FOI230238: Stillbirths and neonatal deaths 2018 to 2022

Released 26 July 2023

Request – original reference FOI230147:

Please provide data for each question for the years 2018 to 2022, broken down by calendar year (i.e. 2018, 2019, 2020, 2021 and 2022).

1. Please provide the number of term stillbirths (37 weeks or more) at your trust

2. Please provide the review process for each stillbirth recorded, e.g.. X number of PMRTs, X number of SIIs, X number referred to the coroner. If relevant, please include the number that led to no review. 

3. In any reviews done following a stillbirth please list how many times each of the following was a contributing factor, concluded from the investigation. 

a.      Failing to monitor reduced foetal movements

b.      Wrongly interpreting test results during pregnancy

c.      Failing to act on test results which highlight a problem

d.      Failure to treat infections in the mother

e.      Poor staffing levels

f.       Failure to notice vital signs of distress

4. Please provide the number of neonatal deaths at your trust

5. Please provide the review process for each neonatal death, e.g. X number of SIIs, X number referred to the coroner. If relevant, please include the number that led to no review. 

6. In any reviews following a neonatal death, please list how many times each of the following was a contributing factor, concluded from the investigation. 

a.      Failing to monitor reduced foetal movements

b.      Wrongly interpreting test results during pregnancy

c.      Failing to act on test results which highlight a problem

d.      Failure to treat infections in the mother

e.      Poor staffing levels

f.       Failure to notice vital signs of distress

g.      Failing in antenatal care

h.      Insufficient or inaccurate handovers

i.        Failing to recognise need for caesarean

7. Please provide the number of maternal deaths at your trust

8. Please provide the number of midwifery staffing red flags at your trust

Assistance provided under Section 16 on 26 June 2023 under original reference FOI230147:

Firstly, please note that University Hospitals Sussex NHS Foundation Trust has only been in operation since 1 April 2021, following the merger of Brighton and Sussex University Hospitals NHS Trust and Western Sussex Hospitals NHS Foundation Trust. On the basis that you are seeking information for periods of time both before and after the merger, can you please confirm if you require this information for all three Trusts (i.e. both legacy Trusts and University Hospitals Sussex NHS Foundation Trust) where applicable, or if you only require information for University Hospitals Sussex NHS Foundation Trust since its inception?

This will likely have a bearing on the amount of information we are able to provide within the ‘appropriate limit’ governed by section 12 provision [cost limit] of the FOIA. Where information is required for the legacy Trusts and University Hospitals Sussex NHS Foundation Trust, we will only be able to report by financial year (i.e. April to March) due to the date of the merger.

With regard to questions 2,3, 5 and 6 the Trust does not currently record details of investigations in a manner that we easily extract data from them, we do not have a central register that contains this information. Information relevant to this would only be recorded within the individual patient notes. Section 12 provision [cost limit] of the FOIA is applicable at this time.

Regarding question 8 we are still trying to establish with the maternity service if this information is logged in a manner that can be reported on but we do not want this to delay our duty of assistance response. We will continue to investigate and advise in our final response.

Based on the fact we are unable to provide a significant portion of your request can you please confirm you still wish us to supply the information for the questions we are able to answer.

Response received 21 June 2023:

I can confirm I require this information for all three Trusts (i.e. both legacy Trusts and University Hospitals Sussex NHS Foundation Trust) where applicable. 

Please provide the information you are able to within costing limits. Would you be able to provide more if I reduced the timespan to three years?

Further assistance provided under Section 16 on 22 June 2023 under FOI230147:

You have asked “Please provide the information you are able to within costing limits” Unfortunately requests in this format are not considered valid under the terms of the Freedom of Information Act. According to guidance issued by the Information Commissioner’s Office, requests defined by the section 12 cost limits are invalid under section 8(1)(c) because their scope is determined by the extent of the record search the authority can carry out within those limits, rather than the distinguishing characteristics of the information itself.

We can advise, due to the number of cases involved and the fact that each case and the associated patient notes would need a full review by a medically qualified expert that reducing your request to three years would still not bring you within the cost limit and S12 provision would still be applicable.

On this basis please confirm you would like us to continue and provide a response for questions 1, 4, 7 and 8 (if information available).

Response received 27 June 2023:

Yes in that case please provide responses for questions 1,4,7 and 8.

Information disclosed under reference FOI230238:

Maternal death data is defined as a death of a woman during or up to six weeks (42 days) after the end of pregnancy (whether the pregnancy ended by termination, miscarriage or a birth, or was an ectopic pregnancy) through causes associated with, or exacerbated by, pregnancy.

Deaths are subdivided on the basis of cause into: direct deaths, from pregnancy-specific causes such as preeclampsia; indirect deaths, from other medical conditions made worse by pregnancy such as cardiac disease; or coincidental deaths, where the cause is considered to be unrelated to pregnancy, such as road traffic accidents.

The maternal death data we have provided includes direct, indirect and coincidental deaths where known by the Trust. Neonatal deaths are reported up to 28 days after birth. Further information about this reporting criteria can be found in the National Guidance on Learning from Deaths available from NHS England

Please refer to the table below for information relevant to the Trust’s four maternity units at Worthing Hospital, Worthing; St. Richard’s Hospital, Chichester; Royal Sussex County Hospital, Brighton; Princess Royal Hospital, Haywards Heath. 

Although data protection legislation does not apply to the deceased, significant case precedent has established the applicability of section 41 exemption [provided in confidence] regarding  information held within the medical records of deceased persons. This has confirmed that the Information contained in medical records will generally be confidential; the duty of confidence will continue to apply after the death of the person concerned. Where sensitive data is relevant to a small number of deceased patients that could be identified this data has been anonymised. The Trust considers the disclosure of more specific information to be exempt under section 41(1)(b). This is an absolute exemption and therefore not subject to further public interest considerations.

8. The Trust uses eleven different red flags and the descriptions for these are indicated below. Information about when red flags are applied is noted on our Datix reporting system and/or in the patient records where applicable. Comprehensive information relevant to this activity is not held centrally.

• Delayed or cancelled time critical activity
• Missed or delayed care (for example, delay of 60 minutes or more suturing)
• Missed medication during an admission to hospital or midwifery led unit (for example, diabetes medication)
• Delay in providing pain relief
• Delay between presentation and triage
• Full clinical examination not carried out when presenting in labour
• Delay between admission for induction and beginning of the process
• Delay recognition of and action on abnormal vital signs (for example, sepsis or urine output)
• Any occasion when 1 midwife is not able to provide continuous 1:1 care and support to a woman during established labour
• Coordinator unable to maintain supernumerary status – providing 1:1 care
• Coordinator unable to maintain supernumerary status – NOT providing 1:1 care