Maternity Investigation Programme Year in Review 2022/23

This is the final maternity review before HSIB transforms into the Health Services Safety Investigations Body (HSSIB) and the maternity programme becomes the Maternity and Newborn Safety Investigations (MNSI) programme, in October 2023.

Highlights from the year:

• We have developed a family inclusivity toolkit, so we fully understand family needs during an investigation.
• The number of investigation referrals relating to brain injury indicate a sustained decrease in babies with abnormal MRI results or neurological damage.
• We have formed a race equality group to develop the data from investigations to analyse demographics and understand the impact of racial diversity on experiences, access to care, and outcomes.

We noted during 2022/23 that the top three themes for our safety recommendations to NHS trusts in order of frequency are clinical assessment, guidance and fetal monitoring.