UK NHS Trust and Health Board stillbirth and neonatal death rates published for first time

Posted by ap507 at Dec 16, 2015 04:05 PM |
Team led by University of Leicester identifies areas for improvement for NHS Trusts and Health Boards

Issued by the University of Leicester Press Office on 16 December

Contact pressoffice@le.ac.uk to request the report and images.

Today MBRRACE-UK* is publishing the first perinatal mortality surveillance report for Trusts and Health Boards in the UK. Commissioned by Healthcare Quality Improvement Partnership**, this is a Supplement to the MBRRACE‑UK perinatal mortality surveillance report for births in 2013 published in June 2015 https://www.npeu.ox.ac.uk/mbrrace-uk/reports. (see NOTE 1)

The purpose of this Supplement is to enable individual Trusts and Health Boards to understand their local stillbirth, neonatal death and extended perinatal death mortality rates and to give local teams an insight into clinical performance based not just on crude mortality rates but also having taken account of at least some important socio-demographic factors that influence pregnancy outcomes.

The report released today (Dec 16) presents data for UK births in 2013 and maps out the country by NHS Trusts and Health Boards using a traffic light system with a Red, Amber, Yellow or Green rating highlighting variation in death rates:

●      mortality more than 10% lower than the average for the comparator group (green)

●      mortality up to 10% lower than the average for the comparator group (yellow)

●      mortality up to 10% higher than the average for the comparator group (amber)

●      mortality more than 10% higher than the average for the comparator group (red)

In today’s report, deaths have been allocated on the basis of where the baby was born (even if the death subsequently occurred in a different organisation). In order to deal with the variation in the proportions of high and low risk pregnancies delivered by the different NHS Trusts and Health Boards they have been divided into five groups based on the complexity of neonatal care they are able to provide or, for those organisations without the highest levels of specialised neonatal care locally, by the number of births. The five groups of NHS Trusts and Health Boards are as follows:

(i)          Level 3 Neonatal Intensive Care Unit with routine neonatal surgical provision;

(ii)         Level 3 Neonatal intensive care unit;

(iii)        4,000 or more births per annum at 24 weeks or later;

(iv)       2,000-3,999 births per annum at 24 weeks or later;

(v)        Less than 2,000 births per annum at 24 weeks or later.

NHS Trusts and Health Boards have then been rated within groups, comparing their mortality rate to the group average,  using the traffic light system with guidance provided as to the action required based on their rating.  In line with the previous report published in June all babies born before 24 weeks of gestation have been excluded.

As with any analysis this complex method  does not guarantee that all NHS Trusts and Health Boards are compared on an entirely equal basis as not all variation in underlying case mix differences in the populations they serve can be removed. However the grading system acts as a means of flagging potentially important differences in performance to local clinical teams. Trusts and Health Boards graded with red or orange traffic lights are advised to carry out reviews of all stillbirths and neonatal deaths in order to identify areas of practice where additional training is required or where improvements in care should be initiated.

Dr Brad Manktelow from the University of Leicester, who led the analysis, said: “We have taken a highly innovative approach, not used previously in the UK to assess Trust and Health Board level performance, to analyse these data in relation to stillbirth and neonatal death.”

Professor David Field, joint perinatal lead for MBRRACE-UK at the University of Leicester, in commenting on the report said: “These data provide NHS Trusts and Health Boards from around the UK with the clearest insight yet in helping them understand their performance against their peers. Whilst there is always room for improvement the data flags those Trusts and Health Boards which need to review their performance as a priority.”

Professor Elizabeth Draper, joint MBRRACE-UK lead from the University of Leicester, said: “This report highlights the need for local review by NHS Trusts and Health Boards and builds on the recent findings of the MBRRACE-UK confidential enquiry report into term antepartum stillbirths.”

*The Maternal, Newborn and Infant Clinical Outcome Review Programme is run by MBRRACE-UK, a collaboration led from the National Perinatal Epidemiology Unit at the University of Oxford with members from the University of Leicester, who lead the perinatal aspects of the work, including this enquiry, and the University of Birmingham and University College London, Bradford NHS Foundation Trust as well a general practitioner, and Sands, the Stillbirth and neonatal death charity.

**The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. HQIP’s aim is to promote quality improvement, and it hosts the contract to manage and develop the Clinical Outcome Review Programmes, one of which is the Maternal, Newborn and Infant Clinical Outcome Review Programme , funded by NHS England, the Welsh Government and, with some individual audits, also funded by the Health Department of the Scottish Government, DHSSPS Northern Ireland and the Channel Islands. The programmes, which encompass confidential enquiries, are designed to help assess the quality of healthcare, and stimulate improvement in safety and effectiveness by systematically enabling clinicians, managers and policy makers to learn from adverse events and other relevant data. More details can be found at: www.hqip.org.uk/clinical-outcome-review-programmes-2/

NOTE 1

In June 2015 MBRRACE-UK published its first perinatal surveillance report which provided rates of stillbirth, neonatal death and extended perinatal death in 2013 for local authorities and commissioners of maternity and neonatal services from across the UK. The data that were produced were based on the geographical areas served by these various bodies and included both crude rates of death as well as ’stabilised and adjusted’ rates using an innovative method which takes into account the size of the unit in terms of the number of babies delivered there as well as a number of factors associated with higher rates of stillbirth and neonatal death such as deprivation and ethnicity. A full explanation of this method was provided in our first report - https://www.npeu.ox.ac.uk/downloads/files/mbrrace-uk/reports/MBRRACE-UK%20Perinatal%20Surveillance%20Report%202013.pdf )

For media enquiries contact: Professor David Field df63@le.ac.uk or Dr Bradley Manktelow email: bm18@le.ac.uk

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