Babies in Midlands and North ‘more likely to die around birth’

Babies born in the Midlands and North of England face a significantly higher risk of dying before, during, or shortly after birth compared to their counterparts in the South, according to a groundbreaking new study. The research, which meticulously analysed data from 121 maternity services across England over a decade (2013-2022), has identified a stark geographical disparity in perinatal mortality rates. Astonishingly, the ten worst-performing maternity centres were all located in the Midlands and North, while the fifteen best-performing were concentrated in the South of England. This troubling revelation comes as a comprehensive review into maternity care in England is ongoing, with Health Secretary Wes Streeting emphatically stating that "systemic failures causing preventable tragedies cannot be ignored."

The comprehensive study, conducted by researchers at the University of Calgary and published in the esteemed Journal of Public Health, drew upon death surveillance reports compiled by MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK). MBRRACE-UK’s vital work meticulously tracks late fetal losses, stillbirths, and neonatal deaths throughout the United Kingdom. The findings of the Calgary study paint a concerning picture of persistent disparities. It highlighted three specific NHS Trusts – Sandwell and West Birmingham Hospitals NHS Trust, Leeds Teaching Hospitals NHS Trust, and Royal Devon University Healthcare NHS Foundation Trust – that exhibited a higher-than-average rate of perinatal death in each of the ten years examined, when compared to services of a similar size.

Adding further gravity to the findings, the Shrewsbury and Telford Hospital NHS Trust, which is currently the subject of a significant ongoing police investigation, was found to have experienced worse-than-average death rates in an alarming nine out of the ten years under review. In stark contrast, the study identified three Trusts that consistently demonstrated lower-than-average death rates across the entire ten-year period: Norfolk and Norwich University Hospitals NHS Foundation Trust, Royal Free London NHS Foundation Trust, and University College London Hospitals NHS Foundation Trust. Crucially, the data used in this analysis was rigorously adjusted for known factors that can influence mortality rates, including socio-economic deprivation, ethnicity, and the gestational age at birth, thereby strengthening the validity of the observed geographical trends.

For a decade, MBRRACE-UK has been instrumental in producing annual reports that identify "red flag" maternity services – those performing poorly – and mandate them to conduct thorough reviews or investigations to pinpoint the underlying factors contributing to their comparatively high death rates. However, the authors of this latest study have expressed concern that there is a lack of clear evidence to suggest that the changes implemented as a result of these reviews have had a discernible impact on improving outcomes. The researchers express hope that their latest study will serve as a catalyst for learning, enabling underperforming services to gain invaluable insights by observing and adopting the "policies, culture, and clinical practices within those reporting consistently lower-than-average or falling rates of deaths." This proposed inter-service learning aims to foster a national improvement in perinatal care.

The scale of the issue is underscored by the total number of perinatal deaths recorded in England between 2013 and 2022, which amounted to a staggering 33,943. This figure is comprised of 10,478 neonatal deaths, occurring within the first 28 days of life, and 23,465 stillbirths. The findings cast a shadow over the government’s ambitious target, set in 2015 by the then-Conservative government, to halve the rates of stillbirths, neonatal deaths, and maternal deaths in England by 2030, a deadline that was later brought forward to 2025. While the report authors acknowledge that this ambitious target has not been met, they do highlight a "significant" 36% reduction in stillbirth and neonatal deaths during this period, bringing the rate down to 4.84 per 1,000 total births. This reduction, while positive, falls short of the intended halving.

A comprehensive review into maternity care in England, spearheaded by Baroness Amos, is slated for publication in the Spring. The interim report, released in December, offered a stark preview of its findings, with Baroness Amos stating that the realities she has encountered thus far "has been much worse" than she had initially anticipated. This sentiment echoes the gravity of the current study’s findings, suggesting a deep-seated and widespread issue within the nation’s maternity services. The geographical disparities highlighted by the Calgary study raise critical questions about resource allocation, regional healthcare provision, and the underlying socio-economic factors that may be contributing to these concerning outcomes in the Midlands and North.

The study’s methodology involved a sophisticated analysis of data from the MBRRACE-UK reports, focusing on the consistency of performance over a ten-year period. By examining which maternity services repeatedly deviated from the national average, either positively or negatively, the researchers were able to identify trends that might otherwise be masked by year-on-year fluctuations. The use of statistical modelling to adjust for confounding variables further strengthens the claim that geographical location is a significant predictor of perinatal mortality risk, independent of other known risk factors. This level of granular analysis provides a robust foundation for targeted interventions and policy recommendations.

The implications of these findings are far-reaching. For parents in the Midlands and North, the study confirms existing fears and anxieties about the safety of maternity care. It necessitates a critical examination of how healthcare resources are distributed across England and whether existing disparities in funding and staffing are contributing to the observed differences in outcomes. The consistent underperformance of certain Trusts, despite repeated identification and mandated reviews, suggests that current mechanisms for driving improvement may be insufficient. This calls for a re-evaluation of accountability frameworks and the implementation of more effective strategies for knowledge transfer and best practice adoption.

The University of Calgary researchers’ emphasis on learning from consistently high-performing services offers a constructive pathway forward. The concept of "benchmarking visits" or "shadowing opportunities" for staff from underperforming Trusts to spend time in centres of excellence could be invaluable. This would allow for direct observation of the tangible elements that contribute to positive outcomes: the specific clinical protocols, the established team dynamics, the communication strategies, and the overarching safety culture. Such practical, hands-on learning is often more impactful than theoretical recommendations alone.

The study’s authors also point to the potential role of leadership and organizational culture in shaping maternity care outcomes. Consistently good or bad performance over a decade suggests that systemic issues, rather than isolated incidents, are at play. This could involve factors such as staffing levels, the availability of specialist skills, the effectiveness of clinical governance, and the responsiveness of leadership to emerging concerns. Addressing these deeper, structural issues will be crucial for achieving sustained improvements in perinatal mortality rates.

The forthcoming report from Baroness Amos’s review is highly anticipated, and it is expected to provide further insights and recommendations for reforming maternity care. The fact that she has already indicated that the situation is "much worse" than anticipated underscores the urgency and severity of the challenges facing the NHS. This current study, by providing concrete data on geographical disparities and the persistence of poor performance, offers vital evidence to inform and strengthen those recommendations.

The government’s commitment to reducing perinatal mortality, while laudable, requires a more nuanced and targeted approach. The missed target highlights the need for a rigorous assessment of current strategies and a willingness to adapt and innovate. The findings of this study suggest that a one-size-fits-all approach to maternity care improvement may not be effective and that regional disparities require specific attention.

Ultimately, the stark reality presented by this research is that geographical postcode lottery in the UK’s maternity services may be a contributing factor to infant mortality. The Midlands and North are not just regions on a map; they are communities of parents and babies who deserve the same standard of care, regardless of where they live. This study serves as a critical wake-up call, demanding immediate and decisive action to ensure that every baby in England has the best possible chance of survival and a healthy start to life. The continued dedication of researchers, healthcare professionals, and policymakers will be essential in bridging this unacceptable gap and ensuring a future where all babies have an equal opportunity to thrive.