Two hospital trusts have recorded high adjusted mortality rates for five of the past seven years, according to HSJ analysis of maternity safety audit findings.
The annual MBRRACE (Mothers and babies: reducing risk through audits and confidential enquiries) study of perinatal mortality and stillbirths compares adjusted death rates using a range of factors — such as health conditions, deprivation, and ethnicity — and then measures each hospital against a comparator group.
A trust is given a “red” rating if its adjusted death rate is at least 5% above the average of its group of trusts with similar facilities and numbers of births.
HSJ analysis of the seven years for which the audit has comparable data shows there are seven trusts that had at least three “red” ratings.
Several of the trusts said they believed their case-mix and populations were not fully adjusted for.
Some argue they take births where the baby has a very low chance of survival because of a heart or other condition, for example, and that this is not accounted for by MBRRACE.
The MBRRACE spokesperson added: “It is essential that care providers review their own data alongside other sources and conduct systematic reviews of each death using the perinatal mortality review tool. We strongly recommend this for all providers.”
Pauline McDonagh Hull, a research analyst at the University of Calgary in Canada, who led a similar review of audit ratings published in the Journal of Public Health, told HSJ: “MBRRACE recommended local reviews or investigations at all those falling into red or amber bands. We need to ask whether these have been taking place, what they found, and what, if any, changes were implemented, and if they haven’t been happening, why not?
“Similarly, has MBBRACE-UK, NHS England, the Royal College of Obstetricians and Gynaecologists, the Care Quality Commission or anyone else followed up on these annual recommendations?”
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Source: HSJ, 28 March 2025
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