Version 1, 11 May 2023

Publication reference:  PRN00433; official

Introduction

The three-year Delivery Plan for maternity and neonatal care includes determining success measures that will be used to monitor outcomes and progress in achieving key objectives on the plan.

This technical guidance includes the following information to provide clarity on the data sources and indicator construction for these measures:

For each of the 4 themes, the following details relating to the outcome measures in the Delivery Plan are included:

• Measure identifier and short name
• Three year Delivery Plan theme
• Measure description
• Measure category (outcome/progress)
• Data source
• Numerator
• Denominator
• Exclusions
• Standardisation (where applicable)
• Organisation levels to be measured
• Desired direction of travel
• Publication link (where applicable)

In addition, for each of the 4 themes the following details relating to the progress measures in the delivery plan are included:

• Measure description
• Associated ambition/ deliverable
• Data source and publication link where applicable
• Additional information pertaining to the measure

Further updates and amendments will be made to this technical guidance in due course, such as when publication links are available for measures not currently in publication.

Summary of outcome and progress measures

Delivery plan theme 1: Listening to and working with women and families with compassion

Delivery plan theme 2: Growing, retaining and supporting our workforce

Delivery plan theme 3: Developing and sustaining a culture of safety, learning and support

Delivery plan theme 4: Standards and structures that underpin safer, more personalised, and more equitable care

Theme 1: Listening to and working with women and families with compassion

Outcome measures

The outcome measures for this theme are based on questions from the Care Quality Commission (CQC) annual maternity survey. These questions have been selected due to their over-arching link to Theme 1 objectives. At national level all of these questions will also be analysed by ethnicity and deprivation. CQC will continue to publish thematic analysis of sub-groups of survey respondents including by ethnicity and deprivation. Trusts and systems will continue to use detailed benchmarking data for all evaluative questions in the CQC Maternity survey to identify areas for improvement.

T1a: Awareness of medical history during antenatal check-ups

Theme

Listening to Women and their families

Measure description

The proportion of women who responded ‘Yes always’ when asked if, during antenatal check-ups, their midwives or doctor appeared to be aware of their medical history?

Metric category

Outcome

Data Source (Previous years available)

Annual CQC Maternity Survey results (2021,2022)

Numerator

Number of respondents who responded, ‘Yes always’ when asked ‘During your antenatal check-ups, did your midwives or doctor appear to be aware of your medical history?’

Denominator

Number of respondents who responded, ‘Yes always’, ‘Yes, sometimes’ or ‘No’ when asked ‘During your antenatal check-ups, did your midwives or doctor appear to be aware of your medical history?’

Exclusions

Those who responded, ‘Don’t know /can’t remember’.

Organisation levels to be measured:

Trust, Integrated Care System, National

Desired direction of travel

Increase

Publication link

National: Maternity survey 2022 – Care Quality Commission (cqc.org.uk)

Trust and Integrated Care System: To be confirmed.

T1b: Involvement in antenatal care decisions

Theme

Listening to and working with women and families with compassion

Measure description

The proportion of women who, when thinking about their antenatal care, were ‘always‘ involved in decisions about their care?

Metric category

Outcome

Data Source (Previous years available)

Annual CQC Maternity Survey results (2019, 2021, 2022)

Numerator

Number of respondents who responded, ‘Yes always’ when asked ‘Thinking about your antenatal care, were you involved in decisions about your care?’

Denominator

Number of respondents who responded, ‘Yes always’, ‘Yes, sometimes’ or ‘No’ when asked ‘Thinking about your antenatal care, were you involved in decisions about your care?’

Exclusions

Those who responded, ‘Don’t know /can’t remember’ or ‘I did not want/need to be involved’.

Organisation levels to be measured:

Trust, Integrated Care System, National

Desired direction of travel

Increase

Publication link

National Maternity Indicators section of the National Maternity Dashboard

T1c: Being listened to during antenatal check-ups

Theme

Listening to women and their families

Measure description

The proportion of women who responded ‘Yes always‘ when asked if, during their antenatal check-ups, their midwives listened to them?

Metric category

Outcome

Data Source (Previous years available)

Annual CQC Maternity Survey results (2013, 2015, 2017, 2018, 2019, 2021, 2022)

Numerator

Number of respondents who responded, ‘Yes always’ when asked ‘During your antenatal check-ups, did your midwives listen to you?’

Denominator

Number of respondents who responded, ‘Yes always’, ‘Yes, sometimes’ or ‘No’ when asked ‘During your antenatal check-ups, did your midwives listen to you?’

Exclusions

Those who responded, ‘Don’t know /can’t remember’.

Organisation levels to be measured:

Trust, Integrated Care System, National

Desired direction of travel

Increase

Publication link

National: Maternity survey 2022 – Care Quality Commission (cqc.org.uk)

Trusts and Integrated care system: To be confirmed.

T1d: Response to concerns during labour and birth

Theme

Listening to and working with women and families with compassion

Measure description

The proportion of women who if they raised a concern during labour and birth felt that it was taken seriously?

Metric category

Outcome

Data Source (Previous years available)

Annual CQC Maternity Survey results (2013, 2015, 2017, 2018, 2019, 2021, 2022)

Numerator

Number of respondents who responded ‘Yes’ when asked ‘if you raised a concern during labour and birth, did you feel that it was taken seriously?’

Denominator

Number of respondents who responded ‘Yes’ or ‘No’ when asked ‘if you raised a concern during labour and birth, did you feel that it was taken seriously?’

Exclusions

Those who responded, ‘I did not raise any concerns’.

Organisation levels to be measured:

Trust, Integrated Care System, National

Desired direction of travel

Increase

Publication link

National Maternity Indicators section of the National Maternity Dashboard

T1e: Involvement in decisions during labour and birth

Theme

Listening to Women and their families

Measure description

The proportion of women who, when thinking about their care during labour and birth, were ‘always’ involved in decisions about their care?

Metric category

Outcome

Data Source (Previous years available)

Annual CQC Maternity Survey results (2019, 2021, 2022)

Numerator

Number of respondents who responded, ‘Yes always’ when asked ‘Thinking about your care during labour and birth, were you involved in decisions about your care?‘

Denominator

Number of respondents who responded, ‘Yes always’, ‘Yes, sometimes’ or ‘No‘ when asked ‘Thinking about your care during labour and birth, were you involved in decisions about your care?‘

Exclusions

Those who responded, ‘Don’t know /can’t remember’ or ‘I did not want/need to be involved‘.

Organisation levels to be measured:

Trust, Integrated Care System, National

Desired direction of travel

Increase

Publication link

National: Maternity survey 2022 – Care Quality Commission (cqc.org.uk)

Trusts and Integrated care system: To be confirmed.

T1f: Kind and compassionate treatment during labour and birth

Theme:

Listening to women and their families

Measure description

The proportion of women who responded ‘Yes always’ when asked if they were treated with kindness and compassion, while thinking about their care during labour and birth.

Metric category

Outcome

Data Source (Previous years available)

Annual CQC Maternity Survey results (New question for 2023)

Numerator

Number of respondents who responded, ‘Yes always’ when asked ‘Thinking about your care during labour and birth, were you treated with kindness and compassion?’

Denominator

Number of respondents who responded, ‘Yes always’, ‘Yes, sometimes’ or ‘No’ when asked ‘Thinking about your care during labour and birth, were you treated with kindness and compassion?’

Exclusions

Those who responded, ‘Don’t know /can’t remember’.

Organisation levels to be reported

Trust, Integrated Care System, National

Desired direction of travel

Increase

Publication link

National: Maternity survey 2022 – Care Quality Commission (cqc.org.uk)

Trust and Integrated Care System: To be confirmed.

T1g: Adequacy of information or explanations during postnatal hospital care

Main theme

Listening to and working with women and families with compassion

Measure description

The proportion of women who, when thinking about the care they received in hospital after the birth of their baby, were ‘always‘ given the information or explanations you needed?

Metric category

Outcome

Data Source (Previous years available)

Annual CQC Maternity Survey results (2013, 2015, 2017, 2018, 2019, 2021, 2022)

Numerator

Number of respondents who responded, ‘Yes always’ when asked ‘Thinking about the care you received in hospital after the birth of your baby, were you given the information or explanations you needed?’

Denominator

Number of respondents who responded, ‘Yes always’, ‘Yes, sometimes’ or ‘No’ when asked ‘Thinking about the care you received in hospital after the birth of your baby, were you given the information or explanations you needed?’

Exclusions

Those who responded, ‘Don’t know /can’t remember’.

Organisation levels to be measured:

Trust, Integrated Care System, National

Desired direction of travel

Increase

Publication link

National: Maternity survey 2022 – Care Quality Commission (cqc.org.uk)

Trust and Integrated Care System: To be confirmed.

T1h: Consideration of personal circumstances during postnatal care at home

Main theme

Listening to and working with women and families with compassion

Measure description

The proportion of women responding that the midwife or midwifery team that they saw or spoke to ‘always‘ took their personal circumstances into account when giving them advice.

Metric category

Outcome

Data Source (Previous years available)

Annual CQC Maternity Survey results (2019, 2021, 2022)

Numerator

Number of respondents who responded, ‘Yes always’ when asked, ‘ Did the midwife or midwifery team that you saw or spoke to take your personal circumstances into account when giving you advice?’.

Denominator

Number of respondents who responded, ‘Yes always’, ‘Yes, sometimes’ or ‘No’ when asked ‘Were you given information about any changes you might experience to your mental health after having your baby?’

Exclusions

Those who responded, ‘Don’t know /can’t remember’.

Organisation levels to be measured:

Trust, Integrated Care System, National

Desired direction of travel

Increase

Publication link

National: Maternity survey 2022 – Care Quality Commission (cqc.org.uk)

Trust and Integrated Care System: To be confirmed.

T1i: Being listened to during postnatal care

Theme

Listening to Women and their families

Measure description

The proportion of women who responded ‘Yes always’ when asked if they felt the midwife or midwifery team that they saw or spoke to always listened to them, while thinking about all the times they were visited at home by a midwife, seen in a clinic by a midwife, or had a phone or video call with a midwife after the birth.

Metric category

Outcome

Data Source (Previous years available)

Annual CQC Maternity Survey results (2013, 2015, 2017, 2018, 2019, 2021, 2022)

Numerator

Number of respondents who responded, ‘Yes always’ when asked ‘Did you feel that the midwife or midwifery team that you saw or spoke to always listened to you?’, while thinking about all the times they were visited at home by a midwife, seen in a clinic by a midwife, or had a phone or video call with a midwife after the birth.

Denominator

Number of respondents who responded ‘Yes always’, ‘Yes, sometimes’ or ‘No’ when asked ‘Did you feel that the midwife or midwifery team that you saw or spoke to always listened to you?’ , while thinking about all the times they were visited at home by a midwife, seen in a clinic by a midwife, or had a phone or video call with a midwife after the birth.

Exclusions

Those who responded, ‘Don’t know /can’t remember’.

Organisation levels to be measured:

Trust, Integrated Care System, National

Desired direction of travel

Increase

Publication link

National: Maternity survey 2022 – Care Quality Commission (cqc.org.uk)

Trusts and Integrated care system: To be confirmed.

T1j: Adequacy of time spent discussing physical and mental Health at the 6-8 weeks GP check

Theme

Listening to and working with women and families with compassion

Measure description

The proportion of women who reported that the GP ‘definitely‘ spent enough time talking to them about their physical health and mental health at the postnatal check-up.

Metric category

Outcome

Data Source (Previous years available)

Annual CQC Maternity Survey results (2019, 2021, 2022)

Numerator

Number of respondents who responded, ‘Yes definitely’ when asked ‘At the postnatal check-up (around 6-8 weeks after the birth), did the GP spend enough time talking to you about your own physical health ‘ and who also responded, ‘Yes definitely’ when asked ‘At the postnatal check-up (around 6-8 weeks after the birth), did the GP spend enough time talking to you about your own mental health?’

Denominator

Number of respondents who responded, ‘Yes definitely’, ‘Yes, to some extent’ ‘No’ or ‘I have not had a postnatal check-up with a GP’ when asked ‘At the postnatal check-up (around 6-8 weeks after the birth), did the GP spend enough time talking to you about your own physical health ‘ and when asked ‘At the postnatal check-up (around 6-8 weeks after the birth), did the GP spend enough time talking to you about your own mental health?’

Exclusions

Those who responded, ‘Don’t know /can’t remember’ to either question.

Organisation levels to be measured:

Trust, Integrated Care System, National

Desired direction of travel

Increase

Publication link

To be confirmed.

Theme 1 progress measures – links and additional information

Theme 2: Growing, retaining and supporting our workforce

We will determine overall success by listening to staff:  Our outcome measures for this theme will be the NHS Staff Survey, the National Education and Training Survey, and the GMC national training survey. These questions have been selected due to them relating closely to Theme 2 objectives. Trusts and systems should continue to use results of other survey questions to identify areas for improvement.

T2a Satisfaction with recognition for good work

Theme

Growing, retaining and supporting our workforce

 Measure description

The proportion of i) Midwives ii) Obstetrician and Gynaecology Specialist Consultants[5] who are satisfied with the recognition they get for good work.

 Metric category

Outcome

 Data source (previous years available)

NHS Staff Survey (2015 to 2022)

 Numerator

The number of i) Midwives and ii) Obstetrician and Gynaecology Specialist Consultants who responded ‘Satisfied’ or ‘Very satisfied’ when asked how satisfied they are with the recognition they get for good work.

 Denominator

The number of i) Midwives and ii) Obstetrician and Gynaecology Specialist Consultants who responded when asked how satisfied they are with the recognition they get for good work.

 Exclusions/ Filters

Filters:

1. i) Midwives’ responses are identified from the response ‘Midwives’ to the question, ‘What is your occupational group?’
   ii) Responses from Obstetrician and Gynaecology Specialist Consultants³

 Organisation levels to be measured:

Trust, Integrated Care System, National

 Desired direction of travel

Increase

 Publication link

To be confirmed

T2b Satisfaction with work being valued by your organisation.

Theme

Growing, retaining and supporting our workforce

Measure description

The proportion of i) Midwives ii) Obstetrician and Gynaecology Specialist Consultants[6] who are satisfied with the extent to which their organisation values their work.

Metric category

Outcome

Data Source (Previous years available)

NHS Staff Survey (2015 to 2022)

Numerator

The number of i) Midwives and ii) Obstetrician and Gynaecology Specialist Consultants who responded ‘Satisfied’ or ‘Very satisfied’ when asked how satisfied they are with the extent to which their organisation values their work.

 Denominator

The number of i) Midwives and ii) Obstetrician and Gynaecology Specialist Consultants who responded when asked the extent to which their organisation values their work.

 Exclusions/ Filters

1. i) Midwives’ responses are identified from the response ‘Midwives’ to the question, ‘What is your occupational group?’.
   ii) Responses from Obstetrician and Gynaecology Specialist Consultants⁴

 Organisation levels to be measured:

Trust, Integrated Care System, National

 Desired direction of travel

Increase

Publication link

To be confirmed

T2c Opportunities to discuss and agree learning needs at the start of training

 Theme

Growing, retaining and supporting our workforce

Measure description

The proportion of i) midwifery placement students and ii) Obstetrician and Gynaecology Specialty trainees that had an opportunity to discuss and agree their learning needs with a supervisor, a mentor or senior colleague at the start of their time in their practice placement or training post.

Metric category

Outcome

Data Source (Previous years available)

National Education and Training Survey (2019 to 2022)

 Numerator

Number of i) Midwifery placement students and ii) Obstetrician and Gynaecology Specialty trainees responding ‘Yes’ to ‘At the start of my time in this learning environment (practice placement or training post), I had the opportunity to discuss and agree my learning needs with a supervisor, a mentor or a senior colleague.’

Denominator

Number of i) Midwifery placement students and ii) Obstetrician and Gynaecology Specialty trainees responding ‘Yes’ or ‘No’ that ‘At the start of my time in this learning environment (practice placement or training post), I had the opportunity to discuss and agree my learning needs with a supervisor, a mentor or a senior colleague.’

 Exclusions/ Filters

Nil response or responses of ‘Don’t know’.

 Organisation levels to be measured:

Trust, Integrated Care System, National

 Desired direction of travel

Increase

 Publication link

To be confirmed

T2d Permitted to attend learning opportunities

Theme

Growing, retaining and supporting our workforce

Measure description

The proportion of i) midwifery placement students and ii) Obstetrician and Gynaecology Specialty trainees who were allowed to attend learning opportunities to meet their curriculum or course requirements.

Metric category

Outcome

Data Source (Previous years available)

National Education and Training Survey (2019 to 2022)

Numerator

Number of i) Midwifery placement students and ii) Obstetrician and Gynaecology Specialty trainees responding ‘Good’ or ‘Outstanding’ when asked to rate the quality of their practice placement or training post for ‘Being allowed to attend learning opportunities to meet my curriculum or course requirements.’

Denominator

Number of i) Midwifery placement students and ii) Obstetrician and Gynaecology Specialty trainees who responded ‘Unsatisfactory’,’ In need of improvement’, ‘Satisfactory’, ‘Good’ or ‘Outstanding’ when asked to rate the quality of their practice placement or training post for ‘Being allowed to attend learning opportunities to meet my curriculum or course requirements.’

Exclusions/ Filters

Nil response or responses of ‘I haven’t been in the practice placement or training post long enough’ or ‘Not applicable or relevant to my experience’.

Organisation levels to be measured:

Trust, Integrated Care System, National

Desired direction of travel

Increase

 Publication link

To be confirmed

T2e Overall educational experience

Theme

Growing, retaining and supporting our workforce

 Measure description

The proportion of i) midwifery placement students and ii) Obstetrician and Gynaecology Specialty trainees who reported a positive overall educational experience.

Metric category

Outcome

Data Source (Previous years available)

National Education and Training Survey (2019 to 2022)

 Numerator

Number of i) Midwifery placement students and ii) Obstetrician and Gynaecology Specialty trainees who responded, ‘Good’ or ‘Outstanding’ when asked to rate ‘The overall educational experience I gained in my current or most recent practice placement / training post’.

 Denominator

Number of i) Midwifery placement students and ii) Obstetrician and Gynaecology Specialty trainees who responded ‘Unsatisfactory’,’ In need of improvement’, ‘Satisfactory’, ‘Good’ or ‘Outstanding’ when asked to rate ‘the overall educational experience I gained in my current or most recent practice placement / training post’

 Exclusions/ Filters

Nil response or responses of ‘I haven’t been in the practice placement or training post long enough’ or ‘Not applicable or relevant to my experience’.

Organisation levels to be measured:

Trust, Integrated Care System, National

Desired direction of travel

Increase

Publication link

To be confirmed

Theme 2 progress measures – Links and additional information

Ambition/ deliverable:

Workforce capacity to grow as quickly as possible to meet local needs. Aligned local and national strategies supporting recruitment to those vacant posts identified through workforce planning.

Theme 3: Developing and sustaining a culture of safety, learning and support

Achieving meaningful changes in culture will take time and progress measures are difficult to identify and can have unintended consequences. We will primarily determine overall success by listening to the people who use and work in frontline services.

Our outcome measures for this theme are midwives’ and obstetrics and gynaecology specialists’ experience using the results of the NHS Staff Survey; the National Education and Training Survey and the GMC National Training Survey. We will explore how to better understand the experiences of other staff groups.

T3a Staff experience of learning culture

Theme

Developing and sustaining a culture of safety, learning and support

 Measure description

The proportion of i) Midwives ii) Obstetrician and Gynaecology Specialist Consultants[7] who agree that when errors, near misses or incidents are reported, their organisation takes action to ensure that they do not happen again

Metric category

Outcome

Data Source (Previous years available)

NHS Staff Survey (2015 to 2022)

Numerator

The number of i) Midwives and ii) Obstetrician and Gynaecology Specialist Consultants who responded ‘Agree’ or ‘Strongly Agree’ when asked whether they agree or disagree with the following: “When errors, near misses or incidents are reported, my organisation takes action to ensure that they do not happen again”.

Denominator

The number of i) Midwives and ii) Obstetrician and Gynaecology Specialist Consultants who responded when asked whether they agree or disagree with the following: “When errors, near misses or incidents are reported, my
organisation takes action to ensure that they do not happen again”.

Exclusions/ Filters

1. i) Midwives responses are identified from the response ‘Midwives’ to the question ‘What is your occupational group?’
   ii) Obstetrician and Gynaecology Specialist Consultants responses⁵

Organisation levels to be measured:

Trust, Integrated Care System, National

Desired direction of travel

Increase

Publication link

Midwives: National Maternity Indicators section of the National Maternity Dashboard

T3b Staff confidence in organisations response to concerns about unsafe clinical practice

Theme

Developing and sustaining a culture of safety, learning and support

Measure description

The proportion of i) Midwives ii) Obstetrician and Gynaecology Specialist Consultants[8] who agree that their organisation would address their concerns about unsafe clinical practice

Metric category

Outcome

Data Source (Previous years available)

NHS Staff Survey (2015 to 2022)

Numerator

The number of i) Midwives and ii) Obstetrician and Gynaecology Specialist Consultants who responded ‘Agree‘ or ‘Strongly Agree‘ when asked to what extent do they agree with following statement about unsafe clinical practice: “I am confident that my organisation would address my concern”.

Denominator

The number of i) Midwives and ii) Obstetrician and Gynaecology Specialist Consultants who responded when asked to what extent do they agree with following statement about unsafe clinical practice: “I am confident that my organisation would address my concern”.

Exclusions/ Filters

1. i) Midwives responses are identified from the response ‘Midwives’ to the question ‘What is your occupational group?’
   ii) Obstetrician and Gynaecology Specialist Consultants responses⁶

Organisation levels to be measured:

Trust, Integrated Care System, National

Desired direction of travel

Increase

Publication link

To be confirmed

T3c Recommendation of the service

Theme

Developing and sustaining a culture of safety, learning and support

Measure description

The proportion of i) Midwives ii) Obstetrician and Gynaecology Specialist Consultants[9] who agree that they would recommend their organisation as a place to work or be happy with standard of care provided by their organisation if a friend or relative needed treatment.

Metric category

Outcome

Data Source (Previous years available)

NHS Staff Survey (2015 to 2022)

Numerator

The number of i) Midwives and ii) Obstetrician and Gynaecology Specialist Consultants who responded ‘Agree’ or ‘Strongly Agree’ to either of the following statements: ‘I would recommend my organisation as a place to work’ or ‘If a friend or relative needed treatment they would be happy with the standard of care provided by this organisation’.

Denominator

The number of i) Midwives and ii) Obstetrician and Gynaecology Specialist Consultants who responded to either of the following statements: ‘I would recommend my organisation as a place to work’ or ‘If a friend or relative needed treatment they would be happy with the standard of care provided by this organisation’.

Exclusions/ Filters

1. i) Midwives responses are identified from the response ‘Midwives‘ to the question ‘What is your occupational group?’
   ii) Obstetrician and Gynaecology Specialist Consultants responses⁷

Organisation levels to be measured

Trust, Integrated Care System, National

Desired direction of travel

Increase

Publication link

Midwives: National Maternity Indicators section of the National Maternity Dashboard

T3d Recommendation of the training post

Theme

Developing and sustaining a culture of safety, learning and support

Measure description

The proportion of i) midwifery placement students and ii) Obstetrician and Gynaecology Specialty trainees who would recommend their practice placement or training post to friends and colleagues as a place to work or train.

Metric category

Outcome

Data Source (Previous years available)

National Education and Training Survey (2019 to 2022)

Numerator

Number of i) Midwifery placement students and ii) Obstetrician and Gynaecology Specialty trainees who responded ‘Likely’ or ‘Extremely likely’ when asked ‘how likely are you to recommend this practice placement or training post to friends and colleagues as a place to work or train’.

Denominator

Number of i) Midwifery placement students and ii) Obstetrician and Gynaecology Specialty trainees who responded, ‘Extremely Unlikely’, ‘Unlikely’, ‘Neither likely nor unlikely’, ‘Likely’ or ‘Extremely likely’ when asked ‘how likely are you to recommend this practice placement or training post to friends and colleagues as a place to work or train’.

Exclusions/ Filters

Nil response or responses of ‘Don’t know’

Organisation levels to be measured:

Trust, Integrated Care System, National

Desired direction of travel

Increase

T3e Comfortable raising concerns

Theme

Developing and sustaining a culture of safety, learning and support

Measure description

The proportion of i) midwifery placement students and ii) Obstetrician and Gynaecology Specialty trainees who are comfortable raising concerns.

Metric category

Outcome

Data Source (Previous years available)

National Education and Training Survey (2020 to 2022)

Numerator

Number of i) Midwifery placement students and ii) Obstetrician and Gynaecology Specialty trainees responding ‘Yes‘ when asked ‘Do you feel comfortable raising concerns?‘

Denominator

Number of i) Midwifery placement students and ii) Obstetrician and Gynaecology Specialty trainees responding ‘Yes’ or ‘No’ when asked ‘Do you feel comfortable raising concerns?’

Exclusions/ Filters

Nil response

Organisation levels to be measured:

Trust, Integrated Care System, National

Desired direction of travel

Increase

Publication link

To be confirmed

T3f. Supportive working environment for trainee doctors

Theme

Developing and sustaining a culture of safety, learning and support

Measure description

The proportion of specialty trainees in Obstetrics & Gynaecology who agree that the working environment is a fully supportive one.

Metric category

Outcome

Data Source (Previous years available)

GMC National training survey (NTS) – Doctors in training (2022)

Numerator

The number of specialty trainees in Obstetrics & Gynaecology who responded ‘Agree’ or ‘Strongly agree’ when asked to what extent do you agree with the following statement ‘The working environment is a fully supportive one’.

Denominator

The number of specialty trainees in Obstetrics & Gynaecology who responded when asked to what extent do you agree with the following statement ‘The working environment is a fully supportive one’.

Exclusions/ Filters

None

Organisation levels to be measured:

Trust, Integrated Care System, National

Desired direction of travel

Increase

Publication link

National Maternity Indicators section of the National Maternity Dashboard

T3g. Quality of clinical supervision out of hours for trainee doctors

Theme

Developing and sustaining a culture of safety, learning and support

Measure description

The proportion of specialty trainees in Obstetrics & Gynaecology who rate the quality of clinical supervision out of hours as good.

Metric category

Outcome

Data Source (Previous years available)

GMC National training survey (NTS) – Doctors in training (2015 to 2022)

Numerator

The number of specialty trainees in Obstetrics & Gynaecology who responded ‘Good’ or ‘Very Good’  when asked “Rate the quality of clinical supervision, OUT OF HOURS, in this post”

Denominator

The number of specialty trainees in Obstetrics & Gynaecology who responded when asked “Rate the quality of clinical supervision, OUT OF HOURS, in this post”

Exclusions/ Filters

None 

Organisation levels to be measured

Trust, Integrated Care System, National

Desired direction of travel

Increase

Publication link

National Maternity Indicators section of the National Maternity Dashboard

T3h. Quality of shift handovers for trainee doctors

Theme

Developing and sustaining a culture of safety, learning and support

Measure description

The proportion of specialty trainees in Obstetrics & Gynaecology who agree that handover arrangements always ensure continuity of care for patients between shifts.

Metric category

Outcome

Data Source (Previous years available)

GMC National training survey (NTS) – Doctors in training (2015 to 2022)

Numerator

The number of specialty trainees in Obstetrics & Gynaecology who responded ‘Agree’ or ‘Strongly agree’ when asked to what extent do you agree with the following statement “Handover arrangements in this post always ensure continuity of care for patients between shifts“

Denominator

The number of specialty trainees in Obstetrics & Gynaecology who responded when asked to what extent do you agree with the following statement “Handover arrangements in this post always ensure continuity of care for patients between shifts”

Exclusions/ Filters

Those who responded ‘Not applicable’

Organisation levels to be measured

Trust, Integrated Care System, National

Desired direction of travel

Increase

Publication link

National Maternity Indicators section of the National Maternity Dashboard

Theme 4: Standards and structures that underpin safer, more personalised, and more equitable care

Outcome measures for this theme are those relating to our existing safety ambitions: maternal mortality rate, stillbirth rate, neonatal mortality rate, rates of brain injury occurring during or soon after birth, and preterm birth rate. We will monitor these measures nationally by ethnicity and deprivation.

T4ai. Stillbirth rate (National ambition England level monitoring)

Theme

Standards and structures that underpin safer, more personalised, and more equitable care

Measure description

The rate of stillbirths per 1000 births

Metric category

Outcome

Data Source (Previous years available)

Office of National Statistics Child and Infant Mortality in England and Wales (2010 to 2021)

Numerator

The number of stillbirths in England in the calendar year

Denominator

The total number of births in England (live births and stillbirths) in the calendar year

Exclusions/ Filters

Stillbirths are defined as: A baby born after 24 or more weeks completed gestation and which did not, at any time, breathe or show signs of life.

Organisation levels to be measured:

National

Desired direction of travel

Decrease

Publication link

Child and infant mortality in England and Wales – Office for National Statistics (ons.gov.uk)

T4aii. Stillbirth rate (ICS and trust level monitoring)

Theme

Standards and structures that underpin safer, more personalised, and more equitable care.

Measure description

The rate of stillbirths per 1000 births

Metric category

Outcome

Data Source (Previous years available)

MBRRACE-UK Perinatal Mortality Surveillance Reports (2013-2020)

Numerator

The number of stillbirths in England in the calendar year

Denominator

The total number of births in England (live births and stillbirths) in the calendar year

Exclusions/ Filters

Stillbirths are defined as: A baby delivered at or after 24+0 weeks gestational age showing no signs of life, irrespective of when the death occurred.

Births less than 24+0 weeks gestational age and terminations of pregnancy are excluded from the mortality rates reported.

Standardisation

Trusts: ‘Crude rates’, ‘stabilised and adjusted rates’ and ‘stabilised and adjusted rates excluding congenital anomalies’ to be measured.

Systems: ‘Crude rates’ and ‘stabilised rates’ to be measured.

See MBRRACE-UK Perinatal Mortality Surveillance Report – Technical Document for further details.

Organisation levels to be measured:

Trust, Integrated Care System

Desired direction of travel

Decrease

Publication link

Reports | MBRRACE-UK | NPEU (ox.ac.uk)

T4bi. Neonatal mortality rate (national ambition England level monitoring)

Theme

Standards and structures that underpin safer, more personalised, and more equitable care

Measure description

The neonatal mortality rate per 1000 live births

Metric category

Outcome

Data Source (Previous years available)

Office of National Statistics Child and Infant Mortality in England and Wales (2010 to 2021)

Numerator

The number of neonatal deaths at 24 weeks gestation and above in England in the calendar year

Denominator

The total number of live births at 24 weeks gestation and above in England in the calendar year

Exclusions/ Filters

Neonatal deaths are defined as: The death of an infant aged under 28 days

Births below 24 weeks gestation are excluded from the mortality rate used to track progress against the National ambition.

Organisation levels to be measured:

National Trust and Integrated Care Board

Desired direction of travel

Decrease

Publication link

Child and infant mortality in England and Wales – Office for National Statistics (ons.gov.uk)

T4bii. Neonatal mortality rate (ICS and trust level monitoring)

Theme

Standards and structures that underpin safer, more personalised, and more equitable care.

 Measure description

The neonatal mortality rate per 1000 live births

Metric category

Outcome

Data Source (Previous years available)

MBRRACE-UK Perinatal Mortality Surveillance Reports (2013-2020)

Numerator

The number of neonatal deaths at 24⁺⁰ weeks gestation and above in England for births in the reported year, where a neonatal death is defined as a liveborn baby (born at 20⁺⁰ weeks gestational age or later) who died before 28 completed days after birth.

Denominator

The total number of live births at 24⁺⁰ weeks gestation and above in England in the calendar year

Exclusions/ Filters

Births less than 24⁺⁰ weeks gestational age and terminations of pregnancy are excluded from the mortality rates reported.

Standardisation

Trusts: ‘Crude rates’, ‘stabilised and adjusted rates’ and ‘stabilised and adjusted rates excluding congenital anomalies’ to be measured.

Systems: ‘Crude rates’ and ‘stabilised rates’ to be measured.

See MBRRACE-UK Perinatal Mortality Surveillance Report – Technical Document for further details.

Organisation levels to be measured:

Trust, Integrated Care System

Desired direction of travel

Decrease

Publication link

Reports | MBRRACE-UK | NPEU (ox.ac.uk)

T4c. Rate of serious brain injury occurring during or soon after birth.

Theme

Standards and structures that underpin safer, more personalised, and more equitable care.

Measure description

The rate of serious brain injury occurring during or soon after birth, per 1000 live births

Metric category

Outcome

Data Source

Numerator: National Neonatal Research Data Base – Neonatal Data Analysis Unit Reports on Brain injury occurring during or soon after birth: annual incidence and rates of brain injuries to monitor progress against the national maternity ambition.

Denominator: Office for National Statistics (ONS) Birth Summary Tables for England.

Numerator

Annual number of infants who received at least one episode of care within a neonatal unit in England with a brain injury occurring during or soon after birth.

Denominator

All live births in England

Exclusions/ Filters

Numerator

Population: All babies admitted to a neonatal unit in England.

Time period after birth: All brain injuries that are detected during the neonatal

unit stay.

Conditions to be included:

1. Infants with a diagnosis consistent with hypoxic ischaemic encephalopathy: term and near-term infants only
2. Infants with a diagnosis of intracranial haemorrhage, perinatal stroke, hypoxic ischaemic encephalopathy (HIE), central nervous system infection, and kernicterus (bilirubin encephalopathy): all infants
3. preterm white matter disease (periventricular leukomalacia): preterm infants only
4. Infants with a recorded seizure: all infants 

Denominator:

Births were extracted from a dataset containing birth registrations linked to their corresponding notification and infants missing gestational age and where birth weight was inconsistent with gestational age were excluded.

Organisation levels to be measured:

National, System

Desired direction of travel

Decrease

Publication link

National: Brain injury occurring during or soon after birth (imperial.ac.uk)

Integrated Care System: To be confirmed.

T4d. Maternal mortality rate

Theme

Standards and structures that underpin safer, more personalised, and more equitable care

Measure description

The rate of maternal deaths during pregnancy and up to six weeks after the end of pregnancy per 100,000 maternities

Metric category

Outcome

Data Source

MBRRACE-UK Saving Lives Improving Mothers’ Care

(Numerator: MBRRACE UK, Denominator: Office for National Statistics, General Register Office for Scotland, Northern Ireland Statistics and Research Agency)

Numerator

The number of women who died in the UK from direct and indirect causes,

classified using ICD-MM (World Health Organisation 2012), during pregnancy or up to one year after the end of pregnancy within the reported triennia.

Denominator

All maternities in the UK

Exclusions/ Filters

Deaths due to COVID 19

Organisation levels to be measured:

UK level

Desired direction of travel

50% reduction between 2009-11 and 2024-26

T4ei. Pre-term birth rate (National ambition monitoring)

Theme

Standards and structures that underpin safer, more personalised, and more equitable care.

Measure description

The rate of pre-term births expressed as a percentage

Metric category

Outcome

 Data Source

The National Maternity Safety Ambition: ONS – Annual Child and Infant Mortality Statistics

Numerator

The total number of births at between 24+0 weeks and 37+0 weeks Gestation

Denominator

The total number of births (live and still) at 24+0 weeks gestation and over

Exclusions/ Filters

Births below 24+0 weeks gestation

Organisation levels to be measured:

National

Desired direction of travel

Decrease

Publication link

Child and infant mortality in England and Wales – Office for National Statistics (ons.gov.uk)

T4eii. Preterm birth rate (Trust level)

Theme

Standards and structures that underpin safer, more personalised, and more equitable care.

Measure description

The rate of pre-term births expressed as a percentage

Metric category

Outcome

Data Source

Maternity Services Data Set v2.0 – Clinical Quality Improvement Metric

Numerator

Number of live singleton babies born whose gestational length was between 22⁺⁰ and 36⁺⁶ weeks.

Denominator

Number of live singleton babies born whose gestational length was between 22⁺⁰ and 45⁺⁰ weeks.

Exclusions/ Filters

Multiple births

Organisation levels to be measured:

Trust

Desired direction of travel

Decrease

Publication link

National Maternity Dashboard – Clinical Quality Improvement Metrics

Theme 4 progress measures – Links and additional information

References

[1] Development of measures on obstetricians and gynaecologists experience for national use is at a scoping stage and will be subject to information governance considerations.

[2] We will also explore how to better understand the experiences of other staff groups, including and staff working in neonatal services.

[3] Development of measures on obstetricians and gynaecologists experience for national use is at a scoping stage and will be subject to information governance considerations.

[4] We will also explore how to better understand the experiences of other staff groups, including and staff working in neonatal services.

[5] Development of measures on obstetricians and gynaecologists experience for national use is at a scoping stage and will be subject to information governance considerations.

[6] Development of measures on obstetricians and gynaecologists experience for national use is at a scoping stage and will be subject to information governance considerations.

[7] Development of measures on obstetricians and gynaecologists experience for national use is at a scoping stage and will be subject to information governance considerations.

[8] Development of measures on obstetricians and gynaecologists experience for national use is at a scoping stage and will be subject to information governance considerations.

[9] Development of measures on obstetricians and gynaecologists experience for national use is at a scoping stage and will be subject to information governance considerations.