To:

• Trusts with maternity services:
  • chief executive officers

cc:

• Trusts:
  • heads and directors of midwifery
  • chief nurses
  • lead obstetricians and neonatologists
  • maternity operational managers and directors
  • board safety champions
  • chairs

16 October 2025

Dear colleagues,

We wrote to you in June following the Secretary of State for Health and Social Care’s announcement of a rapid independent investigation into maternity and neonatal services, an independent taskforce, and immediate actions to improve care for all women, babies and families.

This letter outlines the next steps – across the following 4 areas – to support you to continue to go further and faster to improve maternity and neonatal care:

1. Perinatal Equity and Anti-Discrimination Programme: this will give perinatal teams the skills and tools they need to improve the experiences and outcomes of ethnic minority groups and those from deprived communities, and to improve the working lives of staff from these groups. The programme’s focus is on effecting the behavioural, cultural and organisational changes needed to tackle inequalities and sustain change. Please support perinatal senior leadership teams to attend the programme – Annex 1.
2. Submit a Perinatal Event Notification service: this portal streamlines the administrative time required by frontline staff to notify perinatal safety events to MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries Across the UK); Maternity and Newborn Safety Investigations; and NHS Resolution Early Notification Scheme – Annex 2.
3. Maternity and Neonatal Performance Dashboard: This set of metrics will be used to monitor performance in maternity and neonatal services in all parts of the system, supporting trusts and integrated care boards to monitor and have insight into their own progress. The dashboard represents a balanced scorecard of operational, outcome and patient experience measures – Annex 3.
4. Maternity and Neonatal Improvement Support Team: will replace the current Maternity Safety Support Programme and will have the additional focus of neonatal, as well as maternity, expertise. The team will support trusts to develop diagnostic, and improvement plans for their maternity services, including a focus on tackling inequalities. It will also be supported by lived experience experts to ensure trusts are able to hear and respond to service user feedback effectively. The team will work in partnership with regional teams, neonatal operational delivery networks aligning with improvement teams in other areas, to provide more timely diagnostics and bespoke improvement plans supporting trusts in leading and sustaining their own change efforts – Annex 4.

Further information on each of the 4 areas is in the annexes.

This work has been progressed with involvement from colleagues in trusts, maternity and neonatal service teams, as well as service users and our regulatory partners. If you have any further feedback and suggestions for what else we can do to support you in driving further improvement, please let us know.

Yours sincerely,

Annex 1 – Perinatal Equity and Anti-Discrimination Programme

Racism and discrimination have a significant impact on mothers and babies from ethnic minorities, and those from deprived communities resulting in poorer outcomes and experience. We urgently need to tackle these inequities and will be supporting local leaders to do so through this programme, which follows on from the Perinatal Culture and Leadership Programme (PCLP).

The programme aims to give perinatal teams the skills and tools they need to improve the experiences and outcomes of ethnic minority groups and those from deprived communities, and to improve the working lives of staff from these groups. This supports the aims for service users and their families to receive care, free from discrimination and racism, and for staff to work in an environment free from discrimination and racism.

We have partnered with the NHS Race & Health Observatory to create a programme which will be delivered at every unit with dedicated support. Similar to the PCLP there will be phased intakes over the next 18 months based on a regional rollout, and it will be evaluated throughout. It will be offered to all consultant obstetric sites and their neonatal units. We will work closely with perinatal leadership teams to identify the right people across their teams to join the programme.

There are 5 main elements to the programme:

• Tackling racism and discrimination – the programme will begin with webinars about the impact of racism and discrimination on maternity and neonatal service users and the concerted efforts and actions teams must take to eliminate it.
• Identifying local challenges – working alongside your maternity and neonatal voices partnerships we will offer support to make sure your teams understand the experiences and barriers faced by service users in your area, putting actions to address these at the heart of your improvement plans.
• Engaging leadership – bespoke face-to-face development and support for perinatal leadership teams to help them to lead an anti-racist and anti-discriminatory workplace. This will include support for policy and governance leads on co-producing inclusive, anti-discriminatory and anti-racist policies, guidelines and processes.
• Empowering clinical leadership – bespoke face-to-face development for perinatal, multi-disciplinary clinical leaders such as labour ward coordinators, resident obstetricians and neonatologists and lead neonatal nurses. This will provide practical skills, drive accountability and responsibility to role model the right behaviours and provide tools to manage/hold difficult conversations. A trauma-informed approach and psychological support will be embedded throughout.
• Creating and sustaining cultural change – continuous work to identify and solve local challenges, equip staff with the right skills and maintain a culture of anti-racist and anti-discriminatory behaviours within and across teams. It will build on the PCLP and existing trained culture coaches, linking into existing cultural improvement plans and report progress to trust boards.

 Chief executives are asked to please:

• support perinatal leadership teams and additional clinical leaders to attend the programme
  • feedback and evaluation show that perinatal teams that have the active backing and support from their executive boards and system partners are more successful
• make sure maternity and neonatal board safety champions have strong and positive relationships with perinatal senior leadership, engaging with frontline teams
  • their engagement and support for the programme is incredibly important

If you have any questions or are currently undertaking work on anti-racism and anti-discrimination, please get in touch: england.perinatalcultureleadership@nhs.net . We want to learn from your experiences and to understand any measurable impact you have determined through ongoing or post evaluation work.

We will be in touch again when your trust is due to be onboarded, ensuring your teams have the support they need to take part in this important programme.

Annex 2 – Submit a Perinatal Event Notification service

You will be aware that we have been working to support a reduction in reporting and administration burden on staff. We are delighted to share that your trust will be onboarded on the date within the onboarding schedule to the new Submit a Perinatal Event Notification (SPEN) portal. This will replace your existing legacy reporting systems.

The NHS Submit a Perinatal Event Notification (SPEN) is a web-based portal designed to streamline the notifications of qualifying perinatal safety events to 3 national organisations:

• MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries Across the UK) and any CDOP reporting of neonatal deaths that is made to MBRRACE-UK via the new Cascade system.
• Maternity and Newborn Safety Investigations (MNSI).
• NHS Resolution Early Notification (NHSR EN) scheme.

From 8am on your date of onboarding, please report any new notifications to the organisations above via the SPEN portal. Do not raise new notifications in the existing legacy portals of those 3 organisations after this time.

The portal reduces duplicate data entry as users input information once, which is then automatically routed to the appropriate organisation(s) depending on the event type.

This work is essential to the roll-out of the Maternity Outcomes Signal System which means services can identify safety risks earlier and quickly take appropriate actions. This was a commitment in the 3 year delivery plan for maternity and neonatal services.

SPEN onboarding schedule

After an initial testing period, trusts will begin to use the new service in a phased approach. The table below shows when your region will be onboarded.

Onboarding support for your service

We have asked Arden & GEM CSU to support roll out. The CSU will also be responsible for registering users of the new portal in your trusts.

If your trust is yet to be onboarded, please can your Head or Director of Midwifery send the names and email addresses of your nominated users by 12pm noon on Monday a week prior to your onboarding date to agem.apps@england.nhs.uk.

The Head of Midwifery/Service will also act as your local authoriser for new users of the portal. As a starting point, we would recommend that any individual in your trust who currently reports notifications to the NHSR EN scheme, MBRRACE-UK, or MNSI should be registered as a user of the SPEN.

As part of the onboarding to SPEN, your Head or Director of Midwifery will be sent a comprehensive user guide to help your trust’s nominated users navigate the system and make the most of its features.

The CSU will also be providing training webinars for staff. These will be recorded for those unable to make the sessions. Please ensure that as many nominated users in your trust as possible have registered for a training session in the coming weeks.

The link to book onto a training session is: Book Training

To further support your onboarding, a range of helpful resources is available on the NHS Futures platform, including webinar recordings and system demonstrations. Submit a Perinatal Event Notification (SPEN) Service – Maternity and Neonatal Hub – Maternity

We encourage you to explore these materials to familiarise yourself with SPEN and ensure a smooth implementation within your trust.

Here is a list of some important supportive actions for you as an organisation pre/post your go live date:

1. Make sure as a Head of Midwifery/Service that you have sent the list of required users to apps@england.nhs.uk by the deadline prior to your onboarding.
2. Make sure that contact details are correct for your service in the “Account Details” tab of the portal ahead of submitting notifications.
3. Encourage your users to familiarise themselves with the portal and its functionalities ahead of your go live date.
4. If any of your users are unable to attend the training then there are recordings of the training available on the SPEN NHS Futures Page.

If you have questions, please do contact the team via agem.apps@england.nhs.uk.

Annex 3 – Maternity and Neonatal Performance Dashboard

The Secretary of State has committed to setting strong and consistent expectations for trust chairs, chief executives, and boards, with overhauled oversight and performance frameworks and a new performance dashboard to support trusts to further understand their services.

This is the first iteration of the national set of metrics and definitions that make up the performance dashboard:

This same set of metrics will be used to monitor performance in maternity and neonatal services in all parts of the system, supporting trusts and integrated care boards to monitor their own progress and demonstrate curiosity as to the underpinning conditions leading to the outcomes seen. The dashboard represents a balanced scorecard of operational, outcome and patient experience measures.

All trusts must report regularly to their boards on maternity and neonatal safety, and we will shortly be offering a model board report template for this.

These metrics, together with the broader Perinatal Quality Surveillance Model published this week and the rollout of the Maternity Outcomes Signal System by November, will enable trusts and integrated care boards to monitor their own progress, while supporting our collective work to drive improvements across all maternity and neonatal services and identifying trusts that may need additional support.

The data required for these metrics is already routinely collected and the majority are publicly available. There will be opportunities to amend the dashboard in future as new data sources become available, such as a new Patient-Reported Experience Measure, and as any recommendations from the independent investigation and taskforce are made.

We have attached the first iteration of the dashboard, which shows the national view and a trust level breakdown of this for your information. Data for the final metric on perinatal optimisation will be added imminently. Good quality data will be reliant on submission from Trusts to the new OPEL system for maternity.

We are in the process of developing a digital solution to automate the process further and we will share this with you later in the year. 

Annex 4 – Maternity and Neonatal Improvement Support Team

The Maternity Safety Support Programme (MSSP) is being replaced with the Maternity and Neonatal Improvement Support Team, to support trusts to more quickly identify and resolve concerns and allow for time limited national interventions. The team will work in partnership with regions and neonatal operational delivery networks, enabling trusts to lead and sustain their own change efforts.

The MSSP has demonstrated the importance and impact that trust executives taking an active role in their improvement journey has on sustaining the improvements delivered. All trusts on the programme will have monthly executive meetings, and quarterly improvement review meetings, with their improvement team.

The redesigned process delivers faster support with accelerated diagnostic processes, reducing time from identification of concerns to provision of support from months to just 4-to-6 weeks. Trust boards are engaged from the outset to foster stronger commitment and accountability for improvements. Clear escalation pathways enable timely intervention where necessary, while consistent approaches across regions ensure more uniform support.

We will support trusts on the current programme, so their improvement journey continues without disruption. In the autumn, we will meet with all trust chief executives and regional teams to review their improvement plans and agree together the next steps for the transition. The new improvement support team will be fully operational by 1 January 2026.

Most importantly, the change emphasises listening to and acting on service user feedback, strengthening board-level leadership, and enabling trusts to lead and sustain their own change efforts. This is underpinned by both local responsibility and national support, designed to ensure safe, high-quality, and person-centred care for all families.

Publication reference: PRN02113