Introduction

The Maternity Incentive Scheme (MIS) is a financial incentive program designed to enhance maternity safety within NHS Trusts. It rewards 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 Incentive Scheme can be found here.

This report is intended to provide a national overview of the results of Year 6 of MIS and is correct as at 01/06/2025. It is not intended to provide commentary on the results of individual Trusts.
Year 6 ran from 2 April 2024 to 3 March 2025. 120 Trusts participated, accounting for all maternity units in England.

Initial published results for Year 6 can be found here.

What is the Maternity (Perinatal) Incentive Scheme (MIS)?

As detailed in our 2025-28 strategy, Resolution through Collaboration, our MIS scheme is one way we draw on our unique expertise and work with our system partners to support maternity and neonatal safety improvements. This includes our continued commitment to support improvements in maternity and neonatal outcomes and using our data to support the reduction in rates of stillbirths, neonatal deaths, maternal deaths and brain injuries that occur during or shortly after birth.

Maternity Incentive Scheme (2017) – NHS Resolution operates the MIS on behalf of Secretary of State for Health and Social Care

Key Points – Year 6

• 120 Trusts submitted for MIS Year 6.
• MIS payments into the scheme ranged from £140k to £3.86 million.
• 102 Trusts achieved full compliance (10/10) after validation – the highest since the scheme began.
  • No Trusts were downgraded following external verification suggesting improved data integrity and/or supportive validation processes.
  • 18 Trusts were upgraded following external verification.
  • Trusts appear to have improved openness in self-declaration.
• Safety Action (SA) 8 (Multi-Professional Training) had the lowest compliance, often due to incomplete training coverage across all required staff groups. Challenges with anaesthetic and obstetric compliance.
• SA1 (Perinatal Mortality Review Tool [PMRT]) continued to be a challenge for some Trusts, with delays in completing factual questions and lack of evidence of multidisciplinary review within expected timeframes.
• SA2 (Maternity Services Data Set [MSDS] submission) achieved 100% compliance, reflecting strong engagement with national data requirements.
• All non-compliant Trusts in Year 6 submitted fully costed and sustainable safety improvement plans. Implementation will be overseen by Integrated Care Boards (ICB).
• Four appeals were submitted by Trusts in relation to their compliance outcomes.
  • One appeal was upheld, resulting in a change to the Trust’s compliance status.
  • Three were not upheld as the original decisions were found to be consistent with the standards and evidence.

MIS Years 1-6 Results (final outcomes)

n.b. Data for Years 1-5 includes changes following retrospective reverifications.

What are the ten safety actions?

MIS Year 6 Results Compliance by safety action

Year 5 (for comparison)

MIS Year 6 Results – Regional variation

MIS Year 6 Results – Regional full compliance trends

Non-compliant Trusts

Discretionary Funding

Non-compliant Trusts will not receive their MIS contribution back. However, they can bid for a smaller amount of funding to support targeted safety improvements. This is subject to a maximum cap, calculated as a percentage of their total MIS payment. This cap has been temporarily increased in Years 4-6 of the scheme.

All non-compliant Trusts in Year 6 have submitted fully costed SMART improvement plans, which have been agreed by NHSR. Implementation will be overseen by ICBs, and funding must be ringfenced.

• Trusts are using funding to directly address gaps that hinder compliance.
• There was wide variation in amounts requested (£70k – £780k) corresponding with size of organisation.
• Many Trusts used discretionary funding to address gaps in multi-professional staffing, particularly:
  • Backfill for PMRT reviews (Safety Action 1)
  • Consultant PA time for governance or education (SA4/SA8)
  • Midwifery staffing uplift or temporary workforce solutions (SA5)
  • Trusts must evidence sustainability plans for any staffing solutions, as funding is non-recurring.
  • This is commonly addressed as ‘proof of concept’ while business cases submitted.
• Work is ongoing as part of the evaluation to assess the impact of this funding.

Appeals

Four appeals were submitted by Trusts in relation to their compliance outcomes for MIS Year 6. All appeals were reviewed fairly and transparently by the Appeals Advisory Committee, using the same published criteria and evidence used in the original review process.

One appeal was upheld, resulting in a change to the Trust’s compliance status. Three were not upheld as the original decisions were found to be consistent with the standards and evidence.

Themes for sharing with Trusts:

Understand the standards and how they’re applied

The standards are designed to be fairly and consistently applied across all Trusts. Where interpretation issues arose, decisions were based on whether the evidence met the requirements of the technical guidance. Where needed, seek clarification before submission deadlines.

Respect key dates and deadlines

Appeals sometimes related to timing, such as when reviews were completed or data was submitted. The scheme has to operate within a clear framework of timelines to ensure consistency and fairness.

Check for data consistency

Occasional discrepancies emerged between local data and national sources used in external validation. In most cases, the national data position was upheld. Double-check local data against what will be seen by national bodies (e.g. MSDS, MBRRACE).

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 a genuine error or misjudgement has occurred. Appeals cannot override the core requirements of the scheme.

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

MIS reverification KPI – 90% of reverification processes completed within their respective predefined timescales.

If any delays are outside the direct control of NHSR this is documented on the compliance tool for audit and monitoring.

Currently 95%

• Large number of reverifications for early MIS years, largely triggered by CQC maternity inspections.
• Compliant outcomes have risen steadily while the quality and completeness of evidence submitted has improved year-on-year. This suggests growing familiarity with MIS expectations, improved internal governance, and better preparation at the point of submission.
• Early indications of a growing proportion of reviews triggered by family concerns.
• If a Trust is downgraded through reverification, a limited backward review (current year plus up to two previous MIS years) may be undertaken. This ensures consistent application of standards, while avoiding multiple large financial repayments in quick succession that could destabilise services and compromise safety.
• As of now, no reverifications have been required for Year 6, however, the year only concluded three months ago. Reverifications may be prompted following CQC inspections, and family or other concerns.

MIS Year 7 summary of changes

MIS Year 7 resources