First perinatal mortality surveillance report published for Trusts and Health Boards in the UK

Team led by University of Leicester identifies areas for improvement for NHS Trusts and Health Boards

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.

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."