NHS Resolution Maternity Incentive Scheme report
The scheme uses this financial incentive and until now has encouraged NHS hospitals to implement 10 specific safety actions designed to improve care for people using maternity services and their newborns.
Every hospital pays into a national insurance fund (the Clinical Negligence Scheme for Trusts), which covers clinical negligence liabilities arising from NHS patient care. Under the Maternity Incentive Scheme, they pay an extra 10% on top of their usual maternity contribution. If a hospital declares compliance with all 10 safety actions, it receives a full refund of that extra payment and a proportion of unallocated funds by way of an incentive payment.
The scheme is now in its seventh year and there have been substantial changes over that period. THIS Institute carried out an independent evaluation of the scheme. We asked two questions:
- To what extent do the MIS safety actions influence policy and behaviour in practice, and is it in the ways we thought they would?
- How does each safety action impact on finance, claims, safety, and clinical outcomes?
To find out how the scheme is working in practice, we used two main approaches: a data-based analysis of hospital performance and a qualitative study involving interviews with staff.
We analysed data from 120 NHS trusts over six reporting years (2018–2022) to identify how consistently the 10 required safety actions were met. We also explored how the safety actions were chosen and how the “all-or-nothing” financial incentive affects the behaviour healthcare staff responding to the scheme.
The qualitative study drew on 35 interviews with stakeholders, including:
- Members of the MIS Collaborative Advisory Group
- Maternity services staff, including midwives, obstetricians, neonatologists, and maternity service leads
- Senior staff from Local Maternity and Neonatal Systems, Maternity and Neonatal Voices Partnerships, NHS trusts and integrated care boards
- Representatives from NHS Resolution, and other national-level bodies
We also looked for links between specific safety training and a reduction in brachial plexus injuries claims – these arise from rare but serious injuries that can happen during birth and lead to substantial health issues for the baby.
The evaluation gave us several key insights into how the scheme works in the real world.
Key insights
- Most people agreed that a financial incentive is very effective in encouraging trust boards and senior leaders to prioritise maternity and neonatal safety.
- Most hospitals indicate that they are meeting the safety actions, with compliance rates above 80% for all 10 actions.
- Once safety actions have been met, trusts tend to remain compliant, suggesting that trusts embed sustainable systems rather than relying on ad hoc fixes.
- Many participants thought that the scheme was ‘good in parts’, with some aspects having a positive impact on the safety of maternity services.
- Some people weren’t convinced that the increase in workload devoted to demonstrating MIS compliance was making a difference to maternity safety in practice.
- Some staff suggested that the scheme had turned compliance with the safety actions into an “industry” in an already pressured system, taking time away from clinical care.
- There was a concern that the threat of financial penalties could lead to stress, affecting the wellbeing of staff responsible for the scheme, and penalising trusts that might already be struggling financially.
- It’s still too early to tell if the scheme has significantly reduced brachial plexus injuries due to the long time it takes for claims to be made.
Evaluating improvement programmes in healthcare is essential, enabling the system to identify what is working, what needs to change, and where best to concentrate efforts and resources.
NHS Resolution’s commissioning of an independent rigorous evaluation of the Maternity Incentive Scheme is therefore very welcome. It’s great to see NHSR’s commitment to engaging openly with these findings and listening carefully to feedback. The willingness to use the findings of the evaluation to inform the future direction of the scheme reflects the kind of learning culture that sustained improvement will require.
Mary Dixon-Woods, THIS Institute Director
The power of financial incentives: what this means for policymakers and practitioners
- The evaluation shows that while financial rewards can certainly be a powerful incentive, policymakers could consider simplifying the rules and aligning them with data that hospitals already collect, to reduce the administrative workload.
- The evaluation shows that while financial incentives can be a powerful lever, policymakers could consider simplifying the rules and aligning them with data that hospitals already collect, to reduce the administrative workload.
- It highlights a need to decide if the scheme should stay focused on preventing neonatal brain injury or if it should address safety and the experiences of families more broadly.
- For healthcare staff, although the scheme sometimes acts as a “fantastic lever” to secure funding for more staff and better equipment that might otherwise be ignored, the millions of pounds at stake creates stress which can lead to burnout and sick leave among staff responsible for preparing the submissions.
- The report’s findings suggest that strong leadership, robust governance, and participation in peer-learning networks are essential for lasting success.
A note of thanks
We would like to extend our gratitude to the contributors who shared their time and perspectives with us. Their candid insights into the design, administration, and practical delivery of the MIS have been invaluable in shaping this evaluation and identifying pathways for a safer maternity system.