Last week the College published its first, in what is to become an annual, report that identifies variations in maternity practice and outcomes across the country. The report, Patterns of Maternity Care in English NHS Hospitals, was undertaken with the London School of Hygiene and Tropical Medicine (LSHTM) and presents a series of indicators that can be used to compare the performance of English maternity units.
This report will form part of the Clinical Indicators Project, which is a programme of work that aims to develop robust performance indicators in obstetrics and gynaecology.
Through this project the College has adopted a strategic aim to develop a repository of clinical maternity data to provide information that can be used to enhance evidence-based practice within the specialty. It is a first in maternity data reporting, with identifying discrepancies and comparing hospital units’ data, and it is one the RCOG is proud to lead on.
The RCOG and LSHTM researchers have taken Hospital Episode Statistics (HES) data from 2011/12 and risk adjusted them to make comparisons between hospitals on specific maternity indicators.
Within the first report, there are some instances where indicators were able to reveal considerable variation among maternity units. For example among women giving birth for the first time, there was a two-fold difference between hospitals with the highest and lowest rates of induction of labour, emergency caesarean section after induction of labour and instrumental delivery.
Variations such as these are a source of concern, for both healthcare professionals and the NHS, as it identifies areas within our system where women may not be getting the best possible care. However, the report throws up more questions than it can answers as some of the observed variation could be due to differences in the quality of the data submitted by hospitals, and differences in patient characteristics that were not possible to control for.
We did not publish individual hospital reports this year as this is the first time indicators have been derived using HES data. It will also allow hospitals to make necessary improvements to data capture so that in future these reports reflect a more accurate national picture of maternity care. But looking forward the plan is to release future reports that identify results from individual hospitals.
In addition, we anticipate that the suite of indicators will expand to include other dimensions of maternity care, including particular areas of interest such as neonatal outcomes and measures of patient experience.
In the wake of the Francis Inquiry, this report has come at a very important time as it represents the first step towards enabling the NHS to become more open, transparent and accountable while providing statistics that help to gauge more accurate feedback of patient care.