Maternity safety is an important issue for all members of our Clinical Negligence Scheme for Trusts (CNST). Obstetric incidents can be catastrophic and life-changing, with related claims representing the scheme’s biggest area of spend. Of the clinical negligence claims notified to us in 2016/17, obstetric claims represented 10% of the volume and 50% of the value.
We joined forces with the national maternity safety champions, Matthew Jolly and Jacqueline Dunkley-Bent, to support the delivery of safer maternity care through the introduction of an incentive element to the contribution to the CNST. Introducing such incentives received support through our 2016 consultation on CNST pricing.
We wrote to organisations providing maternity services on 9 March 2018 explaining how the scheme will reward local services that take steps to improve delivery of best practice in maternity and neonatal services. We built in provision for the incentive fund into our maternity pricing for 2018/19 of the CNST, collecting an additional 10% of the maternity contribution from members.
Trusts that were able to demonstrate compliance against ten actions recovered the element of their contribution relating to the CNST maternity incentive fund and will receive a share of any unallocated funds. Those making insufficient progress will benefit from a lesser sum to help them improve their position. The administration and evaluation of the scheme formed a significant work-stream for 2018/19.
Timeline for 2018
- Launch of an evaluation survey: Monday 4 June
- Close of the evaluation survey: Friday 22 June
- Trusts able to submit self-certification reports and action plan to firstname.lastname@example.org: From Friday 1 June
- Deadline for trust self-certification reports and action plan: 23:59pm Friday 29 June
- Review final results/business cases: July
- Appeals deadline extended to: 21 August 2018
- NHS Resolution to process incentive scheme payments: August (subsequently move to September to accommodate a longer appeals process. This decision was made in response to a technical issue that prevented information about the scheme results reaching chief executives and directors of finance within our intended timeframe.)
- Payments made to trusts that met ten out of ten maternity safety actions were issued with their 10% contribution into the scheme on the 6th September with funds being available on the 10th September.
It was noted that for those who intended to appeal their award – to reiterate previous correspondence: “Only trusts that meet the required progress against all 10 maternity safety actions will be eligible for a payment of at least 10% of their contribution to the incentive fund. Trusts that do not meet the 10 out of 10 threshold may be eligible for a discretionary payment from the incentive fund to help them to make progress against one or more of the 10 actions. Such a payment would be at a much lower level than the 10% contribution to the incentive fund.”
Updated guidance on the safety actions
Our updated Final details and evidential requirements for each action document provided further clarity on the safety actions following a number of recent queries. All changes have been highlighted in yellow for ease of reference. There is also a new section dealing with general FAQs around the scheme. Key points to note are that:
We have provided greater clarity around the transitional care action;
We would accept evidence from May and June for both the National Perinatal Mortality Review Tool and the maternity emergencies training action
We relaxed of the reporting times for early notification claims, which will only apply to 2017/18 incidents
Action plan template
As only trusts that meet the required progress against all 10 maternity safety actions would be eligible for a payment of at least 10% of their contribution to the incentive fund. Trusts that did not meet the 10 out of 10 threshold may have be eligible for a discretionary payment from the incentive fund to help them to make progress against one or more of the 10 actions. Such a payment would be at a much lower level than the 10% contribution to the incentive fund.
We updated Section B of the Template Board report and the Q&A document (Q10) to incorporate the action plan template. An action plan was to be completed for each action where the trust had failed to demonstrate the required progress (even where no funding request is being made). The action plans were designed to help us to understand the trust’s recovery plan(s) and consider any associated funding request. A completed action plan was required even where trusts had already completed Section B of the Board report. However, if Section B hadn’t been completed, the action plan template alone was deemed sufficient. Completed action plans formed part of the Trust’s Board response and therefore covered by the Board’s sign-off. If not, it was requested that the action plan was signed off by the trust’s finance director, or an approvals committee, to demonstrate that it is a feasible and implementable plan.
We applied the following criteria when considering requests for discretionary funding:
- Did the action plan have clinical and executive support?
- Did the action plan clearly explain how the maternity safety action will be met and by when?
- Did the action plan have a clearly thought out plan with SMART deliverables?
- Would successful delivery likely result in the required progress against the maternity safety action being met?
Submission timing and process
Trusts were required to submit the following documentation to NHS Resolution:
- Board report template signed by the chief executive to confirm Board approval and commissioner discussion; and
- Completed action plan template – one for each action where the required progress has not been met
Trusts were not required to submit their supporting evidence to NHS Resolution – this assurance was to be provided to your Board with only the final results sent through. We updated Sections A and D of the Board report template to make that clear.
Trusts were be able to submit their completed Board reports to email@example.com from Friday 1 June 2018. The deadline for submissions was 23:59pm Friday 29 June 2018. We aimed to provide an electronic acknowledgement of trust submissions within 48 hours.
Our online survey captured feedback on the effectiveness of the CNST maternity scheme. We emailed out a link to the survey on Monday 4 June which remained open until Friday 22 June. We were grateful for participation to ensure that we are able to use this feedback to inform future planning and developments to the scheme.
- Q&A: Maternity Safety Strategy actions and CNST incentive scheme
- Final details and evidential requirements for each action
- Template Board report for result submission
- CNST local training record form
- Action plan for safer maternity
- Decision making process
A reminder of the ten maternity safety actions agreed with the national maternity safety champions and in partnership with NHS Digital, NHS England, NHS Improvement, Royal college of Obstetricians and Gynaecology, Royal College of Midwives, MBRRACE and CQC:
- Are you using the National Perinatal Mortality Review Tool to review perinatal deaths?
- Are you submitting data to the Maternity Services Data Set to the required standard?
- Can you demonstrate that you have transitional care facilities that are in place and operational to support the implementation of the ATAIN Programme?
- Can you demonstrate an effective system of medical workforce planning?
- Can you demonstrate an effective system of midwifery workforce planning?
- Can you demonstrate compliance with all four elements of the Saving Babies’ Lives care bundle?
- Can you demonstrate that you have a patient feedback mechanism for maternity services, such as the Maternity Voices Partnership Forum, and that you regularly act on feedback?
- Can you evidence that 90% of each maternity unit staff group have attended an ‘in-house’ multi-professional maternity emergencies training session within the last training year?
- Can you demonstrate that the trust safety champions (obstetrician and midwife) are meeting bi-monthly with Board level champions to escalate locally identified issues?
- Have you reported 100% of qualifying 2017/18 incidents under NHS Resolution’s Early Notification Scheme?
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