FOI240240: Maternity Outcomes and Key Performance Indicators

Released: 28 June 2024

Request:

On the 4th June 2024 there were a number of news articles published about a group of nine families who had suffered baby loss attributed to poor care at University Hospitals Sussex NHS Foundation Trust. Dr Maggie Davies (Chief Nurse) was quoted in her response on behalf of the Trust as saying:

“Our outcomes for mothers and babies are now better than most other Trusts in the country, …”

Links to some examples:

• ITV news: nine grieving families call for public inquiry into Sussex maternity services
• Telegraph: nine babies died – NHS Truts want public inquiry

This is good news to hear and I would be interested in learning how this has been measured. I therefore have a few questions as set out below:

1. How are “outcomes” for mothers and babies at UHSx Trust measured?
2. What key performance indicators are used in calculating “outcomes”?
3. How are “outcomes” from all other trusts in the country measured?
4. How do you define “better”?
5. What years or time periods is the data from?
6. Please provide the data that has formed the basis of this statement or a link to where it can be found if publicly available online.

Information disclosed:

Under section 1(1)(a) of the Freedom of Information Act (FOIA) the Trust can confirm that it holds information relevant to your request and this has been provided where possible below.

1. NHS outcomes for mothers and babies are measured as follows:
   • Neonatal death rates: described as the number of neonatal deaths (babies born at over 24 weeks gestation and death occurring within 28 days post birth), as a rate per 1000 live births over 24 weeks; this is reported as a 12-month rolling figure.
   • Stillbirth rates: described as the number of stillbirths (deaths in utero over 24 weeks gestation) as a rate of 1000 registrable births over 24 weeks; this is reported as a 12-month rolling figure.
   • Perinatal Mortality Rate: a combination of the two rates above
   • The rates of Hypoxic Ischemic Encephalopathy (HIE), grades 2 and 3, gestation over 24 weeks per 1000 live births over 24 weeks; this is reported as a 12-month rolling figure. Definition of HIE: HIE is a brain injury that prevents adequate blood flow to the infant’s brain occurring as a result of a hypoxic-ischemic event during the antenatal, intrapartum or postnatal period.
   • Number of complaints received relevant to Maternity services
   • Friends and Family patient feedback, where respondents said the care they received was “Good” or “Very Good”.
2. The key performance indicators used in calculating outcomes are as follows:
   
   The latest data for the period 2021 showed a UK national average for the following rates: 
   Stillbirths: 3.54 per 1000 registrable births 
   Neonatal Deaths: 1.65 per 1000 live births 
   Perinatal Mortality rate: 5.19 per 1000 registrable births 
   Data source: MBRRACE-UK-perinatal-mortality surveillance-report-2021.pdf (le.ac.uk) – page 6 
   
   The UK Government target is: 
   Stillbirths: 2.6 per 1000 registrable births 
   Neonatal Deaths: 1.5 per 1000 live births 
   Perinatal Mortality rate: 4.1 per 1000 registrable births
   Data source: DH Title (publishing.service.gov.uk) – page 31 
   
   The latest data for the period 2019 for HIE showed an England average of rate of HIE 2 & E of 4.25 per 1000 live births.  
   Data source: Microsoft Word – 2018 2019 Brain injury occurring during or soon after birth NATIONAL DATA 280121.docx (imperial.ac.uk) – page 10 
   
   The UK Government has set a HIE target of 2.5 per 1000 live births. 
   Data Source: NHS England » Saving babies’ lives: version 3 – within the Introduction 
   
   The National average of the percentage of maternity service users rating their care as good or very good at the “Birth” touch point was as follows: 
   Jan 24: 93.48% 
   Feb 24: 94% 
   Mar 24: 93% 
   Apr 24: 93% 
   Data source: NHS England » Friends and Family Test data 
   
3. Trusts in the UK are expected to submit the data for Neonatal Deaths, Stillbirths and Maternal Mortality in the same way via the Perinatal Quality Surveillance Model Framework. This framework can be found here – implementing-a-revised-perinatal-quality-surveillance-model.pdf (england.nhs.uk)  
4. Better is defined as lower than the national average for mortality and HIE rates. Better is defined as higher than the national average for patient feedback. National maternity patient surveys, commissioned by CQC, place the Trust in the top third of trusts nationally for patient experience. 
5. The time periods relevant to our data are April 2022 – May 2024 for Perinatal and Maternal Mortality and HIE; June 2022 – May 2024 for the Friends and Family survey.
6. Please refer to the charts provided below for the information requested. Please note the “Target” line in these charts reflects the national average according to the most recent data, as outlined above.