What is the Maternity Incentive Scheme?
The Maternity Incentive Scheme (MIS) is a financial incentive program designed to enhance maternity safety within NHS Trusts. It refunds the Maternity Incentive Scheme payment made to NHS Resolution for Trusts that can demonstrate they have implemented a set of core safety actions, ultimately aiming to improve the quality of care for women, families and newborns.
- The MIS was established on the instruction of the Department of Health and Social Care to incentivise Trusts to actively adopt best practices and implement essential safety measures.
- Obstetric incidents can be catastrophic and life-changing for families. NHS Resolution are working together with our colleagues across the NHS in England to do all we can to help prevent these occurring.
- The MIS aims to deliver safer maternity services and reduce the cases of brain injuries or other harm that can lead to negligence claims.
- The ten standardised safety actions in the scheme have been agreed by senior clinicians to help drive improvements in maternity.
- By meeting all 10 safety actions we believe that this will help trusts to deliver safer maternity services. The safety actions can be used to highlight areas where improvement is needed.
Who do we work with?
The MIS and each of the safety actions aredeveloped with the Chief Midwifery Officer and the National Clinical Director for Maternity, working in partnership with our Collaborative Advisory Group which includes senior representatives of the following organisations:
- NHS England
- The Royal College of Obstetricians and Gynaecologists
- The Royal College of Midwives
- Royal College of Anaesthetists
- Obstetric Anaesthetists Association
- Neonatal Clinical Reference Group
- Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE UK)
- Care Quality Commission (CQC)
- Maternity & Newborn Safety Investigations programme (MNSI)
- Service User Representatives
What are the 10 Safety Actions?
Safety Action 1: Are you using the National Perinatal Mortality Review Tool to review perinatal deaths to the required standard?
The National Perinatal Mortality Review Tool is used by healthcare professionals to investigate and understand why some babies die before they are born or shortly after birth. This safety action is checking whether healthcare professionals are using this tool correctly, following the specific guidelines and standards set for it when they look into the reasons why some babies die during or shortly after birth. The tool helps ensure that the investigations into these situations are done at the right time, and are done effectively, which can lead to improvements in how healthcare is provided to newborns and their mothers or parents.
Safety Action 2: Are you submitting data to the Maternity Services Data Set (MSDS) to the required standard?
The Maternity Services Data Set (MSDS) is a collection of important digital information about maternity care, such as how many babies are born, how mothers are taken care of, and other important details. This safety action is asking whether the people or organisations responsible for providing this information are doing it in the right way. They need to follow certain rules and make sure the information is accurate and complete. This is important because it helps keep track of how well maternity care is being provided, and it ensures that the information collected is reliable for making improvements in maternity services.
Safety Action 3: Can you demonstrate that you have transitional care services in place to minimise separation of mothers and their babies and to support the recommendations made in the Avoiding Term Admissions into Neonatal units Programme?
The goal with this safety action is to make sure Mothers and babies can stay together as much as possible, rather than being separated, and cots on the neonatal unit are preserved for those babies that need them the most. This is in line with recommendations from the “Avoiding Term Admissions into Neonatal Units” Programme. A system needs to be in place that allows mothers and babies to be together as much as possible and avoid unnecessary separation when the baby needs extra attention. This approach promotes the well-being of both the mother and the baby during this time.
Safety Action 4: Can you demonstrate an effective system of clinical workforce planning to the required standard?
This standard ensures that teams have the right number of doctors and nurses with the right qualifications, skills and support. This includes obstetricians, anaesthetists, neonatal doctors and neonatal nurses. The required standards are developed by the relevant professional bodies, ensuring the best practices and guidelines across the whole multi-disciplinary team.
Safety Action 5: Can you demonstrate an effective system of midwifery workforce planning to the required standard?
This safety action ensures that teams have the right number of midwives and maternity support workers in the right places with the right qualifications, skills and support. It is also important that Trust Boards understand any issues that relate to staffing and safety, so this also includes a requirement to monitor staffing and safety issues and report on them regularly.
Safety Action 6: Can you demonstrate that you are on track to compliance with all elements of the Saving Babies’ Lives Care Bundle Version Three?
The “Saving Babies’ Lives Care Bundle Version Three” is a list of safety standards co-developed by NHS England with clinical experts including front line clinicians, Royal Colleges, and professional societies; service users and maternity voices partnerships; and national organisations including charities, the Department of Health and Social Care and a number of arm’s length bodies, to improve safety and outcomes in maternity care.
It includes six sections (elements)
- Reducing smoking in pregnancy
- Fetal growth
- Raising awareness of reduced fetal movement
- Effective fetal monitoring
- Reducing preterm birth
- Management of pre-existing diabetes
Each element includes a range of improvements in clinical care, audits and training. Maternity teams must work towards full compliance with all of the elements.
Safety Action 7: Listen to women, parents and families using maternity and neonatal services and coproduce services with users
This is about making healthcare services for pregnant women and newborn babies better by involving the people who use them.Teams must work in partnership with maternity and neonatal service user representatives to actively seek feedback and ensure the voices of all groups are heard and represented. Teams need to work together with service users to co-design services and respond to feedback.
This means that the people who are going through pregnancy and childbirth, as well as their families, have a say in how the services are provided. It ensures that the services are designed to meet their needs and preferences, making the experience better for everyone involved.
Safety Action 8: Can you evidence the following 3 elements of local training plans and ‘in-house’, one day multi professional training?
This safety action stipulates a minimum training requirement that all maternity teams must meet. This relates to training for obstetric doctors, anaesthetists, midwives, maternity support staff and neonatal nurses. It includes training in the following:
-
- Obstetric emergencies
- Fetal monitoring
- Neonatal life support
Safety Action 9: Can you demonstrate that there are robust processes in place to provide assurance to the Board on maternity and neonatal safety and quality issues?
This safety action focusses on the systems and governance in place to ensure maternity and neonatal care is as safe and high-quality as possible, and ensuring that Trust Boards have oversight, and can have confidence in the evidence (they are assured). There is a requirement to demonstrate how everyone in an organisation feels comfortable to raise a concern, and that there are systems in place to escalate this
Safety Action 10: Have you reported 100% of qualifying cases to Healthcare Safety Investigation Branch (HSIB) (known as Maternity and Newborn Safety Investigations Special Health Authority (MNSI) from October 2023) and to NHS Resolution’s Early Notification (EN) Scheme?
This safety action ensures maternity teams inform the relevant healthcare safety organisations about all maternity cases that meet certain criteria. Families must understand this process and be given the opportunity to raise questions or concerns. This ensures prompt reviews to identify any learning, and provides more timely support for the families involved.
How does the Maternity Incentive Scheme work?
NHS Resolution operates the Maternity Incentive Scheme on behalf of Secretary of State for Health and Social Care.
- Trusts self-declare their progress against the 10 safety actions at the end of each year of the scheme.
- The Trust Board and Integrated Care Board must be assured of this progress before signing the Board declaration form.
- The signed declaration form is submitted to NHS Resolution.
- Evidence used to support the position and assure the Board should be retained. In the event that the declaration is later called into question, this evidence may be reviewed by the NHS Resolution Team.
What is reverification?
As part of the MIS conditions, at any time if concerns are raised about a trust or submission, NHS Resolution are required to investigate these. This may be following a CQC inspection, or concerns raised by an individual. If information that conflicts with the trust MIS submission is identified, then Trusts may go through a ‘reverification’ process:
- Trusts asked to re-confirm and declare whether they meet all ten safety actions based on evidence sent to their Board at the time of the initial submission.
- If their findings do not coincide with the concerns raised, NHS Resolution will ask to review the evidence of their submission.
- There will be a request to review previous years’ submissions if the outcome of a declaration is changed following this review.
- Any maternity incentive scheme contribution and any surplus monies paid to the trust will need to be repaid for non-compliant years.
- The trust will be given the opportunity to develop an action plan and apply for discretionary funding to support this.
This is a transparent process and is reflected in the published details on the website.
Our team
You can read more about our Maternity Incentive Scheme team by viewing their bios below:
How to keep in touch
Why join the FutureNHS workspace?
An NHS Resolution FutureNHS workspace was launched in April 2024.
This includes information and a forum for queries about each action, and information and resources that will hope will support MIS compliance.
- Allows improved communication with members.
- Open and accountable responses to queries.
- Encourages sharing of resources and best practice.
- Support from Maternity Support Programme teams – resources.
- Links to other NHS organisations and information.
Why join the contact list?
In order to ensure that essential communications reach the right people in organisations participating in our maternity incentive scheme, we are asking for Trusts to nominate at least two link individuals as leads for the maternity incentive scheme.
These individuals will be responsible for receiving, cascading and acting as a conduit for responding to all communications relating to the maternity incentive scheme.
If your nominated link individuals change you will need to advise us in order to ensure continuity of communications. Please upload their new details here and alert us via nhsr.mis@nhs.net
Please ensure that you notify us if these individuals leave your organisation.
Evaluation
Since its launch, the Maternity Incentive Scheme (MIS) has undergone a comprehensive interim evaluation in 2020, alongside an annual survey distributed to NHS trusts to gather their ongoing perspectives on each year of the scheme.
To build upon the work of this previous evaluation, we initiated an extensive 18-month evaluation of the MIS in the late summer of 2023, aiming to examine the scheme’s internal processes and its broader impact on outcomes and stakeholders. This evaluation is crucial, and to ensure its robustness, we have embarked on an in-depth listening exercise, engaging with a wide array of clinicians from maternity units across England. This collaborative approach highlights the critical role of stakeholder feedback and experiences in refining the MIS and enhancing its contribution to maternity care improvements.
As our evaluation progresses through the end of 2024, the insights and participation of our stakeholders are pivotal. Their involvement not only enriches our understanding but also steers the MIS towards generating meaningful improvements in maternity care, emphasising the value of community engagement in our evaluation efforts.
Key documents
Year 6: board notification form
Year 6: overview letter to trusts
Results
Year 3: results overview February 2022
Year 2: results regional breakdown
Year 1: results regional breakdown
Events
In April 2025 the MIS team hosted a virtual, half day webinar alongside expert speakers, sharing crucial updates on scheme changes for Year 7. The event was recorded and is available for catch up on our dedicated webpage, where you can also access the presentation slides.
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