A year in the Maternity (Perinatal) Incentive Scheme, 2025/26

The Maternity (Perinatal) Incentive Scheme (MIS) is a financial incentive program designed to enhance maternity and neonatal safety within NHS trusts. It refunds 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. Additional information about the Maternity (Perinatal) Incentive Scheme can be found here.

This report is intended to provide a national overview of the results of Year 7 of MIS and is correct as at 13/04/2026. It is not intended to provide commentary on the results of individual trusts.

Year 7 ran from 2 April 2025 to 3 March 2026. 119 trusts participated, accounting for all maternity units in England. See the published results for Year 7.

Key points: Year 7

• 119 trusts submitted for MIS Year 7.
• MIS payments into the scheme ranged from £185k to £4.5 million.
• 107 trusts achieved full compliance (10/10) after validation, the highest since the scheme began.
• 9 trusts were upgraded following external verification.
• 1 trust was downgraded following external verification.
• Safety Action 1 (Perinatal Mortality Review Tool (PMRT) submission) continued to be a challenge for some trusts, with delays in notifying the death in the appropriate time frame and starting the review on time.
• Safety Action 2 (Maternity Services Data Set (MSDS) submission) achieved 100% compliance, demonstrating consistent national engagement with timely and complete data submissions.
• Safety Action 4 (Clinical workforce) achieved the most significant improvement, increasing from 91% to 97% in Year 7, highlighting progress in medical workforce compliance and alignment with Royal College of Obstetricians Gynaecologists (RCOG) and British Association of Perinatal Medicine (BAPM) standards for safer staffing.
• Safety Action 10 Early Notification Scheme (EN Scheme) achieved 100% compliance, reflecting strong system-wide commitment to embedding the scheme within routine governance processes.
• All non-compliant trusts in Year 7 submitted fully costed and sustainable safety improvement plans.
• Four appeals were submitted by trusts in relation to their compliance outcomes. All appeals were carefully considered, however, none met the criteria for progression as detailed in the scheme conditions.

MIS Year 1-7 results

What are the 10 safety actions?

MIS Year 7 results compliance by safety action (SA)

Year 6 (for comparison)

MIS Year 7 results: safety actions following external verification

MIS Year 7 results: regional full compliance trends

Non-compliant trusts

Discretionary funding

• Non-compliant Trusts will not receive a return of their MIS contribution. However, they may apply for a reduced level of funding to support targeted safety improvements. This funding is subject to a maximum cap, calculated as a percentage of the trust’s total MIS payment.
• All non-compliant trusts in Year 7 submitted fully costed SMART improvement plans (Specific, Measurable, Achievable, Realistic and Time-bound), which were approved by NHS Resolution. Trusts are encouraged to discuss their final results with their regional leads and local Maternity Improvement Advisor, where applicable. Where discretionary funding is agreed, commissioners must ensure that it is utilised to implement the agreed action plan for improvement.
• Trusts are using funding to directly address gaps that hinder compliance which included:
  • PMRT Lead midwife (SA1)
  • Perinatal governance lead midwife (across all SAs) for maternity services
  • Administration support (SA4 & 8)
• There was significant variation in the funding requested, ranging from £14.5k to £1.02 million, reflecting differences in organisational size and the level of need associated with the respective safety action.
• Trusts are required to demonstrate how any staffing solutions will be sustained beyond the funding period, recognising that MIS funding is non-recurring. This is often approached as a ‘proof of concept’, alongside the development and submission of longer-term business cases.

Appeals

• Four appeals were submitted in relation to their compliance outcomes for MIS Year 7 in relation to Safety Actions 1, 4 and 8.
• As set out in the scheme guidance, the NHS Resolution MIS Clinical Team reviewed all appeals to determine whether they met one of the two specified grounds for appeal. None of the appeals met the criteria and therefore were not progressed.
• Appeals are rejected where criteria for valid grounds are not met (as detailed in the Scheme Conditions)
  • Trusts were advised on the grounds for appeal and scheme requirements
  • We provided clear rationale to support each decision
  • The threshold-based nature of the scheme was clearly communicated
  • Trusts were signposted to funding and improvement pathways
  • Trusts were offered support to strengthen future compliance

Appeals will be fair, focused, and evidence-based

• The appeals process exists to ensure fairness and provide review where needed but is not intended as a route for reinterpretation of the standards. Trusts should only appeal where they believe they have been misadvised, or there were circumstances fully outside the control of the trust that could not reasonably have been foreseen or planned for. Appeals cannot override the core requirements of the scheme.

Key learning for organisations

• PMRT percentage compliances are externally verified by Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK), and their decision is final.
• Trusts are responsible for ensuring locum staff are appropriately certified and safe to work prior to working any shifts in the organisation.
• Oversight and forward planning should be strengthened to support the consistent maintenance of ≥90% minimum training compliance, with a target compliance rate of 100%.

How this learning has informed Year 8

• Safety Action C (Learning from reviews and investigations) has evolved to move away from a focus on reporting processes, to prioritising learning and the implementation of change. This reflects a broader move towards embedding meaningful improvement in practice.
• Locum certification (CEL) requirements emphasise proactive workforce assurance, with trusts maintaining live local databases and verifying eligibility to ensure locum staff are appropriately certified and safe to work.
• There is a strengthened focus on training requirements, requiring a minimum of 90% achievement at two key checkpoints across the year, rather than relying on final submission performance. Trusts are encouraged to strive for 100% compliance.

Reverifications

• 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. If information that conflicts with their MIS submission is identified, then trusts may go through a ‘reverification’ process.
• Graph shows all historical reverifications to date.
• NHS Resolution MIS reverification target – 90% of reverification processes should be completed within their respective predefined timescales.
• If any delays are outside the direct control of NHS Resolution this is documented on the compliance tool for audit and monitoring.
• Currently meeting target at 100%.

MIS Year 8 summary of changes

View the MIS Year 8 Core Standards and Supplementary Guidance, published 31 March 2026.

A. Workforce and Capacity

• Year 8 combines all maternity and neonatal workforce requirements into one multi‑professional action.
• Sets clearer expectations for consultant presence, anaesthetic cover, neonatal staffing and locum use.
• Removes supernumerary coordinator and 1:1 labour care from MIS, but services should still monitor and escalate via the Perinatal Quality Oversight Model (PQOM) and red‑flags reporting.
• Operational capacity monitoring and oversight, including elective Caesarean activity via Situation Reports (SitReps).
• Funded midwifery establishment (Birth-Rate+) as a minimum and introduces funded neonatal establishment requirements.
• Confirms need for trained anaesthetic assistants and progress towards peri‑operative team models.

B. Training

• Year 8 strengthens training and assurance with two compliance checkpoints (30 Nov plus one local).
• Training continues to cover fetal monitoring, obstetric emergencies and neonatal resuscitation.
• In‑situ simulation now required in both hospital and community settings.
• Anaesthetic training requirement reduced to a half‑day to support attendance.
• Impacted fetal head (IFH) scenarios must be included by year end to align with Avoiding Brain Injury in Childbirth (ABC) preparation.

C. Learning from Reviews and Investigations

• Year 8 strengthens triangulation of reviews with wider safety intelligence, ensuring early identification of themes and meaningful family involvement.
• PMRT, MNSI and EN learning now aligned, with Submit a Perinatal Event Notification (SPEN) as the single national notification route.
• PMRT external review threshold increased to 60%.
• Quarterly Board‑level thematic reports required.
• Greater focus on learning → action → impact.
• Statutory Duty of Candour reporting removed from MIS (already a legal requirement).

D. Service‑User Voice, Experience and Equity

• Strengthened focus on communication equity, ensuring women and families can understand their care and participate fully with appropriate language support and reasonable adjustments.
• Service‑user-led improvement, using lived experience to identify priorities and barriers to safe, respectful care.
• Emphasis on equity, using local data to identify groups with poorer access or outcomes and addressing identified gaps.
• Maternity and Neonatal Voices Partnerships (MNVPs) structures no longer mandated, but MNVP Leads remain the gold standard where available; where capacity is limited, trusts must ensure diverse and representative service user voices inform priorities, improvement work and governance.

E. Care Bundles

• Year 8 introduces a more targeted local approach to Saving Babies’ Lives Care Bundle’ (SBLCB) alongside preparation for the new Maternity Care Bundle (MCB).
• Quarterly Saving Babies’ Lives Care Bundle Version 3 (SBLCBv3.2) reports required at Trust Board, reflecting local progress, implementation, incidents and safety intelligence.
• ICB assurance step removed as Integrated Care Boards (ICBs) no longer hold a formal oversight role.
• Trusts must develop an MCB implementation plan with quarterly Board oversight.
• Requires development of neonatal pulse oximetry guidance.

F. Governance, Oversight and Culture

• Clearer expectations for Board‑level assurance and use of safety intelligence.
• Routine use of the Maternity Outcomes Signal System (MOSS) and associated Standard Operating Procedures (SOPs).
• Bimonthly Board Safety Champion meetings with MNVP involvement.
• Live Perinatal Culture Improvement Plan required, with quarterly Board review.

Maternity (Perinatal) Incentive Scheme Evaluation

MIS Year 8 resources