Question to the Cabinet Office:

To ask Her Majesty's Government whether the incidence of neonatal mortality and morbidity has decreased over the past five years.

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The information requested falls within the responsibility of the UK Statistics Authority. I have asked the Authority to reply.

Letter from John Pullinger CB, National Statistician, to Baroness Tonge, dated 07 March 2018

Dear Baroness Tonge,

As National Statistician and Chief Executive of the UK Statistics Authority, I am replying to your Parliamentary Questions asking (a) whether the incidence of neonatal mortality and morbidity has decreased over the past five years (HL5969); (b) what was the incidence of neonatal mortality and morbidity in (1) 2000–05, (2) 2005–10, and (3) 2010–15 (HL5970); and (c) what was the incidence of neonatal mortality and morbidity in (1) 2014–15, (2) 2015–16, and (3) 2016–17 (HL5971).

The Office for National Statistics (ONS) is responsible for publishing statistics on deaths registered in England and Wales. Statistics on deaths are normally published using calendar years. Neonatal mortality figures are available for both the year the death was registered and the year the death occurred. Comparisons over time are more meaningful using death occurrences, to allow for delays in registering deaths. The latest year for which death occurrence figures are available is 2015 [see note 1 below]. The neonatal mortality figures for 2016 will be published on 14 March 2018 and the data for 2017 will be published in early 2019.

Table 1 below provides the number of neonatal deaths and the neonatal mortality rates per 1,000 live births for England and Wales, for each calendar year from 2000 to 2015.

Because the number of neonatal deaths each year is relatively small, there is likely to be some random fluctuation, and no single year since 2000 shows a statistically significant change from the preceding year. However, there has been a generally downward trend throughout the period. In the five years 2011-15, the lowest neonatal mortality rate was in 2014, and this was significantly lower than in 2011 and all previous years. The rate in 2015 was higher than in 2014, but is still significantly lower than in 2011 (taking into account rounding of the figures to one decimal place).

NHS Digital is responsible for publishing statistics on NHS patient care in England. There is no widely accepted measure of neonatal morbidity, however trends in the admission of neonates to hospital may be useful information. Therefore, figures based on Hospital Episode Statistics (HES) have been given here.

Table 2 below provides the number of neonatal finished consultant episodes (FCEs) and corresponding neonatal hospitalisation rate per 1,000 live births for England, for each financial year from 2000-01 to 2016-17, and the five-year periods 2001-02 to 2004-05, 2005-06 to 2009-10, and 2010-11 to 2014-15. Note that HES data include activity ending in the year in question and run from April to March, e.g. 2012-13 includes activity ending between 1st April 2012 and 31st March 2013.

Changes to the HES figures over time need to be interpreted in the context of improvements in data quality and coverage (particularly in earlier years), improvements in coverage of independent sector activity (particularly from 2006-07) and changes in NHS practice. For example, apparent reductions in activity may be due to a number of procedures which may now be undertaken in outpatient settings and so no longer include in admitted patient HES data. Conversely, apparent increases in activity may be due to improved recording of diagnosis or procedure information.

There has been year on year fluctuation in the number and rate of hospital episodes for neonates over the period of interest, but with a clear overall upward trend. The hospitalisation rate in 2015-16 was significantly higher than five years before. However, as noted above, it is likely that the trend is influenced to some extent by factors such as changing clinical practice and recording.

Yours sincerely,

John Pullinger

Note 1:

https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/datasets/childmortalitystatisticschildhoodinfantandperinatalchildhoodinfantandperinatalmortalityinenglandandwales

Table 1: Neonatal deaths occurring in England and Wales, numbers and rates, 2000 to 2015

1. Neonatal deaths are defined as deaths of live-born infants at less than 28 days

2. Rates are per 1,000 live births

3. The 95% lower and upper confidence limits have been provided. These form a confidence interval, which is a measure of the statistical precision of a rate and shows the range of uncertainty around the calculated rate. As a general rule, if the confidence interval around one figure overlaps with the interval around another, we cannot say with certainty that there is more than a chance difference between the two figures.

Source: Office for National Statistics

Table 2: Neonatal hospital episodes occurring in England, numbers and rates, 2000-02 to 2016-17

1. Neonatal episodes are defined as counts of patients where there is a finished consultant episode (FCE) for neonates with an extended hospital stay immediately following birth, or an admission within the first 28 days of life. An FCE is a continuous period of admitted patient care under one consultant within one healthcare provider. FCEs are counted against the year in which they end. Figures do not represent the number of different patients, as a person may have more than one episode of care within the same stay in hospital or in different stays in the same year.

2. Rates are per 1,000 live births. The number of births per financial year has been estimated based on births in the relevant calendar years.

3. The 95% lower and upper confidence limits have been provided. These form a confidence interval, which is a measure of the statistical precision of a rate and shows the range of uncertainty around the calculated rate. As a general rule, if the confidence interval around one figure overlaps with the interval around another, we cannot say with certainty that there is more than a chance difference between the two figures.

* A rate for 2016-17 cannot be calculated as the number of births in 2017 is not yet available.

† As a patient may have been in hospital in two consecutive years, the total per five-year grouping will not be equal to a sum of the corresponding five individual years.

Source: NHS Digital and Office for National Statistics