Safety Action 1 of the Maternity Incentive Scheme for England, FAQs

These FAQs are designed to supplement the technical guidance provided by NHS Resolution to support Staff in Trusts in England involved in ensuring that their Trust meets Safety Action 1 of the NHS Resolution Maternity Incentive Scheme: Maternity incentive scheme - NHS Resolution

Download these FAQs as a PDF

Technical issues and updates

What should we do if we experience technical issues with using PMRT?

All Trust staff are reminded to contact their IT department regarding any technical issue in the first instance. If this cannot be resolved, then the issue should be escalated to MBRRACE-UK.

This can be done through the 'contact us' facility within the MBRRACE-UK/PMRT system or by emailing us at: mbrrace.support@npeu.ox.ac.uk

If there are any updates on PMRT for the maternity incentive scheme where will they be published?

Any updates on the PMRT or the MBRRACE-UK notification and surveillance in relation to the maternity incentive scheme safety action 1, will be communicated via NHS Resolution email and will also be included in the PMRT 'message of the day'.

Change to the verification period for SA1

What is the period for verification for SA1 and has this changed?

With the start of the year 6 MIS the standards for SA1 will run from the end of year 5 (8th December 2023) for a year. Going forward SA1 will continue on an annual on-going basis.

Are there any changes to the verification resulting from the scheme announcement being later than the scheme start (Year 6 only)

The year 6 scheme in relation to SA1 is for deaths from the 8th of December 2023 but this wasn't announced until the 2nd of April 2024 and the supporting downloadable reports were not fully available until mid-May.

In view of this, the verification of Safety Action 1 will exclude notifications, SA1a), and the review started standard under SA1 c) for deaths between the 8th of December 2023 and the 1st of April 2024.

Note that at the conclusion of the year 6 scheme all activities to meet the year 6 SA1 standards should continue, prior to the announcement of the start of year 7.

Guidance for SA 1(a) – notify all deaths

Which perinatal deaths must be notified to MBRRACE-UK?

Details of which perinatal death must be notified to MBRRACE-UK are available on the MBRRACE website.

What is the time limit for notifying a perinatal death to MBRRACE-UK?

All perinatal deaths eligible to be reported to MBRRACE-UK must be notified to MBRRACE-UK within seven working days.

When a notification is complete the notification status on the MBRRACE-UK on-line system will show whether surveillance (and review) is required for each case. This is available from the case management screen by clicking on the Case ID and selecting 'Notification Status'.

What is the time limit for completing the surveillance information for MBRRACE-UK?

Following notification within seven working days of the perinatal death, there is no MIS reporting requirement that the surveillance information is completed within a fixed time period, although this was a previous requirement of the MIS. However, as information is transferred from the surveillance form into the PMRT (but not vice versa) it is beneficial for the surveillance form to be completed as soon as possible and we recommend that the surveillance information is completed within one month of the death.

If post-mortem results or results of other investigations are not available and the final cause of death is not confirmed, indicate this in the “Cause of Death/Confirmation of cause of death” section, complete the rest of the information, and close the surveillance form. Once the additional information and the final cause of death is known and confirmed as part of the PMRT review discussion, the surveillance reporter should re-open the form, update the relevant sections and close it again. You can reopen the surveillance form from the case management screen.

How can we keep a check on which of our deaths require surveillance?

There is a report under 'Case summary list' on the MBRRACE-UK case management screen entitled 'Current MIS/CNST period'.

This includes ALL deaths in your Trust which have been notified to MBRRACE-UK and shows the status of the surveillance if required. This will also indicate if surveillance is required and not started/completed.

Guidance for SA1(b) – parent engagement

We have informed parents that a local review will take place and they have been asked if they have any feedback or questions about their care. However, this information is recorded in another data system and not the clinical records. What should we do?

In order that parents' feedback and any questions they have can be responded to this information needs to be incorporated as part of the review and entered into the PMRT. If this information is held in another data system it needs to be brought to the review meeting, included in the PMRT and considered as part of the review discussion.

The importance of parents' feedback and questions is highlighted by their inclusion as the first set of questions in the PMRT.

Materials to support parent engagement in the local review process are available on the PMRT website at: www.npeu.ox.ac.uk/pmrt/parent-engagement-materials

Guidance for SA1(c) – Review the death and complete the review

Which perinatal deaths must be reviewed to meet safety action one standards?

The following deaths should be reviewed to meet safety action one standards:

• Late miscarriages/ late fetal losses (22+0 to 23+6 weeks' gestation)
• Stillbirths (from 24+0 weeks' gestation)
• Neonatal death (up to 28 days after birth)

While it is possible to use the PMRT to review post neonatal deaths (from 29 days after births) this is NOT a requirement to meet SA1.

How can we keep a check on which of our deaths are suitable for review using the PMRT and their review status?

Within the PMRT, users can generate a report for their Trust by going to:

Manage cases > PMRT summary list > Current MIS/CNST period

This is a list of ALL deaths notified by the Trust, at the point when the report is generated. It includes all deaths that are suitable for review using the PMRT as well as those which are not (for example, terminations of pregnancy).

Review assignment

A feature available in the PMRT is the ability to assign reviews to another Trust for review of elements of the care, if some of the care for the woman and/or her baby was provided in another Trust. For example, if the baby died in your Trust but antenatal care was provided in another Trust, you can assign the review to the other Trust so that they can review the care that they provided. Following their review the other Trust can reassign the review back to your Trust. You can then review the subsequent care your Trust provided.

Note that any issues with care identified are 'owned' by the Trust that identified them, as are the related action plans, but a single report from the combined review is generated. This ensures that when the report is discussed with the parents all aspects of the care they received can be covered; this should avoid potentially contradictory findings being conveyed and inappropriate advice being given regarding their next pregnancy.

Guidance for SA1(d) – quarterly reports to Trust Board/Trust Executive

Can the PMRT help by providing a quarterly report that can be presented to the Trust Board?

Authorised PMRT users can generate reports for their Trust, summarising the results from completed reviews of deaths which occurred during user-defined time periods. These are available from:

Your Data > Perinatal Mortality Reviews Summary Report and Data extracts

See the screenshot below; click on the 'Generate a summary report' button.

These reports can be used as the basis for the quarterly Trust Board reports and should be discussed with the Trust maternity safety champion.

Please note that these reports will only show summaries, issues and action plans for reviews of deaths which occurred during that time period and that have been completed and published. Therefore the time period selected may need to relate to an earlier period than the current quarter and may lag behind the current quarter by up to six months