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Published 12 November 2020
NHS Resolution launched its “Maternity Incentive Scheme” in 2018 to support the Department of Health’s Maternity Safety Strategy and to generally seek to improve the delivery of safer maternity and neonatal care. It seeks to do this by financially rewarding Trusts that achieve ten “safety actions” that were agreed with its Collaborative Advisory Group, made up of various organisations, including the Royal College of Obstetricians & Gynaecologists, the Royal College of Midwives and the Care Quality Commission. NHS Resolution has recently relaunched its conditions and guidance for Year 3 of the scheme. In this article, we look at back at what has been learned through the scheme in its first two years, and at some key parts of the conditions and guidance for Year 3.
In Year 1 (2018) 132 Trusts applied to the scheme and, of those, 75 (57%) were able to demonstrate that they had achieved all ten of the safety actions and therefore qualified for financial reward under the terms of the scheme. In Year 2 (2019) 130 Trusts applied and 117 (90%) qualified for financial reward, which represented a significant improvement on the preceding year. This was recognised by NHS Resolution in its interim evaluation of the scheme, which was published in April 2020, and which reported (based on the data and intelligence from Trusts) that the scheme had brought about significant improvements in patient safety culture . For example, Trusts indicated the scheme had ensured maternity services and patient safety issues were treated as high priority at Board level, and that it had facilitated the appointment of quality and safety programme leads, thereby promoting safer and higher quality care. However, NHS Resolution recognised in the evaluation report that some further rules had to be considered in relation to the verification of information provided to the scheme by Trusts, and this is reflected in the Year 3 guidance (see below).
NHS Resolution relaunched Year 3 of the scheme on 27 October 2020. These are some of the key points to note in relation to the updated conditions and guidance that it has published as part of the relaunch:
• NHS Resolution has retained the same safety actions that applied in Year 2, but with some adjustments to the technical guidance for some of them. In particular:
o Changes have been made to account for the impact of the Covid-19 pandemic. For example, under safety action 3 (the need to demonstrate that the Trust has transitional care services to support the recommendations made in the Avoiding Term Admissions into Neonatal Unit Programmes) the conditions require a review of term admissions to the neonatal unit during the “Covid-19 period” (i.e. 1 March 2020 – 31 August 2020) in order to identify the impact of the pandemic. Under safety action 5 (the need to demonstrate an effective system of midwifery workforce planning to the required standard) the conditions require Trust to have plans to flexibly adjust the midwife-to-woman ratio if needed due to the pandemic. Under safety action 8 (the need to evidence that at least 90% of each maternity unity staff group has attended a maternity emergencies training session since December 2019) the conditions confirm that the required training can be provided digitally/remotely, but that there should be training specifically relating to the provision of care during the pandemic.
o Safety action 10 now requires Trusts to have reported all qualifying cases not only to NHS Resolution’s Early Notification (“EN”) Scheme (as was the case in Year 2), but also to the Healthcare Safety Investigation Branch (“HSIB”). It also requires Trusts to be assured that, in qualifying cases that have occurred between 1 October 2020 to 31 March 2021, the families have received information on the role of the EN Scheme and HSIB and that the duty of candour has been complied with. These are new requirements that have been introduced for the first time in the Year 3 scheme conditions.
• NHS Resolution has stipulated additional requirements for the declaration form that Trusts have to submit in order to be eligible for payment under the scheme. Whereas previously the declaration form had to be signed only once by the Trust Chief Executive in order to confirm that the evidence provided to the scheme demonstrated that the safety actions had been achieved and to confirm that the declaration form had been discussed with the commissioner(s) of the Trust’s maternity services, the Trust Chief Executive is now required to sign the form three times in order to verify not only those two requirements, but also that there are no reports from 2019/20 or 2020/21 relating to the provision of maternity services that may subsequently provide information that conflicts with the declaration (e.g. CQC or HSIB investigation reports). The scheme conditions for Year 3 also state that NHS Resolution may ask Trusts to reconfirm if they consider themselves to have achieved the ten safety actions if any concerns arise either before or after the results of the scheme are announced. Trusts may be required to repay any funding received under the scheme, and they may also be required to review submissions made to the scheme in previous years, if they turn out to be “non-compliant”.
These are just some of the most notable new requirements set out in the Year 3 conditions and technical guidance, but, of course, it is crucial that Trusts familiarise themselves with all of the documentation relating to the relaunch of Year 3 of the scheme, which can be found on NHS Resolution’s website.
We have unrivalled experience of advising Trusts on claims arising out of maternity services and on continuous improvement in the way maternity care is delivered and can provide support to you and your Board. Trusts are required to submit the required declarations to NHS Resolution by 20 May 2021 in order to be eligible for payment under the scheme.
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