Big rise in trusts ‘red rated’ for infant mortality

Twenty-three trusts (see table) were flagged for their perinatal mortality in the latest Mothers and Babies: Reducing Risk through Audit and Confidential Enquiries audit for maternity services. Trusts with mortality rates more than 5 per cent higher than an average of peer group providers are given a red rating.

The report was published last month and looked at data for 2020. Average perinatal mortality rates have been falling across England since 2013, although there is significant variation across England.

Six trusts in the latest audit were red rated for both stillbirths and neonatal mortality: Gloucestershire Hospitals; University Hospitals Dorset; Sandwell and West Birmingham Hospitals; University Hospitals Coventry and Warwickshire; University Hospitals of Leicester; and Buckinghamshire Healthcare.

There were zero trusts rated red for both stillbirths and neonatal mortality in the 2019 and 2018 audits, and just one in 2017.

Twenty-three trusts rated red on a combined perinatal mortality indicator (including the six listed above). For 17 of them, their mortality rates were not high enough on one of the stillbirth or neonatal measures to be red rated, but sufficiently high enough on both indicators to tip their overall extended overall perinatal rating into the red.

The overall number of red-rated providers for perinatal mortality was up from 14 in the previous 2019 audit.

Trusts with mortality rates in the red band are expected to carry out detailed local reviews to see if any of the deaths were avoidable or find out any local factors that might explain the high rate.

The Mothers and Babies: Reducing Risk through Audit and Confidential Enquiries report uses stabilised and adjusted mortality rates that account for key risk factors, including deprivation and the baby’s ethnicity. HSJ  looked at the data excluding congential anomalies, as the report said they contribute significantly to mortality but are not amenable to intervention by maternity services. 

However, some of the trusts said there were particular complexities around their caseload and diversity of their populations, while others suggested it could give a misleading picture.

Andrew Furlong, medical director of University Hospitals Leicester, said: “Where learnings have been identified from reviews of care, we have developed robust action plans and strengthened care practice to shape and improve future services.”

These include aiming to improve access to interpreters, provide clearer medical review guidelines, and update ultrasound scanning processes, he added.

A spokesman for University Hospitals Dorset said the trust had examined each of the cases behind the data and found “no consistent themes”.

Sandwell and West Birmingham’s equality, diversity and inclusion team has done “extensive work” raising awareness of the importance of early access to maternity care, which it says has reduced neonatal deaths this year.

An NHS England spokesman said it is supporting trusts and health systems to improve maternity and neonatal care. This includes “investing £127m this year to boost the maternity workforce, strengthen leadership and increase neonatal cot capacity – on top of the £95m annual boost for staff recruitment and training announced last year”.

MBRRACE is commissioned by the Healthcare Quality Improvement Partnership, which is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing, and National Voices.

Liverpool Women’s FT said factors influencing the trust’s higher mortality rates included “higher than average deprivation in the region where adjustments are not fully reflected in the MBRRACE benchmarking”.

Warrington and Halton Hospitals FT said perinatal mortality was not always a reflection of the quality of care. For example, it said it had recorded instances of women who had not been under the trust’s antenatal care presenting for the first time with stillbirth, or where a baby had died under the care of a different trust but the case was reviewed and reported by WHH.

Somerset FT also suggested the MBRRACE audit gave an inaccurate picture because some socioeconomic factors that may be associated with poor outcomes are not taken into account on all births, such as maternal smoking and body mass index (BMI).

<sub>Table contains red rated providers in the 2020 MBRRACE report, excluding congenital anomalies. 
* Comparator group; 4,000 or more births per annum at 24 weeks or later
** Comparator group; Level 3 NICU
^ Comparator group; 2,000-3,999 births per annum at 24 weeks or later
^^ Comparator group: Level 3 NICU and neonatal surgery</sub>

Update: post updated on 23 November to include a statement from Sandwell and West Birmingham.