Part two: safer maternity care – CNST premium incentive scheme

The Government has set a target of halving the rates of stillbirths, neonatal and maternal deaths, and brain injuries associated with delivery by 2025. The first milestone in the process of achieving that target is an expectation of a 20% reduction by 2020, with a range of initiatives announced in recent times.

In our December article we highlighted that NHS Resolution aimed to incentivise the delivery of best practice in maternity services, through a link to CNST scheme contributions. This followed strong support for providing incentives to fund safety initiatives in the 2016 CNST consultation.

In order to qualify for a 10% (at least) discretionary rebate of CNST maternity contributions for 2018/19 under the new incentive scheme, progress will be measured against 10 criteria agreed by the National Maternity Champions.

Contribution notices should now have been received, including for the first time details of how the new scheme will operate for acute trusts delivering maternity services.

As key points:

In order to be considered for a rebate under the scheme a standard template report must be:

1. signed off by the trust board
2. discussed with relevant commissioners
3. submitted by 29 June 2018 with supporting evidence

The template report identifies various steps that will be taken by NHS Resolution to cross-check during the review process, which in turn should be a prompt to ensure consistency of reporting to other organisations.

If progress cannot yet be demonstrated against any of the criterion then it is important to note that all is not lost. Instead the report should contain a credible plan to achieve the criterion, which may qualify for a lower rebate to then be used to fund progress under the plan.

The benefit in terms of patient safety and the financial incentive, which may be large on some contributions, mean that this should be given serious and prompt attention.

The range of criteria inevitably means that evidence gathering may not be quick, particularly for trusts delivering across more than one site which need to be evidenced separately.  

It is also prudent to share the importance of compliance against the various criteria with those with a role in delivering, such as in reporting qualifying maternity incidents under NHS Resolution’s new Early Notification scheme.  

The 10 criteria remain as follows:

1. Use of the National Perinatal Mortality Review Tool to review perinatal deaths
2. Submitting data to the Maternity Services Data Set to the required standard
3. Demonstrating transitional care facilities are in place and operational to support implementation of the ATAIN programme
4. Demonstrating an effective system of medical workforce planning
5. Demonstrating an effective system of midwifery workforce planning
6. Demonstrating compliance with the four elements of the Saving Babies’ Lives Care Bundle
7. Demonstrating a patient feedback mechanism for maternity services, such as the Maternity Voices Partnership forum, and regularly acting on feedback
8. Evidencing that 90% of each maternity staff group have attended an in-house multi-professional maternity emergencies training session within the last training year
9. Demonstrating that trust safety champions are meeting bi-monthly with board level champions to escalate locally identified issues
10. Reporting 100% of qualifying 2017/18 incidents under NHS Resolution Early Notification scheme

If you would like to discuss recent initiatives on maternity care please contact your main contact or Andrew Leslie (Early Notification scheme lead).