Premature Births: Death

Commons Written Answers – House of Commons – Health

Mr. Andrew Smith:

To ask the Secretary of State for Health what progress the NHS is making in reducing the number of babies who die following premature birth.

Ann Keen:

Advances in technology and health care expertise have led to increasing survival rates of very premature babies over the last 20 years. Over the past decade, survival has improved dramatically for babies born at 26 weeks of gestation and above so that now over 80 per cent. survive.

The EPICure Study (led by the university of Nottingham, Department of Child Health) was established in 1995 to determine the chances of survival and later health status by following up children who were born in the United Kingdom and Ireland at less than 26 weeks gestational age during a 10-month period in that year. This is now an ongoing study, which it is hoped will not only show survival and rates of disability but also identify factors at birth, which could give an indication as to the long-term outcome for the survivors.

A new study, EPICure 2, covers all babies born in England at 26 weeks of gestation or less during 2006. This study will demonstrate how effective advances in neonatal care have been since the first study in 1995. Preliminary findings, published in May 2008, found that babies born above 24 and 25 weeks of gestation were significantly more likely to survive in 1995 compared with 2006.

Details of the EPICure studies can be found on the EPICure website:

www.epicure.ac.uk

NCT reveals crucial choice guarantee set to be missed by a mile

Over 95% of women in the UK are not able to choose where to give birth, a new report released today by the NCT (National Childbirth Trust) has found. Offering women choice of where to give birth is government policy across the UK as it is proven to have a positive effect on birth outcomes.

The NCT’s report, ‘Location, location, location’ highlights the benefits of choice to parents and calls for governments and health professionals to act quickly to ensure women have these choices available to them.

The ‘Location, location, location’ results show:

95.8% of women do not yet have access to a real choice between the three options of home birth with a midwife, a local midwifery facility (birth centre) either stand-alone or attached to a hospital and an obstetric unit in a hospital (the choices defined in Maternity Matters1)

89% of women live in areas that realistically do not offer the choice of a home birth with a midwife2

With greater encouragement of home birth, choice could be offered to many more women without any significant investment or shift in the way maternity services are structured.3

Over 40% of women live in areas without reasonable access to both a birth centre and an obstetric unit in a hospital

Women are lacking in the information and support needed to make these choices.3

The research for the report was commissioned in light of the Government’s Maternity Matters1 promise that all women in England will have access to choice of place of birth by the end of 2009. NCT wanted to ascertain how many women in the UK actually have access to choice. Scotland, Wales and Northern Ireland have also made similar policies that support the provision of choice for women.

Belinda Phipps, Chief Executive, NCT, says:

“There is a huge task ahead for trusts and boards as many are very behind in implementing this policy. For every ten pregnant women, nine are not able to choose where they want to give birth. We know across the UK, government policies support women with this choice. However, in reality this is not even close to being delivered yet.

“We want the governments to act now. Although in a few cases more investment in maternity services will be needed, with a simple re-thinking of the way their maternity services are delivered every trust and board can ensure choice is available to all women.

We know there are some financial policy obstacles hindering the achievement of choice the NHS could make much faster progress if it corrected these.

“There are a few trusts and boards in the UK that are succeeding in offering women a real choice and these successes are to be celebrated. We now need the rest of the UK to catch up.”

As part of the ‘Location, location, location’ campaign launched today, the NCT is calling for the commitment to guarantee choice of place of birth by the Department of Health to be implemented fully, and for the governments of Scotland, Wales and Northern Ireland to make a similar commitment to guarantee choice.

To achieve this local and national governments will need to:

Review the financial framework surrounding maternity services

Recognise the importance of midwives in reducing costs and delivering choice

Make sure that women are aware of the options and understand that for healthy women with a low-risk pregnancy, all three options are equally safe places to give birth

Ensure all in the maternity services work together and have sufficient training so they are experienced and comfortable in all three settings.

Make sure parents are provided with unbiased information to help them make their choice

Sarah Banks from Derby says:

“The first thing the midwife asked me was ‘which hospital do you want to go to?’  There was no discussion about other options and no mention of the birth centre nearby.  I told her that I wanted to have my baby at home and she refused to discuss it as she said it was too early and wouldn’t be advisable as it was my first baby.”

Both women and maternity services benefit from choice of place of birth being available. For women it leads to better birth outcomes, increased likelihood of straightforward births and improves their satisfaction with the birth. This in turn leads to higher self esteem and can increase parents’ confidence in being able to look after their baby.

For maternity services, offering these choices is likely to lead to reduced costs. Currently most women give birth in an obstetric unit in a hospital which is an expensive option3. With greater choice provided for women, more are likely to give birth in a birth centre or at home with a midwife. Therefore the effort necessary to deliver all three options will be outweighed by the savings made through less women giving birth in hospitals.

Note:

Please follow link to access: Location, Location, Location report

http://www.dodsmonitoring.com/downloads/PlaceofBirthFINALFORWEB%5B1%5D.pdf

Please ofllow link to access: Research report

http://www.dodsmonitoring.com/downloads/Investigation%20into%20choice%20of%20place%20of%20birth.pdf

Location, location, location’ details access to obstetric units, birth centres and home births in the UK and calculates the rate of women of childbearing age in each area with choice. See below for the results of the top and bottom five Trusts.

Local Authorities that offer the least choice

Local Authority	% of women of childbearing age who have choice
Middlesborough	0.0%
Boston	0.0%
Copeland	0.0%
Carlisle	0.0%
Coventry	0.0%

 

Local Authorities that offer the most choice

Local Authorities	% of women of childbearing age who have choice
South Cambridgeshire	100%
Southwark	100%
Cambridge	100%
Derbyshire Dales	91%
Bath and North East Somerset	91%

Norman Lamb: Number of caesareans deeply worrying

Commenting on figures showing that one in four babies in England is delivered by caesarean section, Liberal Democrat Shadow Health Secretary, Norman Lamb said:

“The staggeringly high number of caesarean sections being performed in this country is a serious cause for concern.

“The fact that the rate is nearly double that recommended by the World Health Organisation is deeply worrying, especially given the concerns about the increased risks of the procedure.

“We urgently need to increase the number of midwives in this country so that mothers are given all the advice and support they need during and after pregnancy.”

NHS Maternity Statistics, England: 2008/09

The new NHS maternity statistics for England 2008-9 were released today.

Belinda Phipps, Chief Executive, NCT, says;
“Again we have a release of figures that show the situation for women and babies is getting worse – high caesarean section rates, increased medical interventions, and fewer women giving birth in a place appropriate to them.

“This clearly demonstrates the effect of the lack of progress on Maternity Matters, the governments choice of place of birth promise, which was highlighted in the NCT’s  Location, location, location research report this week. Choice of place of birth leads to better birth outcomes for women, increased likelihood of a straightforward birth and improved satisfaction with the birth. “

Key Points

The caesarean rate has remained the same at 24.6%, with a rise in the numbers of elective caesareans (0.1%) and a decrease in the number of emergency caesareans (0.1%).  This shows a halt in the trend of increasing caesarean rates.
The instrumental delivery rate has increased by 0.1% to 12.2%, with a rise in the forceps rate from 5.0% to 5.5% and a decrease in the use of ventouse of 0.4%.  This continues the trend of increasing instrumental rates.
The induction rate is down 0.2% to 20.2%.  This reverses the recent upward trend.  Since 1999-2000 there had been an overall downward trend, with a low in 2005 but the rate has subsequently risen again.
Normal delivery rates are not available at the moment.  It is hoped the Information Centre will make these available in due course.

68.8% of women had a spontaneous onset of labour, similar to the previous year which was 68.6%.  [Note: this calculation uses a different source for caesarean as method of onset of labour, which is shown as 11%, rather than the 9.8% shown in Table 32, and does not reflect the rise of 0.1% in elective rates over the year]

62.9% of women had a spontaneous delivery, the same as from 2007-08.  This is at an all-time low.

	2006/07	2007/08	2008/09
Caesarean Rate	24.3%	24.6%	24.6%
Elective	9.5%	9.7%	9.8%
Emergency	14.7%	14.9%	14.8%
Instrumental Delivery Rate	11.5%	12.1%	12.2%
Forceps	4.5%	5.0%	5.5%
Ventouse	7.0%	7.0%	6.6%
Induction Rate	20.3%	20.4%	20.2%
Care on GP/Midwife Ward	10.6	11.7	10.8%
Normal Delivery Rate	n/a	n/a

 

Highs and Lows

There are 8 trusts/maternity units with caesarean rates above 30%:

 

Chelsea and Westminster Hospital	33.3%
Imperial College Healthcare NHS Trust (St Mary’s Paddington and Queen Charlotte’s)	33.1%
East Surrey Hospital	30.9%
Barnet Hospital	30.8%
University Hospital, Lewisham	30.6%
University College Hospital, London	30.6%
Royal Sussex County Hospital, Brighton	30.5%
Royal Free Hospital, Hampstead	30.4%

 

There are 5 trusts/maternity units with caesarean rates below 19%.

Kings Mill Hospital, Sutton-in-Ashfield, Notts	15.8%
Royal Shrewsbury Hospital	16.9%
Pontefract Hospital (part of Mid Yorkshire Hospitals NHS Trust)	17.8%
Barnsley Hospital	18.1%
Salford Royal Hospital	18.8%%

Midwife led care

Data for the current years show no increases in births in NHS midwifery facilities – 9.5% in the current year compared to 9.6% in 2007-08.  Care on consultant wards has increased from 44.7% to 48.8%.

Background – Since 1989-90, data have been collected on the place of delivery.  This uses the following categories:

1. NHS consultant ward
2. NHS GP ward
3. NHS combined consultant/GMP/midwife ward
4. NHS midwife ward/other ward or with delivery facilities associated with midwife ward or unit without delivery facilities

These categories are historical and do not necessarily represent current configurations of alongside birth centres, standalone birth centres, midwife led care beds in an obstetric.  Nonetheless, they can indicate changes in patterns of care.

Year	Total deliveries	Total with known place of delivery	Record completeness	Consultant Ward	Consultant / Midwife / GP Ward	GP ward	Midwife ward / Other ward	Total of midwife plus GP led care
2005-06	611,337	360,273	59%	49.4	41.5	1.6	7.4	9.0
2006-07	629,207	378,439	60%	45.9	43.5	2.3	8.3	10.6
2007-08	649,837	305,930	47%	44.7	43.6	2.1	9.6	11.7
2008-09	652,638	495,535	76%	48.8	40.4	1.3	9.5	10.8

 

This shows a decrease in GP/midwife led care in the previous year, and an increase consultant led care. However, record completeness is much higher than in previous years and changes may reflect a more representative sample than in previous years rather than changes in configurations.

Nurses and midwives will take centre stage in delivering tomorrow’s healthcare

Prime Minister’s Commission sets out its vision for the future.

A vision that will allow nurses and midwives to transform the quality of care was set out today by the Prime Minister’s Commission on the Future of Nursing and Midwifery.

Its ultimate goal is that all nursing and midwifery staff fulfil their potential to help people who use NHS services, families and communities achieve the best possible health and well being.

It also sets out that in the future nurses and midwives will take centre stage in all aspects of health care and that nursing and midwifery practice will be rooted in compassion.

The initial vision has been agreed by the Commission following an extensive engagement exercise over the summer, which sought the views of professions and the public around the country on what they see as the future role for nurses and midwives.

Separate to the vision statement the Commission has identified ten hot topics through responses to the first engagement phase and their own deliberations, which they want further debate on. Included within the hot topics for discussion are the need to address the confusion over roles and title of nurses and midwives and the role of nurses and midwives in putting service users in charge of their own care.

The Commission is now seeking to encourage further views, discussion and debate on their initial vision and ten ‘hot topics’ through a second phase of engagement ahead of publication of their final report in the New Year.

The second engagement phase will last two months and will include meetings with nurses and midwives, stakeholder meetings, public events and seeking views online through the Commission’s website.

A final report will be produced by the Commission in early 2010 and presented to the Prime Minister and Health Secretary, Andy Burnham.

Completion of reform to the healthcare regulatory bodies

The completion of a series of reforms, to strengthen the focus on public protection in the regulation of health professionals including nurses, midwives and dentists, was announced by the Department of Health today.

These reforms mark a significant milestone in the Government’s programme to make safety and quality paramount in the care of patients by modernising the regulation of healthcare professionals, as set out in the White Paper, Trust, Assurance and Safety.

The key features of the reforms are:

- Each regulator has moved to a fully appointed council, with parity between lay and professional members, to ensure that professional interests do not dominate;

- New council members for the regulators will be independently appointed by the Appointments Commission against specific criteria relating to their skills and expertise;

- Smaller, more board-like councils will enhance the ability of the regulators to act strategically.

Women being denied labour beds to give birth

Last year, almost 4,000 women in England gave birth in a location other than a designated labour bed in a hospital.

Hospitals also gave examples of babies being born in midwife offices, lifts, toilets and a caravan. Some of these births will have been genuine emergencies and unavoidable, but many are because services are overstretched.

“New mothers should not be being put through the trauma of having to give birth in such inappropriate places”, Shadow Health Secretary Andrew Lansley said. “It is extremely distressing for them and their families to be denied a labour bed because their maternity unit is full”.

Lansley added that the fact that mothers are getting this sort of sub-standard treatment despite Gordon Brown’s tripling of spending on the NHS reflects the incredible waste of resources in recent years.

He also pledged that under a Conservative Government would make sure every woman who wants a single hospital room will get one, and also that it would make sure the money follows the patient “so that if more women are giving birth then more money is available”.

Health regulators watchdog publishes performance review of NMC

A report by the Council for Healthcare Regulatory Excellence (CHRE), the ‘watchdog’ of the UK’s nine health professional regulatory bodies, concludes that the Nursing and Midwifery Council (NMC) has made ‘significant progress’ over the last year.

The report, ‘Performance review of health professional regulatory bodies 2008/09’, comments that “This has been a challenging and transformative year for the Nursing and Midwifery Council. We are pleased to report on the significant progress it has made in reforming its governance and practice”.

The CHRE performance review also notes that the NMC has ‘…demonstrated excellence or good practice in aspects of its performance….’ and highlights:

• The accessibility of professional standards;
• The development of specific guidance on the care of older people;
• Requiring nurses and midwives to sign a personal declaration that they will conform to the ‘The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives’ at all times;
• Undertaking photographic checks using the British Council’s online checking system for non-EU applicants to register and;
• The use of an expert panel of people with disabilities to inform our work on the NMC’s disability equality scheme.

However, the Royal College of Nursing says there is still room for improvement in the NMC and has described waiting times for fitness to practice hearings as ‘worrying’.

The report is available on CHRE’s website at www.chre.org.uk

Report published on women’s satisfaction levels with maternity care in Wales

Most women are satisfied with maternity care in Wales with services generally meeting an appropriate standard, says a report published this week by the Auditor General. But the report also highlights some specific problems including the way that labour is managed in some trusts and dissatisfaction with support for infant feeding.

The report includes a survey of new mothers and although many women questioned were satisfied with their experience, a significant minority felt they were not always treated with dignity and respect or kindness and understanding.

Antenatal care generally meets good practice guidelines, but some women do not receive enough check-ups and there is generally low attendance at antenatal classes. The report also shows that women in some trusts tend to receive too many scans whilst trusts are not yet offering the most up-to-date screening for Down’s syndrome.

The way labour is managed in some NHS trusts gives rise to concern. A significant minority of women felt they were left alone and worried during or shortly after labour and some trusts could do more to prevent unnecessary Caesarean sections. Women were least satisfied with the postnatal phase of care, with over a third of women being unhappy with the quality of support they received for infant feeding.

The report calls for the Assembly Government to develop an overall strategy for maternity services in Wales. This would help the planning of maternity services which is currently being undermined by the lack of a clear vision and poor information about the cost and quality of care.

The strategy would also provide a comprehensive source of guidance aimed at removing some of the specific problems with maternity services, such as the failure to meet recommended staffing levels in some trusts and the low level of staff training in many trusts.

The report called Maternity Services makes a number of recommendations for improvement, by calling on:

• the Assembly Government to develop a comprehensive strategy for maternity services, highlighting good practice and offering guidance on local service planning
• new local health boards to assess staffing requirements for delivering safe and high quality services
• local health boards to make sure that all maternity staff receive the necessary clinical training
• local health boards to review their training programmes to ensure that there is sufficient focus on the principles of respect, well being, choice and dignity
• the Assembly Government, in partnership with the NHS in Wales and other key stakeholders, to agree a standard set of data that is routinely collected, monitored and used to support service improvement.

RCOG reports on older mothers

In response to growing concern over the rising incidence of later maternal age in the UK, the RCOG convened a Study Group to meet to discuss the issues. Research shows there is a growing trend in the UK for childbearing to occur at a later time in women’s lives and the RCOG says there is an urgent need for better public information on the issues surrounding later maternity.  The RCOG report that whilst women should be supported, rather than constrained, in their life choices, both women and society need to be aware of the possible problems that older mothers may encounter.
 
RCOG reports that later maternal age is an emerging public health issue and organisations such as themselves, NICE and the Centre for Maternal and Child Enquiries (CMACE) must work together with the Department of Health to tackle these new challenges.