Supplementary memorandum submitted by the Department of Health
Questions 74 and 102 (Mr Alan Williams, Nigel Griffiths): Neonatal tariff and how it will operate
The building blocks are in place for the NHS to start collecting the relevant information for neonatal critical care services from April 2008, and this could lead to production of a tariff in 2011-12.
The Department of Health will receive the first data in Summer 2009, but it is optimistic to believe that a national tariff based on the first year's collection of new information will be able to be implemented. Until confidence in the underlying data is robust, setting a price would be a gamble.
The Department needs to ensure that clinical, financial and operational issues are resolved initially so that the cost implications of these issues are not transferred into a price that reflects a suboptimal service and, in such a sensitive area, puts services at risk.
A thorough evaluation and impact of any proposed currencies and price levels will be undertaken. The results of that evaluation and impact assessment will help determine whether a Payment by Results tariff is the best funding mechanism for delivery of neonatal critical care services, and when any tariffs might be implemented.
The building blocks that are required are: patient level data (a minimum dataset) and a unit of activity (healthcare resource group), that can be costed (through reference costs) and paid for (either a local or national tariff).
Patient level data
All the patient data collection systems in the NHS need to be modified to implement new information requirements. The processes to do this are in place: Dataset Change Notices (DSCNs) were issued in August 2006 informing the NHS and the systems suppliers that local clinical data collection systems need to be changed to allow the collection of this data from 1 April 2007.
The NHS has been informed it needs to collect the minimum dataset (ie, it is mandated or mandatory for collection) from 1 April 2008.
Healthcare Resource Groups (HRGs)
The HRGs have been developed and are in place for use from 1 April 2008, in line with the minimum dataset.
Costing information
The first reference cost data collection using the new data will be 2008-09. This will be received by the Department in Summer 2009. It is anticipated that reference costs collected in Summer 2009 will be used to determine Payment by Results tariffs in 2011-12. Depending on the quality of the data and the impact assessment and evaluation, the Department will consider whether Payment by Results should be extended to include neonatal critical care services in 2011-12.
Question 78 (Mr Philip Dunne): What proportion of premature labours result in premature births
It is not possible to answer this request from officially collected data.
The Information Centre collect Hospital Episode Statistics data for England and although these record NHS episodes of false labour these data are not collected by gestational age so it is not possible to link these episodes with subsequent preterm births.
Evidence suggests that more than one-half of women diagnosed as being in early preterm labour will continue their pregnancy to full term. 2, 3 Preterm labour can lead not only to preterm birth, resulting in an increased risk of mortality and disability, but also cots being reserved for babies that are subsequently not born at that time. It is therefore important to minimise the risk of preterm labour and birth.
Some of these risk factors are known, for example, lifestyle influences such as smoking and recreational drug use, etc, and are conveyed in public health advice to pregnant women. Also, through the "Better Care for All" PSAs announced in October 2007, we have developed a new maternity indicator aimed at ensuring that women have early access to maternity care, so that they have seen a midwife or a maternity healthcare professional for a health and social care assessment of needs, risk and choices by 12 completed weeks of pregnancy. This will enable those women who can be identified as being at increased risk of having a preterm baby to be identified at an early stage and the progress of the pregnancy to be closely monitored.
Other causes of preterm labour and birth have still to be identified. The Department of Health's Policy Research Programme funds a five-year programme of research at the National Perinatal Epidemiology Unit (NPEU), which includes workstreams on the compromised fetus and baby, care of the healthy woman and baby and maternal morbidity. Within this framework, the NPEU undertakes a range of studies, including work on pre-term birth.
The Department has recently commissioned the NPEU to take forward a programme of systematic reviews of the research evidence to identify and promote the key interventions that are most likely to contribute to meeting the 2010 infant mortality target and, in the longer term, to improving maternal and child health and a sustainable reduction in health inequalities. The review topics are likely to include the major medical causes of infant mortality, including preterm birth, as well as generic public health interventions.
2 Vendetti F, Mamelle N, Munoz F, Janky E. Transvaginal ultrasonography of the uterine cervix in hospitalized women with preterm labour. Internat J Gynecol Obstet 2001;72:117-125.
3 Peaceman A M, Andrews W W, Thorp J M et al. Fetal fibronectin as a predictor of preterm birth in patients with symptoms: a multicenter trial. Am J Obstet Gynecol 1997;177:13-18.
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