Classification: Official
Publication reference number: PRN00823_iii

This document sets out answers to questions that integrated care boards (ICBs) may have about ensuring effective maternity and neonatal voices partnerships (MNVPs) in line with the MNVP guidance.

These frequently asked questions (FAQs) and answers will be regularly reviewed and updated as required. This information has been co-produced primarily for ICBs; but may also be useful for:

• NHS England regional teams, whose role is to support ICBs
• local maternity and neonatal systems (LMNSs) – the maternity and neonatal arm of ICBs
• MNVP leads.

Theme: About the guidance

1. Why do we need this guidance?

This guidance has been coproduced to give clear and concise advice to ICBs about enabling effective MNVPs. This helps ICBs to fulfil their statutory role in working with people and communities in a maternity and neonatal care setting.

This guidance builds on the commitments outlined in Theme 1 of the Three-year delivery plan for maternity and neonatal services about listening to women and gives ICBs more detailed information about ensuring effective MNVPs.

2. How was the guidance developed?

A co-production group was established to develop the guidance. The group included MNVP leads, service user voice representatives, NHS commissioners, NHS providers, LMNS representatives, national maternity voices and NHS England maternity and neonatal programme representatives.

The co-production group used the findings from the Function & Funding Review of Maternity Voices Partnerships and considered good practice examples to inform the development of this guidance.

3. Where can I get advice and support with implementing this guidance?

This guidance is for ICBs. If you are from an ICB and need advice and support with implementing this guidance, please contact your regional NHS England maternity and neonatal team whose role it is to support you.

If you are from an NHS England region and require advice with supporting ICBs to implement this guidance, you can contact the national team via the maternity and neonatal service user voice mailbox: service.uservoice@nhs.net.

If you are from an MNVP, please make contact with your local trust, LMNS or your regional service user voice representative. The point of contact in a trust or LMNS could be someone in a clinical and/or leadership role and will vary according to the local relationships in place.

If you are having trouble locating the right person to contact locally, you can contact the national team via the maternity and neonatal service user voice mailbox: service.uservoice@nhs.net.

4. What happens if our MNVP isn’t working in the way set out in the guidance?

ICBs and trusts have a statutory duty to involve people and communities in the planning of services, proposals and decisions having an impact on services.

The statutory guidance to support effective partnership working with people and communities can be found on the NHS England website at Working in partnership with people and communities: statutory guidance.

The MNVP guidance advises ICBs how to effectively involve maternity and neonatal service users. If your MNVP is not working in the way the guidance sets out then the LMNS, which is the maternity and neonatal arm of the ICB should be informed. A plan to develop the MNVP in line with the guidance should then be agreed.

The perinatal quality surveillance model (PQSM) seeks to ensure issues and concerns related to the safety of maternity and neonatal services trigger action, escalation, and intervention at the earliest opportunity. See Implementing a revised perinatal quality surveillance model via the NHS England website for more information.

If an MNVP is not adequately funded or resourced, MNVP leads can raise this via PQSM at trust level. This may then be escalated to ICB, regional or national level for resolution. MNVP leads can make contact with the local PQSM group via the local safety champions.

More information about maternity safety champions can be found on the NHS England website.

Theme: Finance

5. How much funding do we need to budget for our MNVPs?

How much funding you will need to identify for your MNVPs will depend on multiple factors. For example:

• How many providers are within your system?
• How big is your geographical area?

Funding needs to be sufficient to cover the main functions outlined in the guidance including senior strategic leadership at system and trust level, a programme of engagement and meaningful involvement in quality and safety surveillance.

You will also need to consider how you will deliver the logistical support needed by the MNVPs and what budget you need to cover this. A budget template can be found in the supporting documents.

Please also see:

• Employ/remunerate an MNVP Lead (see Q11)
• Deliver the annual MNVP work plan (see Q17).

6. What funding streams can we use to pay for our MNVPs?

All LMNSs receive significant capacity and capability funding. A portion of this funding is intended to be used to fund LMNS level service user involvement and engagement. It is for LMNSs/ICBs to determine the appropriate proportion.

Trust-level MNVPs have traditionally been funded by the commissioner and many areas continue to do this as part of their public involvement duty via the ICB or LMNS.

It is the responsibility of ICBs to commission and fund MNVPs to cover every provider in their footprint. ICBs have the autonomy to direct funding to where it is needed to ensure all their statutory functions are achievable.

7. Neonatal services are funded through specialised commissioning; shouldn’t they be paying to listen to neonatal service users and fund co-production of neonatal services?

Specialised commissioning funds neonatal critical care services in line with the published service specification. All neonatal service providers are expected to be working to standards within the service specification.

Feedback from families is a key part of the neonatal service specification and services are expected to support the requirements.

Following the Neonatal Critical Care Review (NCCR), parent advisory groups (PAGs) now exist in all operational delivery networks. MNVPs should work closely with their local PAG to ensure parents with neonatal lived experience are supported to give feedback on their experience and can shape services as desired.

The Next steps towards LMNS document (available via FutureNHS) states:

• Local service users are co-production partners in maternity and neonatal quality and transformation.
• Each LMNS is required to have a clear process for hearing from parents who have received neonatal care and for involving them in co-production.
• Each LMNS should ensure that the needs of families requiring neonatal services is interwoven throughout their workplans.

Theme: MNVP leads

8. With the 30-40% reduction in head count within ICBs and regions, how can ICBs be expected to employ MNVP leads?

ICBs have a statutory duty to involve people and communities in the planning of services, proposals and decisions having an impact on services. MNVPs are a key and invaluable mechanism for ICBs to meet this statutory duty for maternity and neonatal services.

The NHS England three-year delivery plan for maternity and neonatal services includes the responsibility of ICBs in remunerating and supporting MNVP leads. It is important that the remuneration or employment arrangement for the role is in line with the strategic influence that MNVP leads are required to have.

The MNVP guidance outlines different ways to fulfil ICB responsibilities to deliver the MNVP. This includes, but is not limited to, employing your MNVP team directly. If that is not possible, you can explore other options such as externally commissioning a third-party host.

9. What is the difference between an MNVP lead and an LMNS service user voice lead?

An MNVP Lead will be responsible for leading the MNVP programme of work. This includes involvement in provider level quality surveillance and governance, gathering and reporting intelligence and co-producing policy and guidelines for that provider.

An LMNS service user voice lead will be responsible for co-ordinating co-production and involvement at LMNS level, which often spans more than one MNVP. The LMNS service user lead should also represent service user voice on the LMNS board.

In larger systems the LMNS service user voice lead may also coordinate and support the MNVPs within their system. In all systems, there should be close working and communication between LMNS service user voice leads and MNVP leads.

10. What do I do if my MNVP lead does not want to move from a volunteer position to an employed position?

The MNVP guidance is clear that leadership roles (and operational support) are not suitable to be provided by volunteers and ICBs will need to consider this as part of their budget setting for MNVPs (bearing in mind that support functions may be delivered through existing roles in the ICB or partner organisations).

A budget template is included in the supporting materials document for reference. Any decisions about changes to any MNVP roles should be made in partnership with the existing MNVP membership. Regional teams can support with any changes to current MNVP roles.

Some MNVPs may have other roles suitable for a volunteer position.

11. What band should I employ my MNVP lead at? How many WTE?

This will be for local determination and should be in line with the requirements of the role in enabling the MNVP lead to be an equal and respected member of the senior leadership team.

The MNVP guidance supporting materials contain example job descriptions from Kernow MNVP, which is considered to be an effective MNVP. The job descriptions for the Service User Voice lead and the MNVP Lead both include a salary of £48,526 – £54,619 (NHS Band 8a).

The number of hours required for the MNVP lead role will need to be in line with the requirements of the agreed MNVP programme of work.

Theme: Infrastructure and workplans

12. Our trusts want to meet MIS CNST SA7. What sort of evidence can they provide to demonstrate progress to enable full implementation of the MNVP guidance within 12 months?

NHS Resolution’s Maternity Incentive Scheme (MIS) for Year 5 contains Safety Action 7. One of the required standards for Safety Action 7 is:

1. Ensure a funded, user-led MNVP is in place which is in line with the delivery plan and MNVP guidance. Parents with neonatal experience may give feedback via the MNVP and parent advisory group.

It is acknowledged that the timing of the publication of the MNVP guidance did not easily align with the reporting period for MIS Year 5. Therefore, it is recognised that it may not be possible to demonstrate progress to enable full implementation of the MNVP Guidance within 12 months.

If available, evidence could include minutes of meetings and correspondence which confirm discussion and ratification of a plan that covers how the requirements of the guidance will be met.

13. What sort of contracting arrangements are appropriate if we host our MNVPs with a third-party organisation?

The MVP funding and function review showed that MNVPs hosted by ICBs and MNVPs hosted by third-party organisations have both advantages and disadvantages that need to be acknowledged.

Which option works best for each system will be down to local determination but there should be consideration of the impact, sustainability, and risks of both options in your local system.

In systems with multiple MNVPs, the operational and engagement support can be shared across MNVPs whether this is provided by the ICB or commissioned externally.

Some LMNSs have established hosting arrangements for their MNVPs via a local third-party organisation, such as Healthwatch. Other LMNSs commission and oversee their MNVPs directly.

When deciding how to commission and facilitate your MNVPs, ICBs should consider the following:

• The cost of overheads and facilitating the MNVP programme of work. This could be a third-party organisation taking a percentage of the budget or a cost of increasing capacity within the ICB’s existing team.
• Ensuring clear understanding of guidance surrounding MNVPs and the complexities of system-working across maternity and neonatal systems, and the need for MNVPs to support quality and safety surveillance.
• How to manage time limited contracts, non-recurrent funding, and sustainability for your MNVP while ensuring leadership succession planning.
• How to ensure your MNVP is embedded within the system and able to provide strategic influence
• Alignment of workplans and strategy to the provider trusts, LMNS and ICB.
• MNVP leads having access to their MNVP’s budget to deliver the programme of work.
• Ensuring MNVP leads have an appropriate level of responsibility and autonomy to enable them to execute their function as a critical friend across the system.
• MNVP branding should be independent of NHS branding and MNVPs should have control over their social media.
• MNVP strategy and objectives are created and driven by the MNVP and agreed by the ICB. A hosting organisation should not have disproportionate influence over the priorities of the MNVP.

14. Why do we need an MNVP when we already collect feedback through Friends and Families Test (FFT), Patient Experience midwife, CQC, etc?

MNVPs provide a structured and personalised approach to listening to and reflecting the views of local communities. They ensure all groups are heard, including bereaved families.

MNVPs ensure that service users’ voices are at the heart of decision-making in maternity and neonatal services by being embedded within the leadership of provider trusts and feeding into the LMNS (which in turn feeds into ICB decision-making).

MNVPs are led by a service user lead rather than a health professional, which adds to their accessibility for families who have used maternity and neonatal services. By being embedded in decision-making, MNVPs provide regular service user voice insights rather than information from a snapshot in time as with other sources of feedback.

Engagement and collecting feedback is only one function of an MNVP. MNVPs are able to influence and involve service user voice at a strategic level and in quality surveillance. This supports a positive safety culture and in turn supports the safety of women and babies being cared for in NHS maternity and neonatal services.

15. What extra clarity can you provide on the infrastructure, project management, HR, IT, etc needed for an effective MNVP?

MNVPs need to have operational and logistical support in order to be effective. Further detail is provided in paragraphs 2.24-2.31 in the guidance.

16. What NHS meeting should our MNVP leads be attending?

MNVP leads should consider attending the following meetings:

• Maternity and neonatal governance meetings.
• Perinatal mortality review tool (PMRT) meetings.
• Perinatal quality, safety and surveillance group (PQSSG).
• Safety champions.
• Guidelines committees for maternity and neonatal.
• Maternity (labour ward) Forum (quality improvement, multidisciplinary team clinical focus)
• Audit meetings for maternity and neonatal.

There may be additional local meetings that will need to be accounted for in the MNVP workplan.

17. What kinds of activity should be included in the MNVP workplan?

The MNVP workplan should be tailored to local needs and priorities. An example is included in the MNVP guidance supporting documents. Key activities will include:

• Regular outreach to the community.
• Analysing and reporting on feedback from service users.
• Regular meetings between the MNVP lead and provider trust senior leadership team (quadrumvirate).
• Meeting participation and preparation including trust maternity and neonatal governance meetings, interview panels for senior staff, serious incident reviews, guideline committees.
• Active involvement in the trust perinatal quality surveillance model (PQSM), including PMRT reviews and audit meetings.
• Involvement in local policy discussion and decisions.
• Supporting co-production to inform/improve the maternity and neonatal pathway.
• Recruitment of volunteer service user voice representatives.
• Supporting service users to engage with the MNVP.
• Building relationships with local VCSE organisations that represent seldom heard groups.
• Linking with and participating in the local neonatal parent advisory group (PAG).