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Item Open Access Addressing racial disparities in maternal outcomes for the population of Leicester, Leicestershire and Rutland(Leicester City Council, 2024-07-01) Rajangam, Akshaya; Doshani, Anji; Ochieng, B.; Cowlishaw, Beverley; Siddiqui, Farah; Ruddock, Faye; Cox, Floretta; O'Brady-Henry, Gillian; Chapman, Maxine; Bhavsar, Mina; Darko, Natalie; Archer, Natasha; Ayaz, Rabina; Howard, Rob; Abeyratne, Ruw; Etheridge, Sally; McCue, SteveItem Metadata only Blood stream infections in NHS Maternity and Perinatal Care for women and their babies: a feasibility report of linking maternity, neonatal and infection datasets in England. London: RCOG; 2023(Royal college of Obstetrics and Gynaecology, 2023-02-27) Webster, K.; NMPA Project TeamThe aim of this report was to link datasets that contain information about mothers, their babies, and infection data. The NMPA has been unable to obtain linked datasets within the timeframe of the audit programme contract, which ended on 31 December 2022. Therefore, this report focusses on how important it is to join together the datasets that hold different information about infections during and after pregnancy in women and birthing people and their babies. For example, data collected about pregnancy, labour and birth, information about infections and data about admissions to hospital. Had the joined dataset been available, this could have been used to look at aspects of maternity care and outcomes specifically for women and birthing people who had a bloodstream infection during pregnancy or in the six weeks after birth; and for babies who had a bloodstream or CSF infection in the first 3 days of life. Ongoing linkage of these datasets could be used for longer term surveillance of infection and antimicrobial use in women and birthing people, and babiesItem Metadata only Clinical Report 2021: Based on births in NHS maternity services in England, Scotland and Wales between 1 April 2017 and 31 March 2018(Royal College of Obstetrics and Gynaecology, 2021-09-30) Carroll, F.; Coe, M.; Dunn, G.; Fremeaux, A.; Gurol-Urganci, I.; Harris, Tina; Hawdon, J.; Heighway, E.; Karia, A.; Khalil, A.; Muller, P.; Thomas, L.; Waite, L.; Webster, K.; van der Meulen, J.Executive summary Introduction Maternity and perinatal services in the UK are currently subject to a number of maternity and neonatal review programmes, including quality monitoring and improvement initiatives. These programmes focus attention on the quality of care provided by maternity services in the UK at both a national level and the individual trust or board level.1–3 In parallel to the improvement initiatives for clinical care, there are ongoing improvements in the collation and processing of maternity and neonatal data, including improved capture of detailed information about demographics of birthing people and care episodes occurring along the maternity continuum of care. These data are critical to enable evaluation and implementation of improvement strategies. The National Maternity and Perinatal Audit (NMPA) uses these data to produce information that can support the improvement of maternity and perinatal care. In this report, for the first time, the NMPA is using a new centralised data source (MSDS v1.5) for births in England, while continuing to use the established centralised maternity datasets in Scotland and Wales. This report presents measures of maternity and perinatal care based on births in English, Scottish and Welsh NHS services between 1 April 2017 and 31 March 2018. The report also provides contextual information describing the characteristics of women and babies cared for during this time period and whose data have been included in this report. The limitations of MSDS mean that for births in England the key findings and recommendations made in this report are specific to data quality only. There are insufficient data to draw clinical conclusions. For births in Scotland and Wales, the consistency of the data sources used means that clinical key findings are possible in this report. However, clinical recommendations are avoided for all countries in this report. This is because the NMPA’s next clinical report for births in 2018/19 is expected to be published in early 2022 and will use MSDS data with improved completeness; as a result, it will be able to provide a more comprehensive picture of variation of care across the three countries. Throughout this document we use the term ‘birthing people’ as well as ‘women’. It is important to acknowledge that it is not only people who identify as women who access maternity and gynaecology services. Methods The analysis in this report is based on 304 518 births in NHS maternity services in England, Scotland and Wales between 1 April 2017 and 31 March 2018.* The report is estimated to have captured 41.5% of eligible births in this time period (34% of births in England, 97% of births in Wales and 100% of births in Scotland). The NMPA makes use of data collected electronically through healthcare information systems and national datasets. Data for births in England are provided by NHS Digital’s Maternity Services Data Set version 1.5 (MSDS v1.5) as well as by Hospital Episode Statistics (HES) records. * The time lag between the period covered by this report and its publication is due to the delayed receipt of the MSDS dataset for England. National Maternity and Perinatal Audit: Clinical Report 2021 xi Data for births in Scotland are provided by Public Health Scotland Data and Intelligence (formerly the Information Services Division, ISD), based on data from the Scottish Birth Record and Scottish Morbidity Records (SMR-01 and SMR-02). Linkages to records from the National Records of Scotland (NRS) are also made for births, deaths and stillbirths. Data for births in Wales are provided by the Maternity Indicators dataset (MIds), a dataset managed by the NHS Wales Informatics Service (NWIS), as well as Admitted Patient Care (APC) records from the Patient Episode Database for Wales (PEDW), and some fields from the National Community Child Health Database (NCCHD). In order to compare like with like, the majority of measures are restricted to singleton term births. As a general principle, the denominator for each measure is restricted to women or babies to whom the outcome or intervention of interest is applicable; for example, third or fourth degree tears are only measured among women who have experienced a vaginal birth. Rates of measures are also adjusted for risk factors that are beyond the control of the maternity service, such as age, parity, previous caesarean birth and clinical risk factors that may explain variation in results between organisations. The NHS trusts and boards included in the audit provided intrapartum maternity care at one or more sites. Where possible, site-level results are available on the NMPA website.Item Open Access Coventry and Warwickshire Smoking in Pregnancy Review(2020-09) Lee, Bernie; Griffiths, Sarah Ellen; Barror, AiofeN/AItem Metadata only Evaluation of the crash course: Report to Staffordshire Fire & Rescue Service.(De Montfort University, Leicester., 2009) Hoggarth, E.; Anthony, Denis Martin; Canton, Robert; Cartwright, I.; Comfort, H.; Payne, P.; Shafiullah, M.; Wood, J.; Yates, ScottThe original brief for this research from Staffordshire Fire and Rescue Service and its partners was: - To evaluate the impact that the Crash Course has on the participants’ attitudes to safe road user behaviour; - To evaluate the effect that the Crash Course has on participants’ intention to drive safely in future; - To determine the appropriateness of the content and delivery of the programme for the primary target age group; - To evaluate the appropriateness of the content and delivery of the project to meet its stated objectives; - To outline possible courses of action for progression of the programme. The specification also included paying particular attention to gender differences in attitudes to driving and the nature of peer pressure on young people. The evidence and conclusions are summarised here in relation to this brief. Does the course have a positive impact on the participants’ knowledge of safety issues? The evidence from the study indicates that Crash Course does have a positive impact on young people’s knowledge about how to be safer on the road. There were two knowledge based questions in the survey: one concerned the causes of road crashes and the other concerned the ways in which passengers could keep themselves safer. The comparison between those who had experienced the course and those who had not shows statistically significant higher total scores on the questions designed to test knowledge of the key causes of road collisions (p=0.001). The comparisons on the matched sample of young people before they had received the course and afterwards showed improvement at a level approaching significance in respect of what they could do to keep themselves safer as passengers (p=0.068). Does the course have a positive impact on the participants’ attitudes to safe road user behaviour? The evidence shows that the course did have a consistent effect positive effect on attitudes towards the wearing of seat belts. At a statistically significant level, of those who completed the matched ‘before’ and ‘after’ questionnaires, more young people felt it was acceptable always to wear a seat belt after the course than before (p<0.001). For those who had attended the course compared with those who had not, the effect was similar (p=0.034). For those who answered the questions ‘before’ and ‘after’, significant improvement was also evident in respect of whether they thought they could ask a person who had had too much to drink to stop (their ability to be assertive). After the course a greater number of the young people felt able to ask such a driver to stop (p=0.047). In the comparison of those who received the course with those who did not, those who had seen the presentation were significantly more likely to view “Always wearing a seatbelt” as acceptable (p=0.034) and also to think that “reading a text quickly while driving” was “stupid” (p=0.001). The qualitative evidence from the focus groups confirmed that virtually all the young people felt they had gained from the course, had a greater awareness of risks on the road and an increased knowledge about how they might be able to stay safe. Does the course have a positive effect on the participants’ intentions to drive safely in future? . 409 young people completed the free text question about how they now wished to behave in future. By far the greatest number of responses indicated an intention to wear a seat belt in future (253 or 62% of those responding to the question). There is little doubt that this message is absorbed by a considerable proportion of the participants. A number also indicated that they would press others to do so as well. After that the most numerous answers concerned the resolution not to distract a driver and an intention to tell other drivers to reduce their speed or to drive more slowly when they became drivers themselves. Other responses showed an intention not to drink and drive or go with an intoxicated driver with a small number of other safety issues mentioned. The young people’s comments in the focus groups confirmed the finding that the course does have a positive effect on intended behaviour, with respondents being able to illustrate how they now wanted to behave as drivers. Is there any evidence of behaviour change as a result of the course? The survey compared the self reported behaviour over the previous month for those who had attended the course and those who had not. A positive statistically significant difference was found in the self reports of those who had attended the course in respect of how frequently they had “messed” about in a car, potentially distracting the driver (p<0.001). Those who had attended the course also reported being more frequently “scared about the driving” (p=0.006), from which an inference might be drawn that they had become more sensitive to risk. The qualitative evidence from both adult stakeholders and young people provided anecdotal examples of changes in behaviour after the course that offered some triangulation for the quantitative findings. These examples concerned not only the wearing of seatbelts but other changes such as persuading drivers to desist from mobile phone use or refusal to be a passenger with a driver who had been drinking. Some of the young people were clearly also influencing their peers or their families. Are the content and delivery of the programme appropriate for the primary target age group? The researchers observed the course in action with young people on five occasions. The presentation held the attention of the vast majority of the young people for the full two hours. There were no technical problems in any of the presentations observed. The team handled the material and the different media competently, moving well from one item to another. The presentation was described by stakeholders as “very professional”. At the start of the observation visits, some members of the team feared that the material would be overwhelming and too distressing for 15 or 16 year-olds. In the light of the findings, this concern has however now dissipated. Only 34 of those completing their opinions after seeing the presentation found it “too scary” and 76 felt it upset them too much. Focus groups and teacher stakeholders confirmed that the force of the messages was perceived as legitimate, especially given that parents had given permission and any pupil could opt out. The fear-based messages need to be of sufficient strength to motivate a response without being gratuitously graphic. The researchers felt that approximately the right level was reached. While many 15 or 16 year olds still have mercifully little life experience on loss, trauma, or bereavement to relate to the course content, there was no evidence that any significant proportion were ‘shutting off’ from the messages. The focus groups confirmed that most of those respondents felt the shocking nature of the course was necessary and that it did not cause shutting down of responses or particular resistance. It is not recommended that the course should be presented to pupils any younger than Year 11. The research team felt, however, that the potential of emotional disturbance was considerable and that the Crash Course partnership needs to be pro-active about encouraging excellent levels of pastoral care for participants. This is for the most part the responsibility of the schools or other host organisations but should be encouraged at every opportunity. It was felt that an information leaflet should be made available with appropriate contact numbers of agencies to which young people could turn, in addition to their school pastoral support system. This would help to ensure that the responsibilities of the Crash Course partnership are fully met. Are the content and delivery of the programme appropriate to deliver its stated objectives? The view of the research team is that the Crash Course is broadly appropriate to deliver on the objective of increasing safe behaviour in cars with a view to reducing the number of young people killed or seriously injured. It is an unusual presentation and may even be unique. Its particular strengths are the use of speakers who have first-hand experience; their ability to use feelings and emotions as well as factual information (both female and male presenters); the credibility of the multi-agency delivery team and ownership by the partners. The role of the Fire and Rescue Service is significant. It provides an attractive and neutral image to most young people, compared for instance to the police or even the Youth Service and it can provide ample evidence of local incidents. This part of the positive image and branding of the course should be retained. In the view of the research team, the ‘mechanism’ making the Crash Course effective is the use of a combination of facts, visual images and emotion in face to face delivery by a team of credible people with direct experience of the effects of road collisions. The team requires factual knowledge, stark images and a variety of first-hand experience. Team members have to be able to show appropriate feelings but also to control their emotions. They need to be able to engage a youth audience and control anger about inappropriate responses. They need a context of pastoral support for themselves as well as for the young participants. They need stable supportive management and the vigorous backing of a multi-agency partnership. The core content file of the Crash Course should be revisited and updated. The essence of the educational messages and methods needs to be captured to ensure continuing fidelity and for future transfer elsewhere. Thereafter copyright should be taken on this effective pattern of intervention so that the essential mechanism can be preserved and replicated. It is tempting to think that the Crash Course could only be successful with the personalities of the present team involved. These individuals are undoubtedly talented and committed but there is no evidence in this study to suggest that they are irreplaceable or that the basic mechanism could not be transferred elsewhere. It is essential that new personnel are recruited to the team as a matter of priority. Failing that this effective intervention is certain to die out in time and its coverage will be necessarily limited. There is no spare capacity within the current team strength to deliver more and demands are increasing for further presentations to adults. The report suggests the main elements for a person specification for new team members drawing on the responses of adult stakeholders and the young people themselves. From the observations and the suggestions from young people, a few relatively minor recommendations have been drawn that might improve the impact of the course. These issues are outlined in the report and have been discussed with the Crash Course team for their consideration. In particular it is suggested that more content may be needed on coping strategies and on the effects of relatively small amounts of alcohol on judgement and coordination. Follow up could be strengthened. Some schools do discuss the topic in tutor groups after the presentation but few take consistent opportunities to reinforce the messages in other parts of the curriculum. This is a missed opportunity. Similarly there is a need for a handout that can be given to the young people for reference to reinforce the essential messages of the course. This should address directly key steps that young people can positively take to make themselves safer even before they are drivers. It is essential not to leave people with a sense of helplessness at the end of the input. Such a handout might be combined with information on other road safety resources and the contact details of support agencies. Further exploration is needed for Crash Course to seek topics or styles that might further harness the motivation of young men to act safely. In respect of deprivation, it is crucial that delivery should continue to schools and colleges in Stoke-on-Trent where there is more widespread deprivation than in the surrounding county.Item Open Access Evaluation of The SmokeScreen(Oxford Health Alliance, 2011) Anthony, Denis MartinThe SmokeScreen, an intervention aimed at reducing the uptake of smoking in young people was evaluated in schools in Leicester. There were differences in smoking between schools, each gender, ethnic and religious groups. Beliefs about smoking however were constant across these demographic variables. Any future programme will probably fail if it only addresses knowledge of the dangers of smoking. The SmokeScreen evaluated well with young people who found it effective and acceptable. In particular non-smokers stated it made them less likely to want to start. A large proportion of young people completed the pledge to not become a “replacement smoker”. The reasons for completing the pledge were rarely instrumental, and seemed to reflect a genuine desire to not smoke.Item Open Access An exploration of the experience of using the TENA Pants product compared to usual continence products as perceived by carers of people with dementia in care homes(ESSITY UK Ltd, 2018) Knifton, Chris; Bell, Katie; Padley, Wendy; Brown, JayneAbstract: Incontinence is a common symptom experienced by many older people with dementia, with an increased prevalence noted in care home settings when compared to community dwellings. Incontinence may often be a reason for care home admission. Absorbent continence pads are a common form of intervention with this client group. However, disposable continence pants are becoming more common and TENA Pants are one such example. Research Aim: To understand what are the key product satisfaction indicators for absorbent continence pads; and in light of this review the experience of using the TENA Pants product compared to currently used continence products with people with dementia in care homes. Methods: A review of the literature was undertaken to identify factors reported to affect user experience of absorbent continence pads. These results led to the development of a pre and post carer intervention questionnaire that focused on user satisfaction, which together with a semi-structured interview, reviewed a 4 week user trial of the TENA pull-up pants. Findings: Overall, high satisfaction levels with the product were recorded suggesting this to be a suitable continence product for people with dementia residing in care homes. However, the qualitative data showed that satisfaction with the pads was greatest when used with people in the early and mid-stages of disease progression. Three key factors were found to account for the highest percentage of satisfaction and as such are likely to become key predictor variables for good quality and satisfaction when developing absorbent continence pads for this client group, as well as key points for product development and marketing. These were: • Absorbent pads are comfortable to wear when they are dry • Absorbent pads need to be designed so they can be easily fitted and removed • Absorbent pads need to control odour well • Considerations for further research in this area are also discussed.Item Open Access Exploring Parental Experiences of Online Engagement with Arts and Creative Activities During the COVID-19 pandemic: The Talent 25 Longitudinal Sub-sample Study (Executive Summary)(De Montfort University, 2021-12) Daxini, Amar; Dikwal-Bot, Diretnan; Blair, Krista; Ochieng, Rebecca; Nijhof, Dewy; Ochieng, B.Item Open Access Final Report: Leicester Ageing Together (LAT): Evaluation Report(De Montfort University, 2020-01-06) Hinsliff-Smith, K.; Brown, Jayne; Patel, NainaExecutive Summary According to the Office for National Statics (2018) the UK population has been steadily getting older and this trend is projected to continue. In 2016, there were 11.8 million UK residents aged 65 years and over, representing 18% of the total population – 25 years before, there were 9.1 million, accounting for 15.8% of the population. Linked to these statistics over 9 million people in the UK – almost a fifth of the population – say they are always or often lonely, but almost two thirds feel uncomfortable admitting to it (British Red Cross and Co-Op, 2016) and over half (51%) of all people aged 75 and over live alone (ONS, 2010). The Leicester Ageing Together partnership, known as LAT, has been working since October 2015 to reduce isolation and loneliness in older people in Leicester. So far, they have reached almost 6,000 older people, nearly half of whom were aged 80 years plus. This large and extensive programme recruited over 1,300 volunteers, as well as funding local jobs worth £1.5 million. LAT is part of Ageing Better, a programme set up by The National Lottery Community Fund, the largest funder to date of community activity in the UK. Ageing Better aimed to develop creative ways for older people to be actively involved in their local communities, helping to combat social isolation and loneliness. It was one of five major programmes set up by The National Lottery Community Fund to test and learn from new approaches to designing services which aimed to make people’s lives healthier and happier. This report commissioned by the LAT board in December 2018 was conducted by De Montfort University and reports the findings of a qualitative evaluation conducted at the end of the funding stream for the programme. The evaluation aimed to gauge the views and experiences of beneficiaries, stakeholders and provider organisations who were involved in the delivery of the programme. This evaluation was conducted over a four month period in early 2019 and where possible aimed to gain insights from across a range of ethnic groups, contexts and viewpoints. In total 50 participants shared their experiences of the programme, for which the evaluation team at De Montfort and LAT are extremely grateful. This report should be read with the understanding that the views shared in this report are not necessarily the views of everyone involved in the programme. They are time specific based on hindsight offering a snap shot of views at the end of the programme rather than throughout. The findings relate to data collected over a months in 2019 involving 50 participants who were at the time of data collection actively engaged in an activity as a beneficiary or were delivering programmes as a provider. The majority of the views shared in this report are generated from the 35 older people classed as the LAT programme beneficiaries with a further 15 interviews undertaken with provider and stakeholder organisations. This evaluation did not seek the views of the LAT board members. Ageing Better, the Big Lottery funders or organisations that were no longer offering LAT funded activities. The findings and therefore the recommendations are solely based on the evidence gathered during this evaluation exercise and it would be useful for these to be considered in light of the other extensive evaluations that have been commissioned not just for the Leicester programme but others commissioned across the sector. For example at the time of submitting this final report we understand there is an ongoing national evaluation by the Big Lottery which is anticipated to have cross cutting themes to other local evaluations. It would be wise, therefore, to review these in the context of Leicester and other UK Cities and similar programmes aimed to support loneliness and social isolation amongst older people (those aged over 50) and the communities to which they live. The report findings aim to capture the essence of the LAT programme including highlights, strengths and opportunities for future learning for similar programmes of activity.Item Open Access Fostering Creativity and Cultural Engagement with Early Years Children and Families: The Talent 25 Longitudinal (2019-May2023), Summary of Key Findings and Recommendations(De Montfort University, 2024-12) Ochieng, B.Item Metadata only National Maternity and Perinatal Audit Clinical Report 2022. Based on births in NHS maternity services in England and Wales Between 1 April 2018 and 31 March 2019.(RCOG, 2022-06-23) Carroll, F.; Dunn, G.; Fremeaux, A.; Gurol-Urganci, I.; Heighway, E.; Indusegaran, B.; Karia, A.; Khalil, A.; Muller, P.; Oddie, S.; Thomas, L.; Waite, L.; Webster, K.; van der Meulen, J.; Harris, TinaExecutive summary Introduction to the NMPA The National Maternity and Perinatal Audit (NMPA) is a large-scale project established to provide data and information to those working in and using maternity services. The NMPA helps us understand the maternity journey by bringing together information about maternity care and information about hospital admissions. This NMPA clinical audit report is an important step forward in understanding the way in which NHS maternity services care for women and birthing people, and it provides information on a number of measures, based on births in England and Wales from April 2018 to March 2019. This report follows on from the previous NMPA clinical audit reports and is one strategy used by the audit team to understand the care and outcomes experienced by women and birthing people, and to highlight areas of potential service improvement. Data Data for births in England are provided by NHS Digital’s Maternity Services Data Set (MSDS) version 1.5 as well as by Hospital Episode Statistics (HES) records. Data for births in Wales are provided by Digital Health and Care Wales’s Maternity Indicators dataset (MIds), the Initial Assessment (IA) dataset, as well as Admitted Patient Care records from the Patient Episode Database for Wales (PEDW), and some data fields from the National Community Child Health Database (NCCHD). The NHS trusts and boards included in the audit provided maternity care at one or more hospital sites.* This report captures 89% of eligible births (88% in England and 97% in Wales). Data are included from over half a million women and birthing people, and their babies, born between 1 April 2018 and 31 March 2019 in England and Wales. Key findings One-third of women and birthing people with singleton pregnancies at term in England and Wales underwent an induction of labour. Of all women and birthing people experiencing an instrumental birth by forceps, as many as 1 in 20 did so without an episiotomy; of these, 31% experienced a third- or fourth-degree tear. Of the women and birthing people opting for a vaginal birth after a previous caesarean birth, the proportion who experienced a vaginal birth was 61%. This is over 10 percentage points lower than overall proportions reported in national guidance (72–75%). Postnatal readmission rates were higher * Where possible, site-level results are available on the NMPA website. Guidance on using the data on the NMPA website can be found on the Resources page and in the Frequently Asked Questions. A list of organisations and useful publications are also available within the NMPA Quality Improvement page to support those improving the quality of care locally. The NMPA is committed to engagement with anyone accessing the audit’s outputs and we welcome feedback on how these can be made more useful (contact nmpa@rcog.org.uk). ix following a caesarean birth compared with a vaginal birth in both England (4.3% vs 2.9%) and Wales (4.7% vs 3.3%). Of the women and birthing people experiencing their first birth, 23% had an instrumental birth, 23% had an emergency caesarean birth and 44% of those who had a vaginal birth had an episiotomy. Around half of babies born small for gestational age (SGA) were born after their due date. This is in contrast to national guidance recommending earlier induction be offered if there are concerns about a baby being small. Data completeness issues remain for many NMPA measures, especially for anaesthesia, augmentation (helping the progress of labour), labour onset, episiotomy, maternal ethnicity, body mass index (BMI) and smoking status at birth. From our dataset, it is not always possible to tell which type of pain relief a woman or birthing person received during labour or whether they had an epidural or spinal, or general anaesthetic. National datasets in both England and Wales under-report rates of pre-pregnancy conditions such as high blood pressure. Recommendations R1 Improve the availability and quality of information about possible interventions during labour and birth, by offering individualised evidence-based information in a language and format which is accessible and tailored to each woman or birthing person’s circumstances. Consider using the IDECIDE decision-making and consent tool (when available). R2 All women and birthing people should be routinely counselled and offered an episiotomy prior to experiencing a forceps-assisted birth, to reduce the chance of an OASI. R3 Further information is required to better understand the underlying causes and patterns of variation in measures. Use local audit of measures to investigate differences in practice that may contribute to observed variation in rates. R4 Review all cases of postnatal maternal readmission to understand common indications, and identify changes in practice that may decrease the chance of readmission, especially among those having a caesarean birth. R5 Conduct reviews of data completeness, data capture software and practices including mandatory field requirements. Utilise user feedback to identify patterns in missing data and opportunities to support healthcare professionals to provide complete data without compromising clinical care. R6 Amend data fields to: ● collect the availability and timeliness of epidural anaesthesia ● separate the recording of intrapartum analgesia by type for both England and Wales ● collect analgesia and anaesthesia into two separate fields and enhance anaesthesia coding granularity to capture epidural, spinal or general anaesthesia separately in Wales. R7 Develop strategies to ensure harmonisation between national maternity datasets, in particular that data are collected to: ● record pre-existing conditions in the Welsh Initial Appointment dataset ● include a ‘number of infants’ variable in the English MSDS v2.0 ● prevent the under-reporting of all diagnoses within HES and PEDW. R8 Review the appropriateness of routine perinatal and postnatal data to obtain a meaningful measure of care, such as duration of skin-to-skin, who with and reasons for non-occurrenceItem Metadata only National Maternity and Perinatal Audit. Ethnic and Socio-economic inequalities in NHS maternity and perinatal care for women and their babies. Assessing care using data from births between 1 April 2015 and 31 March 2018 across England, Scotland and Wales.(RCOG, 2021-11-18) NMPA Project Team; Webster, K.; Carroll, F.; Coe, M.; Dunn, G.; Fremeaux, A.; Gurol-Urganci, I.; Jardine, J.; Karia, A.; Muller, P.; Relph, S.; Waite, L.; Harris, Tina; Hawdon, J.; Oddie, S.; Khalil, A.; van der Meulen, J.Executive summary Introduction The purpose of this report is to describe inequalities in maternity and perinatal care for women and their babies in England, Scotland and Wales during the period 1 April 2015 to 31 March 2018. Using routinely collected data, care and outcomes experienced by women and babies using NHS maternity services are measured and stratified by ethnicity and by Index of Multiple Deprivation (IMD), a proxy for socio-economic deprivation. This report focuses on the following maternal measures: ● caesarean birth (presented as elective, emergency and both combined) ● birth without intervention ● major postpartum haemorrhage (1500 ml or more) and the following perinatal measures: ● an Apgar score of less than 7 at 5 minutes ● breast milk at first feed ● neonatal unit admission at term. Methods This report uses existing NMPA linked datasets. Ethnicity is coded using the Office for National Statistics (ONS) 2001 census categorisation of 16+1 codes for ethnicity,2 grouped into white, South Asian, Black and Other (comprising ‘Mixed’ and ‘Other’ combined). Socio-economic deprivation is measured using the Index of Multiple Deprivation (IMD), an area-based measurement of multiple deprivation calculated for each lower-layer super output area (LSOA) in England and Wales, and data zone in Scotland.3 IMD is based on residential postcode and grouped into quintiles of national distribution (quintile 1 = least deprived to quintile 5 = most deprived) for analysis. Results for each maternal and perinatal measure are reported by the mother’s ethnic group and IMD quintile. The results presented in this report are crude and therefore descriptive. The results do not take into account the interactions that contributory factors, such as parity, age, pre-existing co-morbidities, ethnicity and deprivation may have on each other, the complexities of which are not easily interpreted in an audit report such as this. An advisory group comprising professionals and a diverse range of service user representatives with experience of accessing maternity care was involved in the sprint audit. The advisory group was involved in the choice of measures for inclusion in this report, interpretation of results, identifying key messages, and reviewing the draft report and recommendations. Key findings Our results demonstrate differences in outcomes of maternity and perinatal care among women and birthing people, and their babies, via comparisons between those living in the most deprived and the least deprived areas in Great Britain, and in those from ethnic minority groups versus white ethnic groups. Women from South Asian and Black ethnic groups and those from the most deprived areas had higher rates of hypertension and diabetes when compared with women from white ethnic groups and those in the least deprived areas. Smoking was considerably higher among women and birthing people from white ethnic groups and those in the most deprived quintile. Women from Black ethnic groups had a higher rate of experiencing a birth without intervention. While this may be desirable in many situations, it may also represent circumstances where interventions are desired or indicated but do not occur. Rates of caesarean birth (both elective and emergency combined) and rates of emergency caesarean birth were highest for women from Black ethnic groups and higher for women from South Asian groups when compared with those from white ethnic groups. Women and birthing people from Black ethnic groups had higher rates of major postpartum haemorrhage (1500 ml or more) when compared with women and birthing people from white ethnic groups. In contrast to the usual association of increased deprivation with increased morbidity, a decreasing trend for major postpartum haemorrhage (1500 ml or more) was observed from the least to most deprived. Babies born to women from South Asian ethnic groups were less likely to have an Apgar score of less than 7 at 5 minutes but were more likely to be admitted to a neonatal unit at term when compared with babies born to women from white ethnic groups. Babies born to women from Black ethnic groups were more likely to be assessed as having an Apgar score of less than 7 at 5 minutes and were more likely to be admitted to a neonatal unit at term when compared with babies born to women from white ethnic groups. Rates of receiving breast milk at their first feed were significantly lower for babies born to white women and to those living in the most deprived areas. We also found areas of concern with regard to data completeness and rates of missing data by ethnic group and IMD. Our results show 1 in 10 women and birthing people in Great Britain (1 in 5 in Scotland) did not have their ethnic group recorded, and IMD was missing for 6%. Recommendations R1 Target efforts for a life-course approach to improve the health of people, addressing the wider social determinants of health as well as specific health-related risk factors. Offer individualised preconception and antenatal information tailored to their circumstances, including BMI, smoking, pre-existing comorbidities (hypertension and type 2 diabetes) and whether this is their first birth or they have previously had a caesarean birth. (Audience: Healthcare professionals working in maternity services, maternity services providers, general practitioners, primary care providers, public health policy makers) R2 Target efforts to reduce smoking. Audit rates of carbon monoxide testing and referrals for smoking cessation for women during pregnancy, and audit compliance with monitoring for fetal growth restriction. (Audience: Healthcare professionals working in maternity services, maternity services providers, general practitioners, primary care providers, stop smoking services, public health policy makers) R3 Support research and investigation into why women from ethnic minority groups and more deprived areas have higher rates of stillbirth, taking into consideration differences in care, specific risk factors and the wider determinants of health. (Audience: National Institute for Health Research, Health and Care Research Wales and NHS Research Scotland in consultation with the Royal College of Obstetricians and Gynaecologists and policy makers, service planners/commissioners, service managers and healthcare professionals working for maternity services) R4 Improve availability and quality of information about choices during pregnancy and labour, with particular attention to the development of evidence-based shared decision-making tools for place, mode and timing of birth and pain relief options. Consider using the IDECIDE tool (when available). (Audience: Healthcare professionals working in maternity services, maternity services providers, NHS England, NHS Scotland, NHS Wales) R5 Avoid term admissions to a neonatal unit through improving transitional care provision, by establishing facilities where they are not currently available; or in hospitals that do have transitional care facilities, by expanding cot space availability and increasing numbers of appropriately trained staff. (Audience: Maternity and neonatal services providers) R6 Offer all women breastfeeding information and support, and target support in specific areas where breastfeeding rates are lowest (see also Priority 4c, intervention 3 of the Equity and Equality: Guidance for Local Maternity Systems). (Audience: Healthcare professionals working in maternity services, health visitors, primary care providers, maternity care services) R7 Review equality and diversity training provision and update to include the risks associated with deprivation, and how to recognise and avoid unconscious bias (see also Priority 4d, intervention 1 of the Equity and Equality: Guidance for Local Maternity Systems). (Audience: Local trusts and health boards, medical Royal Colleges, Royal Colleges of Nursing and Midwifery, General Medical Council, Nursing and Midwifery Council, Health and Care Professions Council, higher education institutions) R8 Ethnicity should be asked of and accurately recorded for all pregnant people using agreed ethnic group coding systems that should be updated regularly in accordance with the most current census groups. Consideration should be given to methods for self-reporting of ethnicity whenever possible (see also Priority 3, intervention 1 of the Equity and Equality: Guidance for Local Maternity Systems). (Audience: Healthcare professionals working in maternity services, maternity service providers, general practitioners, primary care providers, NHS England, NHS Scotland, NHS Wales) R9 Review the ethnic diversity and rates of socio-economic deprivation in the local area of each NHS trust or board and consider ways to reduce inequalities in healthcare outcomes (see also Priority 4, intervention 1 of the Equity and Equality: Guidance for Local Maternity Systems). (Audience: Local trusts and health boards, primary care providers, public health bodies, local government) R10 Prioritise further research in NHS maternity and perinatal care that could improve outcomes for women, and their babies, from ethnic minority groups and those in the most deprived areas. Undertaking quantitative analysis to investigate ethnic and socio-economic inequalities and report on the mediating factors and causal pathways; along with qualitative research to include exploring the experiences of people accessing maternity care. (Audience: National Institute for Health Research, UK Research and Innovation, Health and Care Research Wales and NHS Research Scotland in consultation with the Royal College of Obstetricians and Gynaecologists and policy makers, service planners/commissioners, service managers and healthcare professionals working for maternity servicesItem Metadata only National Maternity and Perinatal Audit: Clinical Report 2017 - revised version(Healthcare Quality Improvement Partnership (HQIP), 2018-03) Blotkamp, A.; Cromwell, D.; Dumbrill, B.; Gurol-Urganci, I.; Harris, Tina; Hawdon, J.; Jardine, J.Item Metadata only National Maternity and Perinatal Audit: Organisational Report 2017(Royal College of Obstetricians and Gynaecologists, 2017) Blotkamp, A.; Cromwell, D.; Dumbrill, B.; Gurol-Urganci, I.; Hawdon, J.; Jardine, J.; Harris, Tina; Knight, H.; McDougal, L.; Moitt, N.; Pasupathy, D.; van der Meulen, J.Organisational report 2017 - A snapshot of NHS maternity and neonatal services in England, Scotland and Wales in January 2017Item Metadata only NHS Maternity Care for Women with a Body Mass Index of 30 kg/m2 or Above: Births between 1 April 2015 and 31 March 2017 in England, Wales and Scotland.(RCOG, 2021-05-13) Relph, S.; Coe, M.; Carroll, F.; Gurol-Urganci, I.; Webster, K.; Jardine, J.; Dunn, G.; Harvey, A.; Harris, Tina; Hawdon, J.; Khalil, A.; Pasupathy, D.; van der Meulen, J.Introduction This report focuses on the maternal and neonatal outcomes of pregnant women with body mass index (BMI) of 30 kg/m2 or above who gave birth between 1 April 2015 and 31 March 2017, compared with those of women with BMI in the range 18.5–24.9 kg/m2 . Methods This study uses existing NMPA linked datasets to explore the characteristics and outcomes of women and babies according to category of maternal BMI at booking with the maternity service provider. Women are grouped by BMI according to established World Health Organization (WHO) categories. The association between maternal BMI and each maternal or neonatal measure is represented using line graphs, stratified by maternal parity (nulliparous, multiparous with previous vaginal births only, multiparous with a previous caesarean birth). We also explored the feasibility of stratifying the outcomes according to the woman’s risk status at the time of labour and birth (as defined by the National Institute of Health and Care Excellence (NICE) Intrapartum Care for Healthy Women and Babies guideline). Finally, we described the type of maternity units in which the women gave birth, by maternal BMI. A lay advisory group was involved at all stages of this sprint audit, including discussing the choice of outcomes, interpreting the results, and reviewing the draft report and recommendations. Key findings For the period 1 April 2015 to 31 March 2017, we estimate that 21.8% of women giving birth had a BMI of 30 kg/m2 or above; however, 16.9% of women did not have a BMI (or height and weight) recorded. The likelihood of a woman experiencing an intrapartum intervention or adverse maternal outcome, or her baby experiencing very serious complications following birth, increases as BMI increases. We do not know whether this is because women with higher BMI are more likely to develop complications requiring intervention or because of differences in the clinicians’ threshold to intervene. However, those women with a BMI of 30 kg/m2 or above who have previously had at least one vaginal birth (and no caesarean births) are almost as likely to have another unassisted vaginal birth as multiparous women with a BMI in the range 18.5–24.9 kg/m2 who have also not previously had a caesarean birth. Babies born to women with a BMI of 30 kg/m2 or above are less likely to receive skin-to-skin contact within 1 hour of birth or breast milk for their first feed than babies born to women with a lower BMI. The proportion of women giving birth in a freestanding midwifery unit, or at home, decreases as BMI increases, although 1.7% of women with a BMI of 35.0–39.9 kg/m2 and 1.1% of women with a BMI of 40 kg/m2 or above did give birth in one of these settings. The lay advisory group requested that we also measure access to birth in water, monitoring of fetal growth by ultrasound, access to perinatal mental health services and prevention of venous thromboembolism in women with a BMI of 30 kg/m2 or above. We currently do not have sufficient information in the NMPA dataset to assess these. Presentation of maternal or neonatal outcomes by maternal BMI, parity and risk status (as assessed at admission for birth) is both feasible and likely to be useful to support informed decision making. It is limited by uncertainty with less common outcomes (particularly those indicating poor condition of the baby at birth), more so when these are estimated in smaller groups of women. Recommendations R1 Audit local rates of missing data on BMI (or height and weight) before the end of the 2021/22 reporting year, and commence local initiatives to improve electronic recording of this where it is low. (Audience: Maternity service providers) R2 Commence by the end of June 2023 the production of, or include in updates to existing documents, detailed guidance on the antenatal and intrapartum care offered to women who are suspected to have a large-for-gestational-age baby, including whether the guidance should differ for women with a BMI of 30 kg/m2 or above. (Audience: National organisations responsible for publishing guidance on maternity care) R3 Support research and investigation into why women with a BMI of 30 kg/m2 or above have a higher risk of stillbirth, in order to inform clinical care which aims to reduce this risk. (Audience: National Institute for Health Research, Health and Care Research Wales and NHS Research Scotland in consultation with the Royal College of Obstetricians and Gynaecologists and policy makers, service planners/commissioners, service managers and healthcare professionals working for maternity services) R4 Ensure that women with a BMI of 30 kg/m2 or above are given preconception and antenatal information tailored to their individual circumstances (including their BMI and whether this is their first birth or they have previously had a caesarean birth). To support women in their decision making, this should include information from this report on their risk of the following: ● birth interventions ● major postpartum blood loss ● postnatal readmission to hospital ● very serious complications for their baby following birth. (Audience: Healthcare professionals working in maternity services, general practitioners) R5 Identify common causes for readmission to the maternity unit following birth specifically for women with a BMI of 40 kg/m2 or above, and commence local quality improvement initiatives to reduce the risk of readmission. (Audience: Maternity service providers) R6 Support all women and babies to experience skin-to-skin contact with one another within 1 hour of birth should they choose to and regardless of the woman’s BMI, unless it is unsafe to do so because either the woman or baby requires immediate medical attention. (Audience: Healthcare professionals working in maternity services) R7 Offer all women breastfeeding information and support during pregnancy and again shortly after the birth. Women with a BMI of 30 kg/m2 or above may require support to be tailored to their specific needs and to be provided by a healthcare professional who is trained to adapt breastfeeding techniques for women with a higher BMI. (Audience: Healthcare professionals working in maternity services) R8 Incorporate information on antenatal assessment of fetal growth status (suspected SGA or LGA) and on venous thromboembolism risk scores and prophylaxis in future trust/board and national maternity dataset specifications. (Audience: Maternity service providers, the Data and Intelligence Division of Public Health Scotland, the National Welsh Informatics Service) R9 Assess the quality of data on labour or birth in water, and where completeness is low, commence initiatives to improve it. (Audience: Maternity service providers)Item Metadata only NHS Maternity Care for Women with Multiple Births and Their Babies A study on feasibility of assessing care using data from births between 1 April 2015 and 31 March 2017 in England, Wales and Scotland.(Royal College of Obsstetricians and Gynaecologists, 2020-08-21) Relph, Sophie; Gurol-Urganci, Ipek; Blotkamp, Andrea; Dunn, George; Harris, Tina; Hawdon, Jane; Pasupathy, Dharmintra; van der Meulen, JanIntroduction This report focuses on the maternity care for women with multiple births during the period 1 April 2015 to 31 March 2017 and their babies. The purpose of this report is to describe the feasibility of assessing maternity care for women with multiple births and their babies, using routinely collected data. Methods This study examines the feasibility of using existing data sources and linkages within NMPA to report the characteristics and outcomes of twin pregnancy and birth and to assess the care of women with multiple birth. National guidelines from the National Institute for Health and Care Excellence (NICE) and the Royal College of Obstetricians and Gynaecologists (RCOG) and recommendations from Twins Trust and the Multiple Births Foundation were consulted in the development of audit measures. Maternal outcomes were reported per pregnancy. Perinatal outcomes were reported per pregnancy or per baby, as appropriate. The characteristics and outcomes of higher order births were assessed and reported separately from those of twins. Given that many of the national guidelines referred to local service configuration, an evaluation of the availability of specific services for women with multiple birth was conducted, by linking the results of the NMPA Organisational Survey 2017 with the location of birth of the women with multiple pregnancy.2 Key findings We have demonstrated that an audit of maternity and neonatal care for women and babies affected by multiple birth is feasible using NMPA methodology and data sources, but such an audit will be limited by data availability and quality issues. We identified 41608 babies born from multiple pregnancies in 20 655 women from England, Scotland and Wales. When compared with the number of multiple births reported in data from the Office for National Statistics, this represented an estimated case ascertainment of 89.5%, compared with case ascertainments of 92% in 2015/16 and 97% in 2016/17 for singleton births. Case ascertainment is affected by inaccuracies in the recorded number of infants born to each woman and by unavailability of data on the number of fetuses identified in the first trimester of pregnancy. Only two of 174 clinical guideline statements can be directly assessed using NMPA methods. These relate to recommendations that mothers should be supported to breastfeed and that neonatal networks should aim to reduce term neonatal admissions. The most common reason that recommendations or clinical guideline statements cannot be assessed isthe absence of information on chorionicity and amnionicity in the data. This information is not routinely collected in maternity datasets. Challenges were also identified in classifying caesarean section into categories according to whether the procedure was planned or the procedure was urgent or an emergency, particularly in the context of risk of spontaneous preterm labour in multiple pregnancies in women with planned caesarean birth. It is also not possible to assess provision of specialist services for twin babies with fetal complications (e.g. twin-to-twin transfusion syndrome) because these diagnoses and related therapeutic procedures are poorly recorded in the data. Assessing maternity care for women with multiple births: feasibility study viii Case mix adjustment using standard NMPA methods is more complex for women with twin births, compared with those with singleton births. For each pregnancy, a choice has to be made which of the two birthweights need to be included in the case mix adjustment. There is also a small number of women affected by less common comorbidities (e.g. hypertension) and antenatal complications (e.g. placenta praevia), usually included in the established NMPA adjustment method. A study of variation in measures of maternity care between NHS trusts or boards, or between hospital sites, is only possible for measures where the outcome is common (e.g. prelabour caesarean birth). When relevant features of care or outcomes are rare, maternity and neonatal care can only be assessed at regional or national level. For the evaluation of maternity and neonatal care that is specific to those babies admitted to a neonatal unit, successful linkage of NMPA maternity data with the NNRD was slightly lower for twin births before 32+0 weeks of gestation than the existing linkage of singleton neonates. For example, the linkage rate at 30+0 to 31+6 weeks of gestation was 87.7% for liveborn twins compared with 94.9% for all liveborn babies. This was particularly noted at gestations less than 28+0 weeks. The most likely explanation for this lower linkage rate is less complete and maybe less accurate data entry, including possible errors or omissions with neonatal NHS numbers. It is possible to assess the availability of specialist services at the level of NHS trust or board, or hospital site, for women giving birth following multiple pregnancy. However, this can currently only be studied according to the place of birth, as information on where antenatal care was received is not available. It should be noted that a similar problem exists for singleton births. Recommendations R1 Maternity service providers should consider the local reasons for inaccuracies in the recording of ‘number of infants’ at birth and work to correct these by the end of the 2020/21 reporting year. This might require auditing local data, mandating the ‘number of infants’ data item and checking data download reports for national datasets to ensure that ‘birth order’ has not been mislabelled as ‘number of infants’. R2 Maternity service providers and national organisations responsible for collating and managing maternity datasets should request/record data on the number of fetuses in the first trimester of pregnancy, in addition to number at birth, for women with multiple pregnancy, and should plan to be compliant with this for the next version of the national data specification. R3 Maternity service providers and national organisations responsible for collating and managing maternity datasets should make chorionicity and amnionicity a compulsory data item in maternity information systems and national datasets for women with multiple pregnancy. This should be implemented in the next version of the national data specification. R4 Maternity service providers who offer specialist fetal procedures, such as intrauterine fetal laser therapy, should work with their coding departments to ensure that the fetal complications and procedures are properly coded into HES, SMR and PEDW by the end of the 2020/21 reporting year. R5 Maternity service providers and national organisations responsible for collating and managing maternity datasets should work to include a compulsory field on planned mode of birth, to enable distinction between those women who have an urgent caesarean birth following labour onset for new clinical reasons and those who have planned caesarean birth. This should be implemented in the next version of the national data specification. R6 Maternity service providers should put local systems in place by the end of the 2020/21 reporting year to ensure that the NHS number for every newborn baby is stored in the maternity information system and linked to the mother’s number. Particular care must be taken to ensure that the baby’s NHS number is not linked to the baby record of the other twin.Item Open Access Nurturing Babies During the COVID-19 Lockdown: Resilience, Art and Creativity The Talent 25 Longitudinal (Sub-sample Study Executive Summary)(De Montfort University, 2020-11) Nijhof, Dewy; Ochieng, Rebecca; Daxini, Amar; Diawal-Bot, Diretnan; Owens, Christopher; Ochieng, B.Item Open Access Statistical analysis plan for the proactive healthcare of older people in care homes (PEACH) study(East Midlands Research into Ageing Network (EMRAN) Discussion Paper Series, 2018-09) Usman, A.; Lewis, S.; Jordan, J.; Gage, H.; Housley, G.; Hinsliff-Smith, K.; Long, A.; Devi, R.; Chadborn, N.The Proactive Healthcare for Older People living in Care Homes (PEACH) study aims to evaluate whether Quality Improvement Collaboratives can be an effective way to work with local health and social care stakeholders, including representatives of the care home sector, to implement Comprehensive Geriatric Assessment (CGA) in the care home setting. It will enlist the support of four Area Improvement Collaboratives from South Nottinghamshire, UK to make changes to enable CGA in care homes in their areas. The primary outcome measure is health-related quality of life (HRQoL), measured using the EuroQoL 5-domain 5-level (EQ-5D-5L) index. A cluster-randomised (where care homes represent clusters) approach will be taken. Secondary outcome measures will be Health Service Resource by service category. These will be analysed using an interrupted time series approach. The methodology is challenging and introduces the need to control for multiple sources of contamination, clustering, time effects including lag effect and measurement issues with the primary outcome variable, including the uncertain reliability of care home staff proxy responses. This paper outlines the statistical analysis plan for the study, describing how these challenges have been addressed. It acts as reference point for further publications from the PEACH study.Item Metadata only Technical Report: Feasibility of evaluating perinatal mental health services using linked national maternity and mental health data sets, based on births between 1 April 2014 and 31 March 2017 in Scotland(RCOG, 2021-01-14) Langham, J; Gurol-Urganci, I; Dunn, G; Harris, Tina; Hawdon, J; Pasupathy, D; van der Meulen, J; NMPA Project TeamIntroduction In this short report, we describe the feasibility of using linked national data sets to evaluate perinatal mental health services. Perinatal mental health conditions are common. About 10% of pregnant women and 13% of women who have just given birth experience a mental health problem. Some perinatal mental health problems can, if not adequately treated, have significant and long-lasting effects on a woman and her baby. For this report, we only used Scottish data sources. The data sets include episodes of admission to secondary care, including hospital admission for perinatal mental health conditions. The results based on Scottish data are expected to inform future analyses of similar data from England and Wales. Specific data sets on mental health services in Wales were not yet available at the time of this study. The report consists of three parts. First, we describe the data sets that were used and how they were linked. Second, we present a grouping of mental health diagnoses that are similar with respect to their prognosis and treatment (to maximise the clinical relevance) while limiting the number of diagnosis groups (to maximise statistical power). Third, we use the results of this preparatory work to demonstrate the clinical relevance of the linked data sets by describing a number of clinical outcomes according to the timing of the perinatal mental health admissions. Methods We used linked national maternity and mental health data for Scotland on all births that took place between 1 April 2014 and 31 March 2017, and inpatient admissions for mental health conditions between 1 April 2000 and 31 March 2018. Births records were identified in the National Records of Scotland (NRS). These records were used as a ‘spine’ against which records from all other Scottish Morbidity Record (SMR) data sets were linked: general/acute inpatient records (SMR-01), maternity inpatient records (SMR-02), mental health inpatient records (SMR-04) and the Scottish Birth Record (SBR). Women who had a mental health admission were identified in SMR-04 data as well as in SMR-01 data if their admission record contained a diagnosis code from Chapter V (‘Mental and behaviour disorders’) of the International Classification of Disease, 10th Revision (ICD-10). Findings Both mental health inpatient data (SMR-04) and general/acute inpatient data (SMR-01) need to be used to identify women who had a hospital admission for mental health indications. We identified 3457 births in women who had a mental health admission. About two-thirds of the mental health admissions were identified in SMR-04 and about one-third in SMR-01. 163109 births were identified. 3043 (2.1%) of these births were in women with a prepregnancy history of a mental health admission. 176 (5.8%) of the women with prepregnancy mental health admission were also admitted during the perinatal period (during pregnancy or in the first year after giving birth). In comparison, only 414 (0.3%) of the 160066 births of women without a prepregnancy mental health admission had a perinatal mental health admission. Therefore, in the majority of cases Evaluating perinatal mental health services using linked national maternity and mental health data sets – 414 of the 590 perinatal mental health admissions (70.2%) – the perinatal mental health admission was a women’s first mental health admission. Diagnostic codes were grouped into eight diagnosis groups aiming to maximise the clinical relevance and statistical power. Based on this grouping, we found that major depressive disorders were the most frequently observed diagnoses (22.9%) among the 590 women with a perinatal mental health admission, followed by admissions for anxiety and post-traumatic stress disorders (19.3%). However, if we only considered the 176 women who had a perinatal mental health admission after a prepregnancy mental health admission, the most frequently observed diagnoses were related to psychoactive substance use (25.0%). Following this preparatory work, we demonstrated the clinical relevance of these data. Babies born to women with a prepregnancy history of perinatal health admission were found to be more likely to be preterm (12.0% born before 37 weeks), to have low birthweight (4.3% with birthweight below 2500 g in term babies) or to need some medical help (2.6% with an Apgar score less than 7 at 5 minutes after birth) than babies born to women without such a history (7.1%, 2.0%, and 1.7%, respectively). Outcomes in babies of women who had a perinatal mental health admission (590) were similar to those of women with a prepregnancy history of mental health admission (3043). Admission to an inpatient psychiatric mother-and-baby unit (MBU) was most frequent in women who had a mental health admission in the first 12 weeks after giving birth (79.5%) and considerably lower in women who had a mental health admission during pregnancy (23.7%) or between 13 and 52 weeks after giving birth (38.1%). Conclusions This study demonstrates the feasibility as well as the clinical relevance of using linked national maternity and mental health data sets from Scotland to assess the care that women with perinatal mental health problems receive. Despite only identifying women with severe perinatal mental health conditions, linkage of data sets of secondary care admission will offer an important opportunity to monitor the impact of national initiatives to improve perinatal mental health services in all four nations of the UK.Item Metadata only Technical Report: linking the National Maternity and Perinatal Audit Data Set to the National Neonatal Research Database for 2015/16(Royal College of Obstetrics and Gynaecology, 2019) Aughey, Harriet; Blotkamp, Andrea; Carroll, Fran; Cromwell, David; Gurol-Urganci, Ipek; Harris, Tina; Hawdon, Jane; Jardine, Jen; Knight, Hannah; Mamza, Lindsey; Moitt, Natalie; Pasupathy, Dharmintra; van der Meulen, JanThe National Maternity and Perinatal Audit (NMPA) is a national audit of the NHS maternity services across England, Scotland and Wales, commissioned in July 2016 by the Healthcare Quality Improvement Partnership (HQIP) on behalf of NHS England, the Welsh Government and the Health Department of the Scottish Government. The NMPA is led by the Royal College of Obstetricians and Gynaecologists (RCOG) in partnership with the Royal College of Midwives (RCM), the Royal College of Paediatrics and Child Health (RCPCH) and the London School of Hygiene & Tropical Medicine (LSHTM). The overarching aim of the NMPA is to produce high-quality information about NHS maternity and neonatal services which can be used by providers, commissioners and users of the services to benchmark against national standards and recommendations where these exist, and to identify good practice and areas for improvement in the care of women and babies. This short report from the NMPA explores the feasibility of linking the NMPA data set, which contains data relating to the majority of women who give birth, to the National Neonatal Research Database (NNRD), which contains detailed information about the majority of babies admitted to a neonatal unit. This feasibility study is limited to linkage between neonatal records and maternity records in England, as a pilot for developing this linkage across England, Scotland and Wales. The linkage of neonatal data to maternity data offers many potential advantages. In particular, it allows the exploration of associations between maternal antenatal and intrapartum factors and neonatal outcomes. It also offers the potential to use one or more neonatal outcomes, such as admission to neonatal care, as an outcome measure of maternity care, and to explore variation in neonatal outcomes between maternity settings. The purpose of this report is to describe the feasibility of linking the NMPA data set with the NNRD data set. It describes the technical process of linking these data sets and explores whether this linked data set can be used on an annual basis to construct clinically relevant measures of maternity care.