Reducing Child Mortality and the New Statutory Guidance on Child Death Reviews

Reducing Child Mortality and the New Statutory Guidance on Child Death Reviews
Dr Jacqueline Cornish National Clinical Director Children, Young People and Transition to Adulthood, Medical Directorate, NHS England & Dr James Fraser Consultant Paediatrician, Bristol Children’s Hospital

There have been significant improvements over the last four decades in the UK’s child mortality rates however, the UK has not kept pace with comparable countries in reducing infant and child mortality and has fallen in European rankings.  In comparison Finland has maintained and Estonia has improved their positions. Social Inequalities play a role in almost all leading causes of infant death where the risk increases with greater levels of maternal deprivation. There is an increased risk of preterm delivery in more deprived groups, as well as suboptimal maternal health in pregnancy (smoking, obesity, poor nutrition, substance abuse, and teenage pregnancy) and reduced uptake of recommended practices such as breastfeeding and safe infant sleeping positions.

Mortality rates show considerable variation across the country; this is likely to be due to a complex interaction between social disadvantage, ethnicity, parenting behaviours and healthcare quality and provision[1]. Around 4,000 children die each year in England, 60% in infancy, and 70% of these in the Neonatal period. Most die in hospital, predominantly in NIC (Neonatal Intensive Care) or PIC (Paediatric Intensive Care) Units.  80% of child deaths have medical causes and almost 30% have modifiable factors.

Dr Jacqueline Cornish will provide an overview of the issues and challenges we face in tackling child mortality and will provide a summary of the wider Programmes steered by NHS England to improve outcomes in children and young people’s physical and mental health.  NHSE’s work also aims to reduce preventable child mortality and to improve the experience of bereaved families, and practitioners, in the period following the death of a child. To do this, a number of strands of work are taking place:

  1. Creating a National Child Mortality Database – NHS England has commissioned a National Child Mortality Database. This has the potential to be the most comprehensive in Europe, gathering not only socioeconomic and health factors but also “active learning” through capturing modifiable factors
  2. Writing a new guide for families – A guidance Document for Parents, Family and Carers has also been developed in cooperation with Bereavement Charities, to signpost and inform at the most emotional and challenging time of the death of a child.
  3. Conducting a national review of child death review processes and producing new Statutory Guidance for practitioners

Dr James Fraser will provide an outline of the key changes to the process of Child Death Review that are contained within new Child Death Review Statutory Guidance. This forms part of the National Learning from Death Programme sponsored by the Secretary of State for Health. It applies to all child deaths, in acute hospital settings, mental health and learning disability organisations, and in community settings, and aims to achieve uniform and simplified processes resulting in standardised information flowing to the National Database.

The presentation will clarify the lower age limits for child death review, highlight the requirement for all child deaths to be reviewed, discuss criteria for a Joint Agency Response, and the expected re-alignment of CDOP’s to existing networks of NHS care. Furthermore the role of the “designated doctor” for child deaths and the required single point of contact “key worker” will also be highlighted.

[1] RCPCH Why children die: death in infants, children and young people in the UK

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