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The Maternity Incentive Scheme: Reflections on NHS data culture 

At a recent roundtable event held by Lifen discussing the impact of the NHS Resolution Maternity Incentive Scheme, patient safety specialists found that while the scheme is helpful, its impact is held back by issues concerning data collection, resource challenges and a lack of clarity around process, as well as complexity inherent in providing data assurance.

By David Duffy

Key Insights

  • Data is central to improving quality of care and improving patient safety. However, much of NHS health remains in siloed systems, making it challenging to develop actionable insights that improve care.
  • Data collection processes for the Maternity Incentive Scheme require examination as part of wider efforts to introduce a ‘culture of data’ within the NHS.
  • Improvements must be made with clarity, guidance and consistency. As the NHS enters into the sixth year of the Maternity Investment Scheme, there remains uncertainty as to what the long-term implications will be for staff. Attendees reported feeling “on the back foot”, without time to deliver what is needed.
  • Electronic patient records are vital to ensuring an effective data-driven culture, but up to 80 per cent of data can be unstructured, requiring manual processes to surface relevant information.
  • As with all healthcare transformation, people and processes remain central to the culture shift required to make sustainable changes.

Background

Obstetric incidents represent the biggest area of spend for the NHS Clinical Negligence Scheme for Trusts (CNST), representing £6 billion worth of new claims in 2021/22. Central to achieving national targets around broader clinical safety is the NHS Maternity Incentive Scheme (MIS), which was set up by the Department of Health and Social Care (DHSC) to support NHS organisations that have taken action to improve maternity safety.

The MIS applies to all NHS trusts that are members of the CNST to support the delivery of safe maternity care. Member trusts contribute 10 per cent of the CNST maternity premium to the scheme, creating the CNST maternity fund. Each trust must meet 10 clinical quality improvement metrics to qualify for the funds – as well as 155 individual standards. Trusts that do not meet 10 out of 10 thresholds will not receive their contribution but may be eligible for a small discretionary payment from the scheme. Measuring success of the MIS for each individual trust requires a comprehensive clinical audit from specific staff and relies on midwives collecting and inputting clinical data.

In the context of the sixth anniversary of the MIS, health tech solution provider Lifen convened key stakeholders for an interactive roundtable and workshop event. Attendees to the event agreed that the MIS helps to deliver safer maternity care and recognised the importance of delivering high quality, safe, patient focused care driven by high quality data insight. There remain, however, several practical and embedded cultural issues that are holding back the impact of the MIS. Many of these issues relate to broader cultural issues surrounding NHS data and digital maturity.

Challenges

Electronic patient records (EPRs) have become one of the most critical components of modern IT healthcare infrastructure, with 90 per cent of NHS trusts now having one. EPRs serve as pivotal catalysts in the ongoing digital transformation of healthcare, seamlessly integrating patient data and leveraging advanced technologies throughout healthcare delivery. However, interoperability between individual systems was raised as a critical issue by roundtable contributors. 

While there is plentiful NHS data, the siloed nature in which it is stored developing actionable insights a challenge. New means must be found to bridge gaps between disparate departmental IT systems and vendor specific solutions, security concerns and organisational barriers between departments. Breaking down these silos requires technological integration, standardised formats, collaborative initiatives, and a shift in culture towards transparency, ultimately unlocking the full value of hospital data.

“There is a need for one unified system rather than disparate siloed efforts which encourages a ‘postcode lottery’ approach to data collection based on geography, and fails to reach distant communities”

However, contributors also stressed that even with a unified EPR there is no ‘magic bullet’, as there are still fundamental issues concerning the process of data collection and administration – a process which has not always been created with the user in mind. A poll conducted during the meeting found that more than half of the attendees were spending more than five hours a day on administrative and data tasks. Key words and phrases provided by attendees included: 

  • Time consuming
  • Lack of data quality 
  • Lack of clarity 
  • Poor accuracy of data
  • Human error

It became clear that there is little patience for laborious data tasks within the NHS and that basic issues concerning MIS data collection processes are holding back its impact. 

“We are using all people hours and resources to source this data, but it is not efficient use of resource”

Attendees highlighted that the multitude of information required to input information on forms increased the likelihood of data being lost. Attendees were keen to stress that while no one operating within the sector expects a perfect system for collection, the process around MIS is not always clear on the required input – thereby increasing the scope for error. There is clearly a need to place usability front and centre of this process. 

There is also a need for clearer guidance to inform data collection processes and unpick ‘clinical grammar’; what constitutes as “avoidable” harm, for instance, was repeatedly flagged as an issue for staff. 

As the NHS enters the sixth year of MIS, there remains uncertainty as to what the long-term implications will be for staff. Attendees reported feeling “on the back foot” with regards to MIS data collection. 

“Are you sure that this data is correct, does the system allow for these mistakes? We need to establish better data processes. Basic data design factors often get overlooked, positioning of certain questions in certain fields can have big consequences later down the line. Staff need assurances around quality of data. Usability is key on prompts and the validation aspects of data collection”

Culture of data collection

While we have improved awareness of data, we also need to communicate that it may not have immediate impact, but it will help us help in the long-term. It is vital we keep the big picture in mind”

A strong theme throughout the event centred around the practicalities of collecting the data required for the scheme – this is reflective of wider trends in the health sector concerning the usability of design within data collection.

For midwives, data collection for MIS must not be viewed as another chore to add to their already stretched workload. It is up to health system leaders to ensure that all clinical staff are aware of the bigger picture and are given confidence that their data collection will eventually improve care delivery. It is vital that this is embedded into staff mentality and wider organisational culture. It must also be stressed that improved data collection process will have limited short-term impact; there is no magic bullet within health and care, and it is important that in communicating to staff the immediate prospect of data-driven transformation is not oversold. 

Questions were raised as to whether NHS organisations are currently making the best use of data and whether further automation would help drive actionable insights. An effective EPR is obviously central to this, however, as one attendee put it:

“You can have the best EPR in the world, but more fundamentally it is about the people at the face of it; people work very differently in hospital sites for instance, [and] some people haven’t even used a laptop before”

If midwives and other key staff are not given sufficient training to become accustomed to data collection systems, it will not be possible to drive fundamental improvements to data processes. Up to 80 per cent of data within EPRs can appear unstructured and will therefore require manual processes to surface the most relevant information, and so the insight gathered from an EPR will be reliant on how familiar midwives are with that system.

In striving to create a culture of continuous data curation and innovation, NHS trusts must improve manual data curation and collection processes and ensure these processes are compatible with current workloads and expertise of clinical staff. Providing additional training for staff will increase the quality of data available while not creating unnecessary burden for clinicians.

Data collection should become a core component of clinician workflows. To facilitate this, the mandatory datapoints required for collection by national datasets need to be streamlined and more clearly defined to maximise benefit. Furthermore, additional training and resources should be provided for staff. This will increase the quality of data held by the NHS while not creating unnecessary burden for clinicians.

Holistic view

No piece of data should be used in isolation and must be applicable throughout the whole life course of a patient or end user. A holistic view creates powerful data and presents a more accurate picture. Practically enabling this means ensuring that every interaction with patients and end users informs datasets and ensuring that data is truly reflective of the care being provided. The point was also made during the discussion that a truly holistic view of an end-user’s life course would include data from local authorities and community services. This relates to broader themes around the quality of data throughout the health and care ecosystem. 

Fundamentally, creating a data-driven culture in the NHS will require a wholesale shift in our understanding of data, starting at the first interaction and throughout the whole pregnancy phase.

EPRs are longer just reproducing card indexes, they are systems which can tell the story of a person’s health. Therefore, it is critical that EPR’s are fuelled with truly holistic data to ensure a patient’s story is collected and retold accurately. Everyone from patient to healthcare professional must be on the same page.

Conclusion

 

“Consistency of evidence is difficult to obtain if our systems are siloed and data is sitting in the wrong place. An analyst is only as good as the data they are working with…If you put garbage in, you will get garbage out”

What was striking from this event was that, while a relatively niche mechanism within a specific speciality of care, the issues relating to the MIS are consistent with broader issues around data collection and administration in the NHS. Maternity staff are still held back by a siloed data ecosystem – and there remains a need to examine how data is submitted and validated, analysed and linked together. 

From a cultural perspective, data collection must be seen as more than a mere box-ticking exercise, and clinical staff should be aware of the many benefits that consistent data collection can unlock. Alongside this, data input and administration processes themselves must place both the service user and patient at the heart. 

Enabling this will not be possible without a highly collaborative multidisciplinary approach, with close collaboration across teams. However, contributors suggested that bringing the right stakeholders together in a collaborative way can at time be a challenge. As such, it is vital that integrated care boards take leadership positioning on the MIS and ensure that it forms part of their wider drive to embed a data culture across health and care services.

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