A new report revealing for the first time stillbirth and neonatal death rates for individual trusts has laid bare “unacceptable” variations in maternity services, say midwifery leaders.
The report published by MBRRACE-UK (Mothers and Babies Reducing Risk through Audits and Confidential Enquiries across the UK) covers perinatal deaths in 2013.
“Whilst there is always room for improvement the data flags those trusts and health boards which need to review their performance as a priority”
It supplements a previous report published in June, providing the first regional breakdown of its kind with figures for each trust and health board.
Out of 162 trusts and boards, 21 were “red banded” for having a higher stillbirth and newborn baby death rate than their peers by the investigators and told they should hold a review (see list below).
A further 52 were placed in the amber band, meaning they have been advised to consider a review. The remainder were banded as yellow or green.
MBRRACE traffic light system highlighting variation in death rates:
- Green – mortality more than 10% lower than the average for the comparator group
- Yellow – mortality up to 10% lower than the average for the comparator group
- Amber – mortality up to 10% higher than the average for the comparator group
- Red – mortality more than 10% higher than the average for the comparator group
Professor David Field, joint perinatal lead for MBRRACE-UK at the University of Leicester, 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,” he stated.
The Royal College of Midwives said the figures showed variation between units that was simply “not acceptable”.
“There are clearly large numbers of women who should have additional surveillance throughout pregnancy”
The government wants to halve stillbirth and neonatal death rates by 2030 and this would be possible if all units achieved the same outcomes as the best performing services, said RCM director of midwifery Louise Silverton.
But she stressed it required investment in maternity services including more targeted care.
“In today’s report we see real regional inequalities highlighted in outcomes for women and this variation must be addressed sooner rather than later,” she said.
“There are clearly large numbers of women who should have additional surveillance throughout pregnancy,” she added.
The college highlighted that this group included young mothers and those aged over 40, non-white women and those from disadvantaged backgrounds.
“There is a strong argument for more targeted services and greater efforts to ensure women in these groups, particularly the most vulnerable, get the right levels of care, support and access to services,” said Ms Silverton.
She said the report also contained lessons for midwives and other health professionals.
“The importance of effective multi disciplinary team work and learning from reviews where things go wrong is crucial in ensuring neonatal death rates are reduced,” she said.
“There is still a worrying variation in the quality of maternity care across the NHS”
She said it was vital midwives had the time and support to vital monitoring and thorough assessments of women and ensuring continuity of care was key when it came to spotting problems and encouraging women to stop smoking and tackle weight problems.
Parliamentary and Health Service Ombudsman, Julie Mellor, said: “Most nurses and midwives work very hard to provide the best possible care for patients but there is still a worrying variation in the quality of maternity care across the NHS.
“Our own casework shows that, too often, patients don’t feel listened to and, as a result, opportunities to improve services are missed,” she said.
“It’s absolutely right that hospitals should investigate higher incidents of stillbirth and newborn baby deaths to make sure they learn from these tragedies and improve their services for others,” she added.
Trusts and boards in the red band:
- NHS Ayrshire & Arran
- Belfast Health and Social Care Trust
- Birmingham Women’s NHS Foundation Trust
- Bradford Teaching Hospitals NHS Foundation Trust
- Buckinghamshire Healthcare NHS Trust
- City Hospitals Sunderland NHS Foundation Trust
- Colchester Hospital University NHS Foundation Trust
- Derby Teaching Hospitals NHS Foundation Trust
- Imperial College Healthcare NHS Trust
- Lewisham and Greenwich NHS Trust
- Milton Keynes University Hospital NHS Foundation Trust
- Northern Health and Social Care Trust
- Northern Lincolnshire and Goole Hospitals NHS Foundation Trust
- Royal Wolverhampton NHS Trust
- Sandwell and West Birmingham Hospitals NHS Trust
- Sheffield Teaching Hospitals NHS Foundation Trust
- Shrewsbury and Telford Hospital NHS Trust
- Western Health and Social Care Trust
- Wrightington, Wigan and Leigh NHS Foundation Trust
- Wye Valley NHS Trust
- York Teaching Hospital NHS Foundation Trust