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There is a large body of research to suggest that serious errors are widespread throughout medicine. The traditional response to these adverse events has been to adopt a 'person approach' - blaming the individual seen as 'responsible'. The culture of medicine is highly complicit in this response. Such an approach results in enormous personal costs to the individuals concerned and does little to address the root causes of errors and thus prevent their recurrence. Other industries, such as aviation, where safety is a paramount concern and which have similar structures to the medical profession, have, over the past decade or so, adopted a 'systems' approach to error, recognizing that human error is ubiquitous and inevitable and that systems need to be developed with this in mind. This approach has been highly successful, but has necessitated, first and foremost, a cultural shift. It is in the best interests of patients, and medical professionals alike, that such a shift is embraced in the NHS.

In August 1999 the Government set a national objective of reducing the numbers of children acquiring human immunodeficiency virus (HIV) infection from their mothers by 80%. The key policy change towards achieving this objective was that HIV testing was to be recommended as a routine and integral part of antenatal care. The UK has fallen behind other Western industrialized countries in the uptake of antenatal testing and reduction in mother-to-child transmission. This article examines the background to these new recommendations, the substantial benefits of available interventions and the reasons why current testing policies have been failing.