The Maternity Incentive Scheme Evaluation: A summary

The Maternity (Perinatal) Incentive Scheme (MIS) was launched by NHS Resolution in 2018 to incentivise improvements in maternity and neonatal safety and care across NHS trusts in England, ultimately aiming to improve care and outcomes for women and families. It offers a financial incentive for trusts that demonstrate they have implemented a set of core safety actions, defined at system level. The scheme aims to address the significant human, clinical and financial impacts of avoidable harm in maternity and neonatal services.

The purpose of the evaluation (covering Years 1 to 6) was to understand how MIS is experienced by stakeholders, to review its processes and to assess (as far as possible) the scheme’s impact on safety, compliance and outcomes. To support this work, NHS Resolution commissioned The Healthcare Improvement Studies Institute (THIS Institute) to undertake independent qualitative work and targeted quantitative analysis. The final report combines these findings with internal analysis and insights.

What are the key findings?

1. MIS has offered a mechanism through which system leaders can provide clarity for trusts on where best to focus efforts.

2. MIS has raised the profile of maternity and neonatal safety at trust Board level and provided staff with leverage to press for safety improvements.

3. Compliance with MIS safety actions has steadily improved over time. In the first year, 53% of trusts achieved full compliance; by Year 6, this had risen to 84%.

4. The introduction of external verification of appropriate safety actions has strengthened the scheme by providing independent assurance of compliance. Over time the external verification of safety actions has resulted in a net upgrade in compliance rather than downgrade. 

5. The MIS reverification process has provided a valuable check and challenge to trust internal governance procedures. Over time, this has been associated with a reduction in downgrades and an increase in the proportion of checks reconfirming compliance, demonstrating an improved understanding of the scheme and more effective local governance processes. 

6. The opportunity to apply for discretionary funding is an important element of MIS to help reduce a widening gap between ‘high performing’ trusts and those needing more support. Across all years, there were only six occasions when a trust that did not achieve full compliance did not seek discretionary funding with £47.2 million allocated to trusts to support compliance.

7. The data suggests that all trusts, regardless of their size or financial contribution to the scheme, have an equal opportunity to meet the set of core safety actions.

8. The number of MIS sub-actions was substantially reduced in Year 6, focusing on those that were agreed by system stakeholders to add the most value. This was well received, and has helped to mitigate some unintended consequences identified in the research by THIS Institute, such as increased reporting burden and staff experience of stress. We have taken this forward into the development of refreshed scheme design for Year 8.

9. It remains challenging to directly attribute improvements in maternity and neonatal safety to individual initiatives; however, the importance of supporting best practice is undiminished. Statistically significant relationships between MIS compliance and external data were difficult to demonstrate primarily due to high overall compliance and limited data variability. However, MIS has been found to have some key strengths as a mechanism for incentivising and embedding maternity and neonatal safety practices.

What’s changing in MIS Year 8 (2026-27)

Greater focus A transition year reducing the existing 10 core actions to six with substantially fewer sub-actions and a shift from process to impact, reducing burden while strengthening assurance. Actions with a common outcome have been brought together across professional/system boundaries. MIS documentation has been simplified, separating out the ‘core standards’ and supplementary guidance.	Stronger Board oversight and accountability Clearer expectations of Boards to understand their local services and population, oversee emerging risks, and take responsibility for ensuring learning leads to meaningful improvement.
Moving from process to learning and action Year 8 emphasises learning from reviews and investigations and crucially, acting on those findings. The focus is on visible change and outcomes, not paperwork.   Each standard now begins with a clear explanation of purpose. This helps teams understand the intent, prioritise what matters, and link their work more closely to safety and experience.	Sharing ‘what good looks like’ Alongside the standards, Year 8 promotes the sharing of good practice and examples of excellence. This supports consistency, reduces variation, and helps services learn from each other.
Whole‑system collaboration and a combined workforce approach The standards align requirements across the whole maternity and neonatal system, with no single organisation acting as the ‘owner’.   Workforce expectations now reflect a truly multidisciplinary approach, including perioperative staff who play a critical role in delivering safe care.   The standards reinforce the benefits of training alongside multidisciplinary colleagues as a team.	Strengthened equity and communication requirements A clearer focus on hearing the voices of women and families directly, ensuring communication is accessible, and ensuring consent based on genuine understanding.   The standards also underline the importance of looking at outcomes alongside women’s protected characteristics to identify patterns, address inequities, and improve care for all.
Learning from national reports, inquiries and real‑world scenarios Year 8 encourages trusts to draw on learning from recent reports and national investigations and inquiries, including examples such as running realistic training in community settings and collaborating with paramedics and other partners wherever possible.	A less prescriptive, outcomes‑focused approach The standards now focus on the outcomes that matter, rather than specifying rigid processes.   This gives services flexibility to apply the standards in ways that reflect their own communities, workforce and governance arrangements.