Table 1 and Table 2 illustrate the number of incidents reported to the National Reporting and Learning System (NRLS) where the incident report contained keywords indicating multiple pregnancies. It is important to note that the inclusion of these keywords may not always indicate the incident directly affected a multiple pregnancy; for example, reference in the incident report may be made to previous pregnancies. The harm reported may relate to the mother or to one or more foetuses/infants. The table is attached.

Information on the specific causes for the maternity incidents outlined in Question 217335 is not held centrally as these are only available after local investigation. The NRLS collects incident reports from maternity services through upload from local reporting systems. The majority of learning and action on the causes of patient safety incidents is undertaken within trusts. NHS England reviews all reports of death and severe harm made to the NRLS and where specific remediable causes are identified NHS England issues advice through the National Patient Safety Alerting System.

Increasing numbers of reported patient safety incidents are considered to be a sign of an improving patient safety culture and increases in the number of incident reports should not be interpreted as deterioration in the safety of patients.

As organisations change considerably across time this data reflects NHS organisational structures as of 31 December 2014. This means that incidents reported before that date may have taken place in a site that was not associated with a given trust at that time.

NHS England has a wide programme of work in partnership with other organisations seeking to improve outcomes for mothers and babies, including reducing stillbirth and neonatal death and avoidable admissions to neonatal care.

Table 1 and Table 2 illustrate the number of incidents reported to the National Reporting and Learning System (NRLS) where the incident report contained keywords indicating multiple pregnancies. It is important to note that the inclusion of these keywords may not always indicate the incident directly affected a multiple pregnancy; for example, reference in the incident report may be made to previous pregnancies. The harm reported may relate to the mother or to one or more foetuses/infants. The table is attached.

Information on the specific causes for the maternity incidents outlined in Question 217335 is not held centrally as these are only available after local investigation. The NRLS collects incident reports from maternity services through upload from local reporting systems. The majority of learning and action on the causes of patient safety incidents is undertaken within trusts. NHS England reviews all reports of death and severe harm made to the NRLS and where specific remediable causes are identified NHS England issues advice through the National Patient Safety Alerting System.

Increasing numbers of reported patient safety incidents are considered to be a sign of an improving patient safety culture and increases in the number of incident reports should not be interpreted as deterioration in the safety of patients.

As organisations change considerably across time this data reflects NHS organisational structures as of 31 December 2014. This means that incidents reported before that date may have taken place in a site that was not associated with a given trust at that time.

NHS England has a wide programme of work in partnership with other organisations seeking to improve outcomes for mothers and babies, including reducing stillbirth and neonatal death and avoidable admissions to neonatal care.

The Organisation for Economic Co-operation and Development rankings on patient safety are informed by the Health Care Quality Indicators which currently do not compare or rank nations specifically by patient safety incidents involving multiple pregnancies. There are five indicators which are used to rank countries for patient safety:

1. retained surgical device or fragment
2. post-operative wound dehiscence
3. post-operative pulmonary embolism or deep vein thrombosis
4. post-operative sepsis
5. obstetric trauma

Women should receive excellent maternity care that focuses on the best outcomes for women and their babies and on women’s experience of care.

There must be a relentless focus on safe care, right first time. This means creating a culture within the National Health Service that is open. A culture that reports errors, analyses what went wrong, and puts those lessons into practice as quickly as possible.

A safety culture is open and fair, shares information openly and freely, delivers fair treatment for staff when an incident happens, and encourages people to speak up about mistakes.

The Department commissioned the National Institute of Care and Excellence (NICE) to produce clinical guidelines and quality standards for the management of twin and triplet pregnancies in the antenatal period. NICE have also produced a pathway to support professionals to care for women with multiple pregnancies who suffer from complications.

NHS England has developed a Maternity Safety Thermometer – which is available to all trusts and allows maternity teams to take a temperature check on harm and records the proportion of mothers who have experienced harm free care, but also records the number of harm(s) associated with maternity care. It supports improvements in patient care and patient experience, prompts immediate actions by healthcare staff and integrates measurement for improvement into daily routines.

The Maternity Safety Thermometer was tested in a pilot phase from June 2013 until October 2014 and is now fully released and available to any organisation wanting to use it.

NHS England is undertaking a major review of the commissioning of NHS maternity services, in line with commitments made in the NHS Five Year Forward View. The review will assess current maternity care provision and consider how services should be developed to meet the changing needs of women and babies.

Recent advances in maternity care, changes in the demographics of women having babies, and preferences of where they want to give birth will form a key focus. Firstly, the review will evaluate the United Kingdom and international evidence and make recommendations on safe and efficient models of maternity services. Secondly it will ensure that the NHS supports and enables women to make safe and appropriate choices of maternity care for them and their babies. Thirdly it will support NHS staff including midwives to provide responsive care.

The terms of reference for the review were published on the 3 March. They can be found online at:

http://www.england.nhs.uk/wpcontent/uploads/2015/03/maternity-rev-tor.pdf

This review, which is expected to report in by the end of the year, will be led by an external chair, supported by a diverse panel.

The information requested is provided in the following table:

* Note 2014 data are incomplete

The table illustrates the number of incidents reported to the National Reporting and Learning System where the incident report contained keywords indicating multiple pregnancies, from 1 January 2005 to 30 September 2014, by degree of harm reported as caused by the incident. It is important to note that the inclusion of these keywords may not always indicate the incident directly affected a multiple pregnancy; for example, reference in the incident report may be made to previous pregnancies. The harm reported may relate to the mother or to one or more foetuses/infants.

The overall number of patient safety incidents reported to the National Reporting and Learning System has increased every year since its inception. Increasing numbers of reported patient safety incidents are considered to be a sign of an improving patient safety culture and increases in the number of incident reports should not be interpreted as deterioration in the safety of patients.

I thank the hon. Gentleman for that question. This is a matter for local authorities, and of course they are keen to reduce the carbon footprint resulting from having needless lights on. The experience around the country is mixed. In fact, some local authorities have shown that turning off lights does not detract from road safety.

The Department for Transport is working with international bodies to develop recommendations on adding artificial sound to quiet vehicles. These recommendations are expected to specify the characteristic of the sound and the vehicle speed up to which the

sound should be generated, so that levels from electric and conventional vehicles are similar. The Department recently published a research report on the audibility of electric vehicles which can be found at the following link:

http://assets.dft.gov.uk/publications/assessing-the-perceived-safety-risk-from-quiet-electric-and-hybrid-vehicles/PPR525-assessing-the-perceived-safety-risk-from-quiet-electric-and-hybrid-vehicles.pdf

I have met with Guide Dogs and RNIB to discuss adding artificial sound to electric and hybrid electric vehicles. The Department has also received correspondence requesting the mandatory fitment of added sound devices, most recently from Guide Dogs. However, if such systems were mandatory, we will need to ensure that fitment is cost-effective, and that while assisting the visually impaired road users does not add to general sound pollution that is damaging to health.

The Department for Transport is working with international bodies to develop recommendations on adding artificial sound to quiet vehicles. These recommendations are expected to specify the characteristic of the sound and the vehicle speed up to which the

sound should be generated, so that levels from electric and conventional vehicles are similar. The Department recently published a research report on the audibility of electric vehicles which can be found at the following link:

http://assets.dft.gov.uk/publications/assessing-the-perceived-safety-risk-from-quiet-electric-and-hybrid-vehicles/PPR525-assessing-the-perceived-safety-risk-from-quiet-electric-and-hybrid-vehicles.pdf

I have met with Guide Dogs and RNIB to discuss adding artificial sound to electric and hybrid electric vehicles. The Department has also received correspondence requesting the mandatory fitment of added sound devices, most recently from Guide Dogs. However, if such systems were mandatory, we will need to ensure that fitment is cost-effective, and that while assisting the visually impaired road users does not add to general sound pollution that is damaging to health.