APPENDIX 23
Memorandum by BirthChoiceUK (MS 29)
1. INTRODUCTION
TO BIRTHCHOICEUK
BirthChoiceUK is an independent voluntary organisation
dedicated to helping women choose where to have their baby through
information provided by way of a website: www.BirthChoiceUK.com.
The website includes maternity statistics produced by the Department
of Health and fully referenced résumés of the research
relating to choices in childbirth. BirthChoiceUK workers include
two childbirth educators and a statistician. The views expressed
in this document are those of BirthChoiceUK. A representative
of BirthChoiceUK would be happy to submit oral evidence if requested.
2. SUMMARY
It is in the interest of the Government, the
Department of Health and services users that accurate and meaningful
maternity statistics are collected, analysed and made publicly
available. Hospital Episode Statistics are the primary source
of maternity statistics but many Hospital Trusts either fail,
or make a minimal effort, to accurately compile and submit these
statistics. This is the overriding issue that needs to be tackled.
Improvements in the way data are collected, together with meaningful
analyses of those data, could dramatically improve the quality
of national statistics and the information they provide about
maternity services.
3. THE COLLECTION
OF DATA
FROM MATERNITY
UNITS
3.1 The Need for Maternity Statistics
3.1.1 National maternity statistics are
essential to assess the quality of services being provided and
to monitor and evaluate changes in the provision of health care.
3.1.2 Users of maternity statistics will
include NHS managers, clinicians, medical researchers, and those
campaigning for improvements in maternity services. More recently,
pregnant women have been identified as a major user of maternity
statistics.
3.2 Quality of Data
3.2.1 All users need access to accurate,
complete and readily available data. The data also need to be
collated in a form which is useful for each user group. Where
data are produced for individual maternity units, the data needs
to be comparable, using standard data definitions.
3.2.2 National maternity statistics for
England are collected by the Department of Health through the
HES (Hospital Episode Statistics) system. It is widely acknowledged
that national maternity data for England are incomplete, often
inaccurate or unavailable and that they need to be improved (Kenney
and Macfarlane, 1999) [48]
3.2.3 The latest Department of Health
Statistical Bulletin[49]revealed
that in 2000-01, only 66% of hospital deliveries and 12% of shome
deliveries were recorded by the HES system. It is not known how
accurate these submissions were. In 2001-02 about 60 NHS Hospital
Trusts failed to submit any usable HES records to the DoH.
3.3 No aggregation of data
3.3.1 Even where Hospital Trusts do submit
data of sufficient quality, these data are often aggregated where
there is more than one maternity unit within a trust. Where data
are aggregated, information is lost and the statistics fail to
show differences in outcomes between the individual maternity
units.
3.3.2 It is important that HES data are
available for individual maternity units, including freestanding
midwifery-led and GP units, rather than for Hospital Trusts. Where
women may be transferred out of midwifery-led GP units during
labour, the transfer rates should also be collected.
3.4 Measuring "non-intervention"
The basis of much of the data analysis is that
of measuring individual intervention rates. Many users, including
pregnant women, are now becoming interested in "non-intervention"
rates, such as women having spontaneous onset of labour together
with spontaneous delivery. It is not possible to calculate "non-intervention"
rates using published intervention rates as often multiple interventions
are used. Some of these analyses are possible with the current
HES system but are not published.
3.5 Limitations in analysis
There are limitations in the way that data is
collected that prevent meaningful analysis of national statistics.
Therefore with the current HES system it is not possible to, for
example, determine differences in birth outcome between primiparous,
and multiparous women for individual maternity units.
3.6 Duplication of Effort
Many Trusts collect maternity statistics at
a local level and calculate their own intervention rates, in addition
to providing data for the HES system. This represents a duplication
of effort and often there are large discrepancies between HES
statistics and those produced independently. BirthChoiceUK has
spoken to Trust workers tasked with the local collection of maternity
statistics who are unaware of the parallel effort being put into
compiling the HES records.
3.7 Conclusion
Despite the requirement for Trust Chief Executives
to sign up to affirm the quality of their HES data, maternity
statistics remain inadequate and of poor quality.
3.8 Recommendations
We are BirthChoiceUK would like to see up-to-date
accurate, complete and relevant statistics for each maternity
unit in England. At a national level we would like to see: the
submission of data about each of its individual maternity units
being made mandatory for hospital Trusts; representatives of user
groups being consulted on which figures should be produced and
published; and agreed data definitions to allow data to be compared
more easily. At a local level we would like to see Hospital Trusts
ensuring that data collected for local use match data submitted
for national analysis.
3.9 Further information
This evidence is intended to be self-contained.
However, more detailed information can be found in our document
"National Maternity Statistics for England: A consumer organisation's
perspective" available at www.BirthChoiceUK.com/Professionals/PDFs/StatisticsDocument.pdf.
4. THE STAFFING
STRUCTURE OF
MATERNITY CARE
TEAMS
We are not providing written evidence under
this term of reference.
5. CAESAREAN
SECTION RATES
We are not providing written evidence under
this term of reference. For the benefit of the committee we would
like to point out that Caesarean section rates for UK hospitals
can be viewed at www.BirthChoiceUK.com. National, regional and
historical rates can be viewed at www.BirthChoiceUK.com/Professionals.
6. THE PROVISION
OF TRAINING
We are not providing written evidence under
this term of reference.
Miranda Dodwell
Rod Gibson
Ruth Armes
13 February 2003
48 Kenney N, Macfarlane A. (1999), Identifying
problems with data collection at a local level: survey of NHS
maternity units in England. BMJ, 1999; 319: 619-622. Back
49 Department of Health (2002) NHS Maternity Statistics,
England: 1998-99 to 2000-01 Statistical Bulletin 2002-11.
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