What is the NMPA?
The National Maternity and Perinatal Audit (NMPA) is a large scale audit of the NHS maternity and newborn services across England, Scotland and Wales. It began in July 2016 and is initially commissioned for three years. The audit aims to evaluate services, processes and outcomes in order to identify good practice and areas for improvement in the care of women and babies.
What do these results mean for me? Should I use them to plan where I give birth?
A decision about where to give birth should always be made together with a midwife or obstetrician. We encourage discussion of these results with the local team.
Can I compare between sites?
It is possible to compare the results from your site, trust or board, region or nation to those of others. You can select up to four options at each level.
Why can’t I find separate information about labour wards vs alongside midwifery units on the same site?
Data are presented at site level because, at present, there is no reliable way to separate out the information for obstetric labour wards and alongside midwifery units on the same site.
How should I interpret these results?
In order to gain a full understanding of a service, you should look at the whole pattern of their results and explore the relationships between the indicators, rather than focussing on individual results that may stand out as being high or low. Many of the indicators are inter-related (for example, a site with a higher caesarean section rate may have a lower instrumental delivery rate) and as such it is important to consider all results together, rather than in isolation.
The full report contains sections on how to interpret the variation seen in each group of indicators.
Where can I get more detail about the measures?
Information about the detailed specifications and the coding used for all indicators can be found in the "Technical Documents" section of this website.
Who is responsible for the audit?
Commissioned by the Healthcare Quality Improvement Partnership (HQIP), the audit is led by the Royal College of Obstetricians and Gynaecologists in partnership with the Royal College of Midwives, the Royal College of Paediatrics and Child Health and the London School of Hygiene and Tropical Medicine.
Why is Northern Ireland not included?
Northern Ireland are not currently participating in the NMPA, but the audit may expand its coverage in the future.
How is the NMPA funded?
The National Maternity and Perinatal Audit is an independent project commissioned by HQIP, itself an independent body which is funded by the NHS in Scotland, England and Wales.
What is the purpose of the audit?
The aim of the audit is to provide relevant and comprehensive information about the maternity and neonatal services provided by the NHS in England, Wales & Scotland for mothers and babies. This information will allow clinicians, NHS managers, commissioners and women to compare and evaluate services, and can be used to inform care quality improvements.
Who carried out the audit?
The report was developed by a team of clinicians including midwives, obstetricians and neonatologists, together with experts from the London School of Hygiene and Tropical Medicine. It has had input from stakeholders including professional bodies, commissioners, charities and a group of women who have recently had a baby.
How were the measures in the report selected?
The selection of measures was guided by a panel of clinical and academic experts, including obstetricians, midwives, statisticians and health service researchers, as well as our women and families group.
How does case mix adjustment work?
Case mix adjustment (or risk adjustment) is a statistical process by which we take into account characteristics of the women a service cares for, such as age, ethnic background, BMI and socio-economic status, to ‘even the playing field’ between hospitals.
Is the quality of the data provided robust?
Data quality is a national issue. The majority of all hospitals in England and Wales failed at least one of our assessments on data quality. If NHS trusts and boards are to be provided with information about their care, to examine and ultimately improve the care provided to women, the quality of routinely collected data must improve. In Scotland, the quality of data is better as it has been centrally collected for longer and systems have had time to embed.
What is a potential outlier?
A site is determined to be a potential outlier if it has a higher than expected value of one of our three outlier indicators: blood loss equal to or greater than 1500ml, Apgar score of less than 7 at 5 minutes, and severe perineal tear. Having a high rate doesn’t necessarily mean that a site is providing ‘sub-standard’ care: it may be as a result of better detection of tears or blood loss.
Can women use these results to choose which hospital they will give birth in?
Women can access key findings online and thereby find out more information about rates of events surrounding childbirth, together with the availability of services and facilities in their local maternity units. However, a woman’s decision about where to give birth should always be made together with her midwife or obstetrician.
Why is there missing information?
Not every trust was able to provide information to derive every measure, and a small number of NHS trusts in England were unable to provide any data. Furthermore, the majority of trusts and boards failed our data quality checks for at least one measure; further work and investment is required to increase data quality.
Why was the 2017 clinical report revised and what has changed?
Following publication of the first clinical audit report in November 2017, it came to light that some sites were affected by a data quality issue, which impacted on results for modes of birth, VBAC, labour induction and obstetric haemorrhage. This prompted further analysis and the publication of a revised report in March 2018, which can be found here.
To address the data quality issue, the revision included redefinition of the affected measures to include all fetal presentations, as opposed to cephalic only. As a consequence, some previously included sites have been excluded on data quality grounds, while others could now be included. It also means that results for most sites included in the audit changed to some degree, as did national rates. All trusts and boards participating in the audit were given the opportunity to check their results. Further information can be found here.