mortality Review Tool. It was developed by a team of collaborators from the Universities of Oxford, Leicester, Bristol, Manchester, as well as the Royal College of Obstetricians and Gynaecologists, The Royal College of Midwives, the British Association of Perinatal Medicine, the International Stillbirth Alliance, the Bristol PARENTS study group and Sands. Sands has played a key role in ensuring the voice of parents is at the heart of the work.
FAQs about the PMRT - if you have questions/concerns about your care you want the hospital to address
I have questions about what happened – how do I get these addressed? You should have been informed about the PMRT review process after your baby died. If not, contact your hospital and ask them about their process for reviewing your baby’s death. Let them know you have questions and concerns you would like addressed by the review team and ask how this might be done.
Can I choose the way that I feedback my questions and views about my care? You should be given options about how you feed your questions and views to the hospital review team, either in a face-to-face meeting at a location within the hospital, on the phone, or in an email or letter. In some cases, the hospital may be able to offer you a face-to-face meeting at home. This is not always possible however.
I want our story to be part of the review but I can’t face doing this now – is there a time limit? Most reviews are done within 4 months so it is good to share your questions and your feelings about your care within this time frame. Check with your hospital what the time-frame is likely to be.
How do I know the team reviewing my care will take my views seriously? While sometimes it can be hard to properly answer all parents’ questions about aspects of their care, the hospital should take your views seriously. It may be possible for the health professional (this may be a bereavement midwife, nurse or community midwife) who’s taken your questions and concerns about your care, to present them at the review team meeting. You could ask if this might happen. If this is not possible, your questions and concerns will be recorded and presented at the meeting by another health professional.
I’m worried about saying anything negative – will it affect my care?The hospital review team will consider all aspects of care, good and bad, as well as issues to do with communication. What you say should not affect how the hospital treats you. Raising issues about poor care or communication may help staff at the hospital learn lessons to improve care for future families.
Is the PMRT process independent of the hospital or Trust/Health Board where my baby died? The PMRT process is not independent of the NHS Trust or Health Board, but it should be rigorous and objective, nevertheless. The way the PMRT is structured, assessing care against local and national (set out by National Institute for Clinical Guidance NICE) guidelines, aims to achieve that. The responsibility for good quality hospital-based review rests with the governance structure of the Trust or Health Board where your baby was born and/or died. Some review teams will include an external reviewer, but due to limited resources in the NHS, not all reviews do currently include an independent reviewer.
FAQs about the PMRT - timings and report findings
How long does it take a review team to finalise its report into my care? If you consented to a post mortem the review will not take place until the results of the post mortem are ready because the information from the post mortem will be important to consider, as part of the review. This may mean that the review takes place after 3 months or so and its findings are not reported back to you until at least 4 months or later. If there is no post mortem, there will be less information for the review to consider. While this may mean it takes less time for the review to conclude its findings, it may also mean that the review cannot answer all your questions about why your baby died.
Can I see the final review report? The final review report should be summarised in plain English for you, both in a letter and during a face-to-face meeting, if you wish. It is up to you how you would like the findings communicated back to you. You can also ask to see the final, more technical, report of the review into your baby’s death if you wish. Ask your hospital for this if you would like it.
If something went wrong with my care or my baby’s care will the hospital tell me? NHS staff have a Duty of Candour to be open and honest with families when something goes wrong in NHS care. In cases where the hospital is already concerned that there may have been an issue with your care they will also open a Serious Incident Investigation. If your baby died at term (37 weeks’ gestation or more during labour or soon after birth, an investigation will be undertaken by the Healthcare Safety Investigation Branch (HSIB) which is independent of the NHS. This will only happen with your consent.
I am thinking about taking legal action but I don't know whether I should. Can anyone help me? In the first instance you may want to make a complaint via the PALS (Patient Advisory Liaison) service where your baby was born (or died, if this is not the same hospital). Every Trust or Health Board has details of the PALS service on their website. If you do decide you would like to explore legal action, we recommend that you contact the charity AvMA https://www.avma.org.uk/?download_protected_attachment=How-AvMA-can-help-you.pdf (Action Against Medical Accidents). AvMA can provide help and advice via their helpline, can help you find a solicitor and can advise on compensation claims. Free, impartial advice from a trained solicitor is available, who can sign post you on to further services. AvMA produces self-help guidance for parents seeking information and support. This can be found at www.avma.org.uk/guides. These guides give advice on finding a solicitor.