Two Birmingham NHS trusts red-flagged over ‘higher-than-average’ baby deaths

MBRRACE UK ranked Birmingham Women’s and Children’s NHS Foundation Trust and Sandwell and West Birmingham Hospitals NHS Trust at number one for consistently recording higher than average deaths each year between 2015-21.

Both trusts said patient care is a top priority while all deaths are fully investigated and efforts are made to make improvements to services.

But they added there were significant contributory factors which had a major impact on the recorded rates and provided context to the figures.

Latest data shows the perinatal death rate for the UK in 2023 increased to 5.19 per 1,000 total births compared with 4.85 per 1,000 total births the previous year.

MBRRACE statistics present ‘crude’ mortality rates – which simply record the total number of deaths within an organisation – with Birmingham Women’s Hospital standing at 8.51 per 1,000 total births in 2023 and Sandwell at 12.07 per 1,000 in the same year.

But when further ‘stabilised and adjusted’ mortality rates – where factors such as babies at high risk of death are taken into account – are presented, both trust’s figures reduce significantly.

Birmingham Women’s Hospital (BWH) is one of two specialist units in the country which looks after the most complex births in the region and beyond.

It also regularly has patients transferred from other hospitals to receive specialist care.

MBRRACE data shows the overall ‘stabilised and adjusted’ mortality rate in 2023 to be 6.38 per 1,000 total births.

But when congenital anomalies – birth defects which impact a child’s survival rate and a significant factor in perinatal deaths – are excluded the rate drops to 4.49 per 1,000 total births.

Dr Satish Rao, chief medical officer at Birmingham Women’s and Children’s NHS Foundation Trust, said: “Our Women’s Hospital is one of two specialist hospitals in the UK and cares for patients and babies with the most complex, high-risk conditions from across our region and further afield.

“The trust’s mortality rates are comparable to others across the country, which offer similarly specialist services.

“This is documented in the most recent MBRRACE-UK report which, when taking into account all factors including congenital anomalies, shows the trust is not an outlier.

“The high-quality care, safety and experience our families receive is our priority. We’re proud to work with them to ensure their care is personalised and safe with the best possible outcomes, regardless of intervention or type of birth.

“We monitor stillbirth, neonatal and extended perinatal mortality rates closely, engage with national maternity transformation initiatives and ensure we continually and proactively look at ways to improve the services we provide.”

The last Care Quality Commission inspection of BWH rated its services, including maternity, as ‘Good’.

For Sandwell and West Birmingham, the area served experiences a higher-than-average rate of stillbirths and neonatal deaths.

Trust bosses said demographic challenges including a highly deprived, multi-ethnic population where late presentation with complications and language barriers can impact maternal and neonatal health outcomes partly influences this.

Work is being carried out to promote awareness of the importance of early and timely access to care while local communities are being engaged to identify barriers, co-produce solutions, and enhance care.

Latest MBRRACE data shows the overall ‘stabilised and adjusted’ mortality rate in 2023 to be 4.98 per 1,000 total births.

When excluding congenital anomalies, the mortality rate for 2023 for SWB stands at 4.73 per 1,000 total births.

Helen Hurst, director of midwifery, said: “A stillbirth or neonatal death is a tragedy and we offer our deepest sympathies to any parent who has experienced this.

“We always ensure that a full investigation is carried out in this sad circumstance to ensure that the correct learning takes place as quickly as possible to improve the care we provide.

“We have seen a notable reduction in neonatal deaths over the last year and continue to put the care of our mums and their babies at the forefront of everything we do.”

The MBRRACE Report concluded: “Our findings provide evidence of a minority of NHS hospital trust maternity services in England that have consistently reported higher-than-average rates of deaths over seven years (2015–21).

“Further research is needed to examine reasons for the geographic proximity of most ‘red flag’ trusts, including any potential conflict around measures of clinical performance.”