Publication of MNSI report 2023/2024

The Maternity and Newborn Safety Investigations Annual Report highlights the organization's efforts over the past year and outlines its aims for 2025 and beyond. In 2023/24, MNSI remained dedicated to providing safe maternity services across England, initiating over 600 new maternity safety investigations.

Their latest efforts have been directed towards reducing disparities in outcomes for Black and ethnic minority women and their babies, enhancing communication between mothers/birthing people and maternity services, and increasing the effectiveness of thematic learning information. Progress in these areas and scope for future development is highlighted. The significant impact on the MNSI’s work has had on the women, birthing people, and their families involved in our investigations is included. It is hoped that no other family endures their experiences. Achieving this goal in England's maternity care is still a work in progress so it is crucial to prioritize and maintain efforts to provide safe, personalized maternity care for all. 

During the year, over 600 new maternity safety investigations were opened, playing a crucial role in identifying and addressing safety concerns in maternity care. These investigations aim to understand the root causes of incidents and provide recommendations to prevent future occurrences. They cover a wide range of issues, including clinical practices, communication between healthcare providers and patients, and systemic factors affecting maternity care. The findings from these investigations are used to improve policies and practices within maternity services, ensuring safer outcomes for mothers and babies. These efforts are part of a broader strategy to enhance maternity safety and address disparities in care, particularly for Black and ethnic minority women and their babies.

The report highlights the necessity of addressing disparities in maternity care. This requires efforts to ensure equitable access to high-quality maternity services and the reduction of higher rates of adverse outcomes. Another key focus is improving communication between mothers/birthing people and maternity services. Effective communication is essential for making mothers feel supported throughout their maternity journey. This includes providing clear, consistent information and better engaging with patients to understand their needs and concerns. Additionally, the report underscores the importance of enhancing the impact of thematic learning information. This involves examining data from investigations to identify common themes and trends, using this information to inform best practices. The goal is to create a continuous learning environment where lessons from past incidents lead to improvements in maternity care. These focus areas are part of a broader strategy to ensure safe, personalised maternity care for all, and to drive system-wide changes that can sustain these improvements over time.

Finally, the report highlights the importance of improving the impact of thematic learning through a variety of key activities. This process entails examining data from multiple maternity safety investigations to uncover common themes and patterns, allowing the MNSI to identify recurring problems and areas that require improvement. The insights derived from this analysis will guide policy adjustments and best practices within maternity services. Furthermore, the MNSI partners with other organizations to exchange knowledge, forming a cohesive strategy to enhance maternity safety across various regions and healthcare providers. By concentrating on these areas, the MNSI seeks to promote systemic enhancements in maternity care, guaranteeing that all mothers and babies receive safe, individualised care.