Massive Obstetric Haemorrhage numbers (FOI)

Request

A

What is the Government of Jersey’s definition of a massive obstetric haemorrhage (MOH)?

B

How many MOHs were declared in 2021?

C

How many MOHs were declared in 2022?

D

How many MOHs were declared in 2023?

E

Has there been an increase? If so do we know why?

F

Has an external review of MOHs been commissioned?

G

If so, what is the cost of this?

H

What actions are being taken to reduce MOHs in Jersey?

I

Is the Jersey maternity unit safe enough to be providing care?

Response

A

Massive obstetric haemorrhage (MOH) is defined in Health and Community Services’ (HCS) Massive Obstetric Haemorrhage policy, as follows:

‘Post partum haemorrhage (PPH) is blood loss from the genital tract exceeding 500 mls. Massive Obstetric Haemorrhage (MOH) occurs when the loss is 1500 ml or more.’

B

59 MOHs were recorded in 2021.

C

31 MOHs were recorded in 2022.

D

45 MOHs were recorded in 2023.

E

There is variation in the figures year-on-year, however there is no statistical trend. Variation in rates will be more marked in Jersey due to the relatively small total number of births in comparison with a larger mainland unit.

F

All MOH episodes are reviewed internally. In addition, a series of MOH events in 2023 are currently being reviewed by an external agency who specialise in investigation of adverse events in healthcare. This work has been commissioned to provide additional assurance to the HCS Board on this matter and not in response to the rate of MOH or any specific index episode.

G

The commissioning of external services is deemed commercially sensitive, and as such, Article 33 of the Freedom of Information (Jersey) Law 2011 has been applied.

​H

In 2023 the MOH management guidance has been thoroughly reviewed and revised taking into account current UK best practice guidance issued by the Royal College of Obstetricians and Gynaecologists and learning from review of episodes occurring in Jersey. The revised guidance puts particular emphasis on early intervention following lesser degrees of post-partum haemorrhage (with specific action after a blood loss of 500 ml). The processes around MOH are continuing to be reviewed on an iterative basis with the aim of achieving ongoing continuous improvement in the management of this common post-partum issue and to provide assurance of safety of management.

I

The question is a request for comment. Freedom of Information is a mechanism to enable access to information held in recorded form by a Scheduled Public Authority, rather than to pose questions requiring comment or opinion. Information is not held by HCS to satisfy the question posed. Therefore, Article 3 of the Freedom of Information (Jersey) Law 2011 applies.

Maternity services in Jersey are under continuing review with the aim of improving quality. Over the last six months, a comprehensive maternity improvement plan has been introduced and progress against this is regularly reviewed by the HCS Executive Leadership Team. Governance processes are in place to provide assurance that service provision is in line with UK clinical best practice, and to a level of quality and safety consistent with that provided by units in the UK.

Articles applied

Article 3 - Meaning of “information held by a public authority”

For the purposes of this Law, information is held by a public authority if –

(a)     it is held by the authority, otherwise than on behalf of another person; or

(b)     it is held by another person on behalf of the authority.

Article 33 - Commercial interests

Information is qualified exempt information if –

(a) it constitutes a trade secret; or

(b) its disclosure would, or would be likely to, prejudice the commercial interests of a person (including the scheduled public authority holding the information).

Public Interest Test

Article 33 is a qualified exemption and as such, HCS has conducted a prejudice test as required by law. 

When responding to requests of this nature, HCS has to balance the public interest with the impact that disclosing this information would, or would be likely to, have upon the organisation and / or third parties. Whilst it may be in the public interest to understand the costs of contracting external resources, protecting the commercial interests of HCS is an essential component in controlling public finances, which in itself is in the public interest.

It has been concluded that disclosing information relating to the contractual service arrangements in this instance is likely to prejudice the commercial interests of both HCS and the external agency providing the specialist review service.

When considering the application of this exemption, HCS has determined that whilst it is in the public interest to disclose information, this is outweighed by the necessity to limit any impact on the commercial interests of HCS and third parties in future contract negotiations, and as such, Article 33 has been applied.​