MBRRACE-UK

MBRRACE-UK
Name	MBRRACE-UK
Formation	2003
Type	Surveillance and audit collaboration
Headquarters	Oxford
Region served	United Kingdom and Ireland
Leader title	Director
Affiliations	University of Oxford, University of Leicester, Royal College of Obstetricians and Gynaecologists, Royal College of Paediatrics and Child Health

MBRRACE-UK is a national perinatal surveillance and audit collaboration that produces confidential enquiry reports on maternal, perinatal, and infant mortality across the United Kingdom and the Republic of Ireland. It coordinates epidemiological analysis, case review, and guideline-informed recommendations to inform clinical practice at institutions such as National Health Service (England), NHS Scotland, NHS Wales, Health and Social Care in Northern Ireland, and Health Service Executive. MBRRACE-UK’s outputs are used by policymakers, professional bodies, and academic centres to reduce avoidable deaths and improve perinatal outcomes.

History

MBRRACE-UK evolved from earlier confidential enquiries including initiatives by the Confidential Enquiry into Maternal Deaths (UK), projects linked to the Centre for Maternal and Child Enquiries, and surveillance systems developed at the University of Leicester and the University of Oxford. Its lineage intersects with national reviews such as those following the Tommy’s Stillbirth Research Programme and inquiries like the Ockenden Review and high-profile events including the Kirkup Inquiry. Key collaborations have involved organisations such as the Royal College of Obstetricians and Gynaecologists, the Royal College of Paediatrics and Child Health, and research funders including the National Institute for Health and Care Research and the Wellcome Trust. Over time, MBRRACE-UK incorporated datasets from registries like the Office for National Statistics, the Northern Ireland Statistics and Research Agency, and the Central Statistics Office (Ireland), aligning with international efforts exemplified by the World Health Organization and the European Perinatal Health Report.

Organisation and governance

MBRRACE-UK operates as a multi-institutional partnership involving academic units at the University of Oxford, University of Leicester, and collaborating units allied to professional bodies like the Royal College of Obstetricians and Gynaecologists and the Royal College of Paediatrics and Child Health. Governance includes advisory input from entities such as Public Health England (now UK Health Security Agency and Office for Health Improvement and Disparities), clinical leads drawn from tertiary centres like Guy's and St Thomas' NHS Foundation Trust, policy stakeholders from Department of Health and Social Care, and lay representation akin to panels in reviews by the Care Quality Commission. Academic oversight aligns with ethics frameworks used by institutions such as Nuffield College, Oxford and funders such as the Medical Research Council.

Surveillance and methodology

Surveillance protocols combine linked administrative datasets, case-based confidential enquiry, and epidemiological methods used by researchers at centres like London School of Hygiene & Tropical Medicine and Imperial College London. Methodology includes data linkage with registries such as Hospital Episode Statistics, coding frameworks influenced by International Classification of Diseases, and audit cycles similar to those employed by the National Perinatal Epidemiology Unit. Multidisciplinary case review panels mirror approaches used by Royal College of Anaesthetists reviews and incorporate statistical techniques promoted by groups at University College London. Outputs follow reporting practices exemplified by publications in journals such as The Lancet, BMJ, and PLOS Medicine.

Key findings and reports

MBRRACE-UK has published reports highlighting causes of death and contributory factors comparable to findings in Perinatal Mortality Review Tool analyses and recommendations similar to those in reports by the Confidential Enquiry into Maternal Deaths 2014 and subsequent national perinatal mortality reviews. Major themes include obstetric haemorrhage, sepsis, cardiovascular complications, neonatal respiratory disorders, congenital anomalies, and inequalities linked to demographic factors studied by groups at University of Manchester and University of Glasgow. Reports have influenced guidance by professional bodies such as the National Institute for Health and Care Excellence and clinical standards promulgated by the Royal College of Midwives.

Impact on policy and practice

Findings have informed policy interventions adopted by agencies including Department of Health and Social Care, Health Scotland, and Public Health Wales. Clinical practice changes traceable to MBRRACE-UK recommendations include enhanced training initiatives at NHS Trusts such as Guy's and St Thomas' Hospital, adoption of safety bundles endorsed by the Royal College of Obstetricians and Gynaecologists, and commissioning decisions influenced by NHS England policies. The programme’s influence is evident in guideline updates from bodies like NICE, workforce planning discussions involving Royal College of Nursing, and audit frameworks used by the Care Quality Commission.

Data sources and confidentiality

Data inputs encompass vital statistics from the Office for National Statistics, hospital episode data from NHS Digital, birth registrations from the General Register Office for Scotland, and perinatal records from regional maternity systems such as those in Health and Social Care in Northern Ireland. Confidential enquiry processes mirror safeguards used by academic ethics committees at institutions such as University of Oxford and data governance models used by the Information Commissioner's Office. Secure data linkage and de-identification protocols follow standards applied by the Health Research Authority and align with regulatory frameworks like the Data Protection Act 2018.

Criticism and controversies

Critiques of MBRRACE-UK have paralleled debates seen in reviews of the Ockenden Report and inquiries like the Kirkup Report, addressing issues of timeliness, case ascertainment, representativeness, and the translation of recommendations into practice. Stakeholders including activists associated with organisations like Tommy’s and professional groups such as the Royal College of Obstetricians and Gynaecologists have debated methodological transparency and resource allocation. Questions raised echo methodological controversies familiar from debates around projects at Nuffield Trust and reporting tensions seen in publications by BMJ and The Lancet Regional Health – Europe.

Category:Health in the United Kingdom