Continuity of Carer (COC) measures

Slide 1

Welcome to this short video on understanding the policy behind the Continuity of Carer measures. This video is part of a series of videos to help you understand measures built from the Maternity Services Dataset, often referred to as MSDS

Slide 2

The Better Births report released in 2016 highlighted that women should have continuity of the person looking after them during their maternity journey, before, during and after the birth. This continuity of care and relationship between care giver and receiver has been proven to lead to better outcomes and safety for the woman and baby, as well as offering a more positive and personal experience; and was the single biggest request of women of their services that was heard during the Review.

Due to the staffing crisis, targets for implementation have been lifted. However NHS England is committed to delivering continuity of carer so that it, in time, becomes the default model of care for women in maternity services across England.

Supporting links:

• Dec 2017: Implementing Better Births, Continuity of Carer.
• Patient Safety Learning guidance on provision of Continuity of Carer

Slide 3

To support this policy, NHS Digital have developed 2 key measures:

• Percentage of women placed on a continuity of carer pathway: This metric is designed to measure the percentage of women placed on a continuity of carer pathway by the 28-week antenatal appointment. This is measured at 29 weeks
• Percentage of women receiving continuity of carer (ongoing): This metric is designed to measure the percentage of women who were placed onto a continuity of carer pathway by 29 weeks gestation and who are receiving continuity of care from that point until discharge. 

Both measures also show the data split by

• Ethnicity
• Deprivation, which is based on postcode of mother's usual address

Slide 4

NHS Digital publish these measures as part of the Maternity Services Monthly Statistics. Additional videos in this series offer guidance on navigating the Maternity Services website and finding the published data

Slide 5

In the published data you will find these two key measures referred to by the following names

• COC_by_28weeks
• COC_receiving_ongoing

Slide 6

In the published data you will find the two key measures broken down by ethnicity and deprivation and these breakdowns referred to by the names seen on the previous slide plus the breakdown, for example

• COC_by_28weeks_Ethnicity_BAME
• COC_receiving_ongoing_IMD_01_Most_deprived

Slide 7

This brings us to the end of the video.

Thank you for watching this video demonstration on how the measure for the percentage of women placed on a continuity of carer pathway is built from MSDS

We hope you found this useful. This video is part of a suite of videos to help you understand key measures in MSDS.

We value your feedback, please use the email address if you wish to get in touch.

Thank you.

Slide 1

Welcome to this short video demonstration on how to understand the measure for the percentage of women placed on a continuity of carer pathway. This video is part of a series of videos to help you understand measures built from the Maternity Services Dataset, often referred to as MSDS

Slide 2

Today we will look at a measure that calculates the percentage of women placed on a continuity of carer pathway. The purpose of this measure is to identify, in any given month, what percentage of woman who are at 29 weeks gestation have been placed on a Continuity of Carer Pathway

Slide 3

We do this by determining a denominator and numerator. For the denominator we will look for all women who have reached 29 weeks gestation in a given month and who have not been discharged. For the numerator, we take this cohort of women then retain only those where there has been a formal antenatal booking appointment by 29 weeks gestation, where there is an Antenatal Care Plan, where there is an indication the woman is on a Continuity of Carer Pathway, here there is a named lead midwife and where there is a named team

Slide 4

We will look at the data items in MSDS that contribute to this measure. All of these data items can be found in the technical output specification version 2.0.25 available from the top link. There is also published meta data to explain how the measures are built. This is available with each monthly data release following the bottom link. Please note, all links in this video are referenced in the transcript for this video.

Slide 5

This video explains how this measure for women placed on a continuity of carer pathway is constructed and the data items used. This measure is referred to as COC_by_28weeks, this is to align with NHS England policy. However, it is measured at 29 weeks to allow for possible appointment delays. Here we see the description, numerator and denominator as shown in the metadata. To understand how these are constructed, we will look at all the fields in MSDS that underpin this measure. For information, this measure was previously known as COCDQ02

Slide 6

We will look at each MSDS table in turn. Some data items are derived from several items sent by providers, this is identified in the source field in each table shown in the next few slides. We will start with looking at the table MSD000 Header. We use this table to establish the reporting month and the organisation who submitted the data.

Slide 7

We want to be able to uniquely identify each woman, we do this through data submitted to MSD001 mother’s demographics. From the data submitted by all providers, NHS Digital creates a field called Person ID (Mother). This is primarily generated from the NHS Number.

Slide 8

We use the table MSD101 pregnancy and booking details to get 4 pieces of information.

Unique pregnancy ID: NHS Digital gives each pregnancy a unique identifier derived through items submitted by all providers. Some of the data items used to calculate this as shown here.

Next, we get the appointment date of a Formal Antenatal Booking. This is used to mark the start of the booking and calculate gestational age.

We then use gestational at booking, this is a derived field from information from the Formal Antenatal Booking Appointment and then either, the estimated date of delivery or the last menstrual period date.

We also use discharge date to check if a woman is still in maternity services at 29 weeks.

Slide 9

We use MSD102 Maternity Care plan to get details of the care plan. We need 5 pieces of information

• The date the care plan was put in place identified via maternity care plan date
• If the care plan was an antenatal care plan, identified by 05 in Maternity care plan type
• If there is an indication this care plan is on the continuity of carer pathway, identified as Y in continuity of carer pathway indicator
• We then look to see if a lead midwife has been assigned identified through Care Professional Local Identifier
• And if a team has been assigned to the women’s care, identified through Care professional Team Local identifier

Slide 10

We will start by looking at the denominator, all women who reach 29 weeks gestation in a chosen month and who have not been discharged

Slide 11

We use both PERSON ID (MOTHER) and UNIQUE PREGNANCY ID to count unique pregnant women in the month. As we have just seen, both of these are derived fields.

We next consider only those who reach 29 weeks gestation in the month. We will count this in days, and 29 weeks gestation is 203 days. We will take the Gestational age at booking then add on the number of days between the antenatal appointment, which is when the gestational age was estimated and the start of the reporting month.

We will then do the same for the end of the month. We are interested only in those women who reach 203 days gestation within the month.

We then look at the discharge date from maternity services to check the woman has not been discharged, or if she has she did this after 203 days gestation.

Overall, this is our denominator, all the women who reach 29 weeks gestation in the month and who are still in services at that point.

Slide 12

We will now look at how the numerator is calculated. We will be looking for women who reach 29 weeks gestation in the month, this is from the denominator and where there's also been a formal antenatal booking appointment before 29 weeks gestation. Where there's an antenatal care plan in place, where there is an indication the woman is on a continuity of carer pathway, where there is a named lead midwife and when there is a named team.

Slide 13

For the numerator, we use the cohort of women we found in the denominator. We then retain only those who have a care plan in place on or before 29 weeks gestation. This is calculated from gestational age of booking. And then adding on the number of days which is a count of days between the Maternity Care Plan Date and the Appointment Date, which is a Formal Antenatal Booking Appointment. This total count needs to be less than 203 days. We then include only those who have an Antenatal Care Plan. This is identified in a maternity care plan type and needs to be 05. We include only those who have an indication of a continuity of carer pathway. This is found in the Continuity of Care Pathway Indicator field and needs to be set to Y. We include only those where there is a named midwife. So, this needs to be not blank. Care Professional Local Identifier needs to be filled in and the same goes for Care Professional Team Local Identifier, this needs to have something placed in it.

Slide 14

I just want to highlight a few key points:

• If the data shows a woman was placed on a continuity of carer pathway but this is after 29 weeks gestation, then this record will not be counted as being on the pathway
• If the data shows a woman was placed on a continuity of carer pathway before 29 weeks gestation but there is not data identifying the midwife or the team then this record will not be counted as being on the pathway
• If the status of indicator of CONTINUITY OF CARER PATHWAY INDICATOR up to 29 weeks gestation changes, i.e. from No to Yes to No we will take the latest data and show this woman is NOT on a Continuity of Carer pathway

Slide 15

The final step is to take the numerator and the denominator and to create the measure as a percentage

Slide 16

We can see here that we simply divide the numerator by the denominator then multiply by 100 to get a percentage. Published monthly here: Maternity Services Monthly Statistics. 

Slide 17

For information, this measure is also broken down by mother’s ethnicity and by mother’s derived social deprivation. This is taken from MDS001 and the most recent record in the reporting period is used.

Slide 18

Here we see how the measures are identified in published data. Percentage of women placed on a continuity of carer pathway by the 28 weeks antenatal appointment, as measured at 29 weeks gestation can be found in the published data as COC_by_28weeks and then split by ethnicity and deprivation, and these are highlighted on the measure end names.

Slide 19

This brings us to the end of the video.

Thank you for watching this video demonstration on how the measure for the percentage of women placed on a continuity of carer pathway is built from MSDS. We hope you found this useful. This video is part of a suite of videos to help you understand key measures in MSDS. We value your feedback, please use the email address if you wish to get in touch.

Thank you.

Slide 1

Welcome to this short video demonstration. This video is part of a series of videos to help you understand measures built from the Maternity Services Dataset, often referred to as MSDS

Slide 2

Today we will look at data quality thresholds that support the measure for the Percentage of women placed on a continuity of carer pathway by the 28 weeks antenatal appointment, as measured at 29 weeks gestation. This is  published with measure ID COC_by_28weeks

Slide 3

Let’s look at why data quality thresholds are used. Measures built from the Maternity Services Dataset (MSDS) are published at various breakdowns, most commonly:

Provider, National, NHS England (Region), Local Maternity System, MBRRACE Grouping

To try and reduce the impact of poor data quality at provider level on national and sub national breakdowns, we sometimes apply one or more data quality thresholds to measures. Providers have to pass these thresholds for their data for the measure they support to be published and contribute to national and sub national breakdowns.

Provider level data for each data quality thresholds will be published alongside a result of pass or fail. If a provider fails the data quality threshold, no data will be published for the measure that the data quality threshold were supporting and so data for that provider will not be used in any national and sub national breakdowns.

This video will look at the thresholds for COC_by_28weeks and show some examples of how these are currently displayed in the published data.

Slide 4

There are 2 data quality thresholds that support COC_by_28weeks. The first is referred to as COC_DQ04 and calculators the Percentage of women who had an antenatal care plan in place for which continuity of carer indicator status was known, by 29 weeks gestation. This takes all the women who reach 29 weeks gestation in the month as the denominator and then assess if the continuity of carer indicator status is complete to calculate the numerator.

The second is referred to as COC_DQ05 and calculates the Percentage of women with an antenatal care plan in place and the continuity of carer indicator completed by 29 weeks gestation, who have a named lead midwife and team. This takes all the women who reach 29 weeks gestation in the month and who have been marked as being on a continuity of carer pathway as the denominator, then assesses if a named midwife and team have been recorded to calculate the numerator.

Providers have to pass both of these measures at 5% for data for COC_by_28weeks to be published and included in national and sub national figures.

Slide 5

We will look at the data items in MSDS that contribute to these measures. All of these data items can be found in the technical output specification version 2.0.25 available from the first link. There is also published meta data to explain how the measures are built. This is available following the second link. Data items used in these data quality thresholds also exist in the measure they are supporting COC_by_28weeks

Please note, all links in this video are referenced in the transcript for this video.

Slide 6

We will look at each MSDS table in turn. Some data items are derived from several items sent by providers, this is identified in the source field in each table shown in the next few slides. We will start with looking at the table MSD000 Header. We use this table to establish the reporting month and the organisation who submitted the data.

Slide 7

We want to be able to uniquely identify each woman, we do this through data submitted to MSD001 mother’s demographics. From the data submitted by all providers, NHS Digital creates a field called PERSON ID (MOTHER). This is primarily generated from the NHS Number.

Slide 8

We use the table MSD101 pregnancy and booking details to get 4 pieces of information.

1. UNIQUE PREGNANCY ID, NHS Digital gives each pregnancy a unique identifier derived through items submitted by all providers. This is used to uniquely identify each pregnancy
2. APPOINTMENT DATE (FORMAL ANTENATAL BOOKING), which is used to mark the start of the booking and to calculate gestational age
3. GESTATIONAL AGE AT BOOKING, NHS Digital derives this information from the APPOINTMENT DATE (FORMAL ANTENATAL BOOKING) and either the ESTIMATED DATE OF DELIVERY or the LAST MENSTRUAL PERIOD DATE
4. DISCHARGE DATE this is used   to check if a woman is still in maternity services at 29 weeks gestation

Slide 9

We use MSD102 Maternity Care plan to get care plan details. We need 5 pieces of information

1. MATERNITY CARE PLAN DATE to determine date the care plan was put in place
2. MATERNITY CARE PLAN TYPE to determine if the care plan was an antenatal care plan, identified by 05
3. CONTINUITY OF CARER PATHWAY INDICATOR to determine if there is an indication as to whether this care plan is on the continuity of carer pathway or not. Identified as Y for yes or N for no.
4. CARE PROFESSIONAL LOCAL IDENTIFIER to determine if a lead midwife has been assigned to the care
5. CARE PROFESSIONAL TEAM LOCAL IDENTIFIER to determine if a team has been assigned to the women’s care

Slide 10

We will start by looking COC_DQ04. This data quality threshold measure is assessing, for all women who reach 29 weeks gestation in the month, is there information recorded in MSDS on whether an antenatal care plan was in place by 29 week and is there is an indication that it is a continuity of carer plan.

Slide 11

We will start with the denominator: All women who reached 29 weeks gestation in the chosen month who have not been discharged.

Slide 12

We use both PERSON ID (MOTHER) and UNIQUE PREGNANCY ID to count unique pregnant women in the month. As we have just seen, both of these are derived fields.

We next consider only those who reach 29 weeks gestation in the month. We will count this in days, and 29 weeks gestation is 203 days. We will take the Gestational age at booking then add on the number of days between the antenatal appointment, which is when the gestational age was estimated and the start of the reporting month.

We will then do the same for the end of the month. We are interested only in those women who reach 203 days gestation within the month.

We then look at the discharge date from maternity services to check the woman has not been discharged, or if she has this was after 203 days gestation.

Overall, this is our denominator, all the women who reach 29 weeks gestation in the month and who are still in services at that point.

Slide 13

We will now look at how the numerator is calculated. We will be looking for women who reach 29 weeks gestation in the month, this is from the denominator. Then we retain only women where there's also been a formal antenatal booking appointment before 29 weeks gestation. Where there's an antenatal care plan in place and where continuity of carer pathway indicator is not blank

Slide 14

We use the cohort of women we found for the denominator, then retain only those who had an antenatal booking appointment at or before 29 weeks gestation and who have MATERNITY CARE PLAN in place at or before 29 weeks gestation

Retain only women who have an antenatal care plan in place, type 05 in MATERNITY CARE PLAN TYPE

Retain only women where CONTINUITY OF CARER PATHWAY INDICATOR is not blank

Slide 15

The final step is to take the numerator and the denominator and to create the measure as a percentage. we simply divide the numerator by the denominator and multiply by 100 to get a percentage.

Slide 16

Next, we will look at COC_DQ05. This data quality threshold measure is assessing, of women who are on a continuity of carer pathway by 29 weeks gestation in the month, is there is information recorded in MSDS on the named lead midwife and team.

Slide 17

We will start with the denominator: All women who reached 29 weeks gestation in the chosen month who have not been discharged and who are marked as being on a continuity of carer pathway.

Slide 18

We will take the denominator from COC_DQ04

Retain only those who have MATERNITY CARE PLAN in place by 29 weeks gestation

Retain only women who have an antenatal care plan in place, this is care plan type 05 in MATERNITY CARE PLAN TYPE

Retain only women where CONTINUITY OF CARER PATHWAY INDICATOR is Y to indicate yes, they are on a continuity of carer pathway.

Slide 19

Next, we will look at the build of the numerator. This is actually the same build as the numerator for COC_by_28weeks which is the measure we are applying this threshold to, however the denominator for this threshold measure is different to that of COC_by_28weeks.

Slide 20

For the numerator, we use the cohort of women we found in the denominator for COC_DQ05

Retain only those where there is a named midwife identified in CARE PROFESSIONAL LOCAL IDENTIFIER

Retain only those where a team is identified in CARE PROFESSIONAL TEAM LOCAL IDENTIFIER

Slide 21

The final step is to take the numerator and the denominator and to create the measure as a percentage. we simply divide the numerator by the denominator and multiply by 100 to get a percentage.

Slide 22

Providers needs to pass both data quality thresholds COC_DQ04 and COC_DQ05 at 5%. We will now look at how this is showing up in published data

Slide 23

We will use data published for June 2021, the link for this available from the transcript below this video. We will look at two randomly selected organisations. First we will look at R0A, we can see from this image that R0A have passed COC_DQ04 with 87.4% women having details recorded as to whether they are on a continuity of carer pathway or not. However, they have not passed COC_DQ05 as they only have 4.8% women that are on a Continuity of Carer pathway where they have recorded details of lead midwife and team

Next, we will look at R0D, here we see they have passed both data quality thresholds, with 100% of women having information recorded as to whether they are on a continuity of carer pathway as shown in COC_DQ04, for COC_DQ05 we see that of the women what are on a continuity of carer pathway 86.7% of women have details recorded in relation to lead midwife and team.

We will next look at what this means for the measure COC_by_28weeks that these thresholds are supporting

Slide 24

As R0A did not pass both data quality thresholds their data is not published in the final measure of COC_by_28weeks and does not feature in the national or sub national figures either

As R0D have passed both data quality thresholds so their data for COC_by_28weeks is published and will contribute to national and sub national figures

Slide 25

Let’s look at the overall picture. For June 2021 124 providers submitted data to MSDS. Looking at COC_DQ04, all 124 providers passed this threshold with an average pass rate of 91%. Meaning that for approximately 91% of women who reach 29 weeks gestation in the month there is an indication of whether or not they are on a continuity of carer pathway.

Looking at COC_DQ05, 94 providers passed this threshold with an average pass rate of 73%. For these providers this means that of the women who reach 29 weeks gestation in the month and who are flagged as being on a continuity of carer pathway, information on midwife and team have been supplied to MSDS for approximately 73% of women.

30 providers have not passed this 5% threshold yet as they are not supplying enough information on midwife and team allocated to a woman’s care

Note that the threshold of 5% could alter in future as providers start to improve data quality and providers should be aiming to pass a completion rate of much higher than 5% for both data quality thresholds

Providers can access a Data Quality Submission Summary Tool designed to help them understand the validation reports provided after a submission on SDCS cloud portal, please use the link in the transcript to access this.

Slide 26

This brings us to the end of the video.

Thank you for watching this video demonstration we hope you found this useful. This video is part of a suite of videos to help you understand key measures in MSDS.

We value your feedback, please use the email address here if you wish to get in touch email [email protected]

Thank you

Slide 1

Hello and welcome to this short video demonstration on how to understand the measure for the percentage of women receiving continuity of carer​. This video is part of a series of videos to help you understand measures built from the Maternity Services Dataset, often referred to as MSDS

Slide 2

Today we will look at a measure that calculates the percentage of women receiving continuity of carer​. The purpose of this measure is to identify, that of the women who were placed onto a Continuity of carer pathway by 29 weeks gestation, what percentage received continuity of carer from that point and up to discharge​

Slide 3

We are assessing if a women received continuity of career since being placed on a Continuity of carer pathway by 29 weeks gestation up to discharge. To do this we look over a 4 month period.

So let’s establish the denominator and numerator.

For the denominator we consider all women who reached 29 weeks gestation 4 months before the chosen month. This allows us to look over that four month period to see if the woman actually received continuity of care.

The numerator is the denominator, which is all women who reached 29 weeks gestation four months before the chosen month, and then we include only women who were placed on a continuity of carer pathway by 29 weeks gestation. This is a published measure in its own right and is called COC_by_28weeks as that is what the policy is called. We include only women who were discharged from maternity services over those four months. And we include only women seen by their lead midwife or team for at least 70% of all antenatal and postnatal care contacts that occur between the maternity care plan date and the discharge date. Finally, we include only women with no delivery recorded in MSD301 Labour and Delivery or those with the delivery recorded who were seen by their lead midwife or team during the intrapartum care.

Slide 4

We will look at the data items in MSDS that contribute to this measure. All of these data items can be found in the technical output specification version 2.0.25 available from the top link. There is also published meta data to explain how the measures are built. This is available with each monthly data release following the bottom link. Please note, all links in this video are referenced in the transcript for this video.

Slide 5

This video explains how the measure Women receiving continuity of carer (ongoing) is constructed and the data items used. This measure is referred to as COC_receiving_ongoing. Here we see the description, numerator and denominator as shown in the metadata. To understand how these are constructed, we will look at all the fields in MSDS that underpin this measure. For information, this measure was previously known as COCDQ03.

Slide 6

We will look at each MSDS table in turn. Some data items are derived from several items sent by providers, this will be identified in the source field in each table shown in the next few slides. We will start with looking at the table MSD000 Header. We use this table to establish the reporting month and the organisation who submitted the data.

Slide 7

We want to be able to uniquely identify each woman, we do this through data submitted to MSD001 mother’s demographics. From the data items submitted by all providers, NHS Digital creates a field called Person ID (Mother). This is primarily generated from the NHS Number.

Slide 8

We use the table MSD101 Pregnancy and Booking Details to get 4 pieces of information.

• Unique Pregnancy ID, NHS Digital gives each pregnancy a unique identifier derived through items submitted by all providers.
• We want to know the Formal Antenatal Appointment Date which is used to mark the start of the booking.   
• We need to know the gestational age at booking, NHS Digital derives this information from the Formal Antenatal Appointment Date and either the Estimated Date of Delivery or the Last Menstrual Period.
• And then lastly, we need the Discharge Date. We use this to check if a woman is still in maternity services at 29 weeks gestation, but this is also used to check 4 months later that the woman has been discharged from maternity services​

Slide 9

We use MSD102 Maternity Care Plan to get care plan details. We need 5 pieces of information from this table

• The date the care plan was put in place, from Maternity Care Plan Date field
• If the care plan was an antenatal care plan. This is taken from Maternity Care Plan Type and we need to see 05 here to identify antenatal care plan.
• If there is an indication this care plan is on the continuity of carer pathway. We get this information from the Continuity of Care Pathway Indicator, and we need to see 'Y' here to indicate yes
• We look to see if a lead midwife has been assigned from the Care Professional Local Identifier field
• And we look to see if a team has been assigned, identified in the Care Professional Team Local Identifier field.

Slide 10

We use MSD201 Care Contact (Pregnancy)​ to get the details of all antenatal and postnatal care contacts during the pregnancy. We need 3 pieces of information

• We take the ‘CARE CONTACT IDENTIFIER’ to uniquely identify each care contact from the care plan date to discharge. 
• We need ‘CARE CONTACT DATE’ to identify which care contacts take place between Continuity of Carer care plan date and discharge​
• And then we need ‘ATTENDED OR DID NOT ATTEND CODE’ to identify only those care contacts which were attended, we will look for 5 and 6 in this field.

Slide 11

We use MSD202 Care Activity (Pregnancy) to get the details of the activities for the contacts we identified in the previous table MSD201 Care Contact (pregnancy). We need 3 pieces of information from this table.

• The ‘CARE CONTACT IDENTIFIER’ so we can link to the contacts we identified in 201
• The ‘CARE PROFESSIONAL LOCAL IDENTIFIER’ to see whether​ the woman was seen by their lead midwife during the care contacts
• And the ‘CARE PROFESSIONAL TEAM LOCAL IDENTIFIER’ to identify the team who performed the care activity during the pregnancy.

Slide 12

We use MSD301 Labour and Delivery and MSD302 Care Activity (Labour and Delivery) to get the details of intrapartum care. We need 3 pieces of information

• From MSD301 Labour and Delivery, we take ' LABOUR AND DELIVERY IDENTIFIER’ to uniquely identify a labour or delivery
• From MSD302 Care Activity (Labour and Delivery) we take ‘CARE PROFESSIONAL LOCAL IDENTIFIER’ to establish the lead midwife who performed the care activity during intrapartum care
• And we also take ‘CARE PROFESSIONAL TEAM LOCAL IDENTIFIER’ to establish the team who performed the care activity during intrapartum care.

Slide 13

We use MSD901 Staff Details to get details of the care professionals we have identified in the previous tables we've looked at. We need 2 pieces of information from this table.

• ‘CARE PROFESSIONAL LOCAL IDENTIFIER’ to locate the care professionals named as providing care, and to assess consistency of the woman’s contact with her lead midwife during pregnancy and labour
• We take ' CARE PROFESSIONAL STAFF GROUP (MATERNITY)’ to identify where the care professional at a care contact is a midwife. Here we are looking or entries 05, 06, 07 only.

Slide 14

We will start by looking at the denominator, all women who reach 29 weeks gestation 4 months before the reporting month

Slide 15

For our denominator we use both PERSON ID (MOTHER) and UNIQUE PREGNANCY ID  to count unique pregnant women. Both of these are derived as we have seen previously.

Next, we consider only those who reached 29 weeks gestation 4 months prior to the chosen month. We will count this in days, and 29 weeks gestation is 203 days. To calculate this, we take the Gestational age at Booking then add on the number of days between the antenatal appointment date, which is when the gestational age was estimated, and the start of the reporting month, Reporting Period Start Date.

We will do the same calculation but for the reporting period end..

We are interested in only those who reach 203 days gestation between the start and end of the month.

We then look to use the Discharge Date from maternity services to check the woman has not been discharged, or if she has, it was after she reached 203 days gestation.

This is our denominator, all the women who reach 29 weeks gestation 4 months prior to the chosen month.

Slide 16

We will now look at how the numerator is calculated. We will be looking for women who reached 29 weeks gestation 4 months before the chosen month, this is the denominator we've already seen. We will include women where there has been a Formal Antenatal Booking Appointment before 29 weeks gestation. Include only women placed in a continuity of carer of pathway by 29 weeks gestation. This is a measure in its own right and is called COC_by_28weeks there was another video on this. We will include women who were discharged from maternity services over the following four months. Include only women seen by their lead midwife or team for at least 70% of all antenatal and postnatal care contacts that occur between the maternity care plan date and the discharge date.

Then we will include only women with no delivery recorded in MSD301 Labour and Delivery or those with a delivery recorded who were seen by their lead midwife or team during the intrapartum care.

Slide 17

We will look in stages how these data items are used together for this measure. We use the cohort of women we found in the denominator, then retain only those who were placed on a Continuity of Carer pathway by 29 weeks gestation based on their latest antenatal care plan record.  We can see this from the data items here; Maternity care Plan Type is 05, they've got an indication of yes for Continuity of Carer Pathway Identifier, the Care Professional Local Identifier is not blank and the Care Professional Team Local Identifier is not blank.

We include only those from this group who were discharged from Maternity services at some time within the 4 months.

Slide 18

We interrogate all the care contacts we have found in antenatal and postnatal care to identify those where the patient attended and where a midwife was present, and we retain only those women who were seen by their lead midwife or team for 70% of their appointments. We can see this here. We've taken all the care contacts that were attended where we know the care professional. We are then linking the contacts to the care activities and finding the team or the care professional that was identified.

Finally, we retain only those women who were seen by their lead midwife or team during intrapartum care. For pregnancies where delivery is recorded in MSD301 Labour and Delivery or who have no delivery recorded in MSD301 Labour and Delivery

Finally, from this group, we retain only those women who were seen by their lead midwife or team during intrapartum care for pregnancies where delivery is recorded in MSD301 Labour and Delivery, or who have no delivery recorded in MSD301 Labour and Delivery.

Slide 19

Here's some key points for the measure of women receiving continuity of care

• If the data shows a woman was placed on a continuity of carer pathway but this is after 29 weeks gestation, then this record will not be counted as being on the pathway
• If the data shows a woman was placed on a continuity of carer pathway before 29 weeks gestation but there is not data identifying the midwife or the team then this record will not be counted as being on the pathway
• If the status of the CONTINUITY OF CARER PATHWAY INDICATOR changes, i.e., from No to Yes to No, up to 29 weeks gestation then we will take the latest data and show this woman as NOT on a Continuity of Carer pathway 
• Only women who have been discharged from maternity services will be included in this measure.  (DISCHARGE DATE (MOTHER MATERNITY SERVICES) should be populated at some point from 29 weeks gestation over the next four months.
• For at least 70% of all antenatal and postnatal care contacts that occur between the ‘Maternity Care Plan Date’ and the discharge date a woman should be seen by their lead midwife or team. Only appointments that were attended by the woman will be interrogated and only care contacts where a midwife is present will be interrogated
• If a delivery is recorded in MSD301 Labour and Delivery for the woman, then there should be a corresponding record in MSD302 Care Activity (Labour and Delivery) to show the woman has been seen by the lead midwife or team during intrapartum care

Slide 20

The final step is to create the measure as a percentage. We will calculate the percentage of women receiving continuity of carer (ongoing).

Slide 21

We simply divide the numerator by the denominator and multiply by 100 to get the Percentage of women receiving continuity of carer. Data is published can be seen via this link which will be added to the transcript.

Slide 22

This measure is also broken down by mother’s ethnicity and by mother’s social deprivation as derived from her postcode. This data is taken from MDS001 and the most recent record in the reporting period is used.

Slide 23

These measures can be found in the published data as COC_receiving_ongoing, and then split by ethnicity and deprivation.

Slide 24

This brings us to the end of the video.

Thank you for watching this video demonstration on how the measure for the percentage of women receiving continuity of carer (ongoing) is built from MSDS

We hope you found this useful. This video is part of a suite of videos to help you understand key measures in MSDS.

We value your feedback, please use the email address if you wish to get in touch.

Thank you.

Slide 1

Welcome to this short video demonstration. This video is part of a series of videos to help you understand measures built from the Maternity Services Dataset, often referred to as MSDS

Slide 2

Today we will look at data quality thresholds that support the measure for the Percentage of women receiving continuity of carer (ongoing)​. This is published with measure ID (COC_receiving_ongoing)

Slide 3

Let’s look at why data quality thresholds are used. Measures built from the Maternity Services Dataset (MSDS) are published at various breakdowns, most commonly:

Provider, National, NHS England (Region), Local Maternity System, MBRRACE Grouping

To try and reduce the impact of poor data quality at provider level on national and sub national breakdowns, we sometimes apply one or more data quality thresholds to measures. Providers have to pass these thresholds for their data for the measure they support to be published and contribute to national and sub national breakdowns.

Provider level data for each data quality thresholds will be published alongside a result of pass or fail. If a provider fails the data quality threshold, no data will be published for the measure that the data quality threshold were supporting and so data for that provider will not be used in any national and sub national breakdowns.

This video will look at the thresholds for COC_receiving_ongoing and show some examples of how these are currently displayed in the published data.

Slide 4

There are four data quality thresholds that support COC_receiving_ongoing. The first is referred to as COC_DQ06 and calculates the Percentage of women who reached 29 weeks gestation 4 months prior to the chosen month, who were placed on a continuity of carer pathway and who were discharged from maternity services after being placed on a continuity of carer pathway​.

The second is referred to as COC_DQ07 and calculates the Percentage of women who reached 29 weeks gestation 4 months prior to the chosen month, and were placed on a continuity of carer pathway with at least 3 care contacts recorded since their care plan date.

Slide 5

The third DQ measure is referred to as COC_DQ08 and calculates Percentage of care contacts attended and where care professional information was recorded, for women who reached 29 weeks gestation 4 months prior to the chosen month and were placed on a continuity of carer pathway​.

The fourth one is referred to as COC_DQ09 and calculates the Percentage of women who reached 29 weeks gestation 4 months prior and were placed on a continuity of carer pathway and had a labour recorded, where the labour had care professional information recorded.

Providers have to pass all of these four measures at greater than 5% for data for COC_receiving_ongoing to be published and included in national and sub national figures.

Slide 6

We will look at the data items in MSDS that contribute to these measures. All of these data items can be found in the technical output specification version 2.0.25 available from the top link. There is also published meta data to explain how the measures are built. This is available following the bottom link. Data items used in these data quality thresholds also exist in the measure they are supporting COC_receiving_ongoing.

Please note, all links in this video are referenced in the transcript for this video.

Slide 7

We will look at each MSDS table in turn. Some data items are derived from several items sent by providers, this is identified in the source field in each table shown in the next few slides. We will start with looking at the table MSD000 Header. We use this table to establish the reporting month and the organisation who submitted the data.

Slide 8

We want to be able to uniquely identify each woman, we do this through data submitted to MSD001 mother’s demographics. From the data submitted by all providers, NHS Digital creates a field called PERSON ID (MOTHER). This is primarily generated from the NHS Number.

Slide 9

We use the table MSD101 pregnancy and booking details to get 4 pieces of information.

• UNIQUE PREGNANCY ID, NHS Digital gives each pregnancy a unique identifier derived through items submitted by all providers. This is used to uniquely identify each pregnancy
• APPOINTMENT DATE (FORMAL ANTENATAL BOOKING), which is used to mark the start of the booking and to calculate gestational age
• GESTATIONAL AGE AT BOOKING, NHS Digital derives this information from the APPOINTMENT DATE (FORMAL ANTENATAL BOOKING) and either the ESTIMATED DATE OF DELIVERY or the LAST MENSTRUAL PERIOD DATE
• DISCHARGE DATE this is used   to check if a woman is still in maternity services at 29 weeks gestation, but this is also used to check 4 months later that the woman has been discharged from maternity services

Slide 10

We use MSD102 Maternity Care plan to get care plan details. We need 5 pieces of information

• MATERNITY CARE PLAN DATE to determine date the care plan was put in place
• MATERNITY CARE PLAN TYPE to determine if the care plan was an antenatal care plan, identified by 05
• CONTINUITY OF CARER PATHWAY INDICATOR to determine if there is an indication as to whether this care plan is on the continuity of carer pathway, and we need to see 'Y' here to indicate yes.
• CARE PROFESSIONAL LOCAL IDENTIFIER to determine if a lead midwife has been assigned to the care
• CARE PROFESSIONAL TEAM LOCAL IDENTIFIER to determine if a team has been assigned to the women’s care

Slide 11

We use MSD201 Care Contact (Pregnancy)​ to get the details of all antenatal and postnatal care contacts during the pregnancy. We need 3 pieces of information

• We take the ‘CARE CONTACT IDENTIFIER’ to uniquely identify each care contact from the care plan date to discharge. 
• We need ‘CARE CONTACT DATE’ to identify which care contacts take place between Continuity of Carer care plan date and discharge​
• And then we need ‘ATTENDED OR DID NOT ATTEND CODE’ to identify only those care contacts which were attended, we will look for 5 and 6 in this field.

Slide 12

We use MSD202 Care Activity (Pregnancy) to get the details of the activities for the contacts we identified in the previous table MSD201 Care Contact (pregnancy). We need 3 pieces of information from this table.

• The ‘CARE CONTACT IDENTIFIER’ so we can link to the contacts we identified in 201
• The ‘CARE PROFESSIONAL LOCAL IDENTIFIER’ to see whether​ the woman was seen by their lead midwife during the care contacts
• And the ‘CARE PROFESSIONAL TEAM LOCAL IDENTIFIER’ to identify the team who performed the care activity during the pregnancy.

Slide 13

We use MSD301 Labour and Delivery and MSD302 Care Activity (Labour and Delivery) to get the details of intrapartum care.

• From MSD301 Labour and Delivery, we take ' LABOUR AND DELIVERY IDENTIFIER’ to uniquely identify a labour or delivery
• From MSD302 Care Activity (Labour and Delivery) we take ‘CARE PROFESSIONAL LOCAL IDENTIFIER’ to establish the care professional information is recorded

Slide 14

We use MSD901 Staff Details to get details of the care professionals we have identified in the previous tables we've looked at. We need 2 pieces of information from this table.

• ‘CARE PROFESSIONAL LOCAL IDENTIFIER’ to locate the care professionals named as providing care, and to assess consistency of the woman’s contact with her lead midwife during pregnancy and labour
• We take ' CARE PROFESSIONAL STAFF GROUP (MATERNITY)’ to establish whether the care professional information at a care contact is recorded.

Slide 15

We will start by looking COC_DQ06. This data quality threshold measure is assessing, of all the women who reach 29 weeks gestation 4 months prior to the chosen month how many were discharged from maternity services after being placed on a continuity of carer pathway.

Slide 16

We will start with the denominator: All women who reached 29 weeks gestation 4 months prior to the chosen month, who were placed on a continuity of carer pathway.

Slide 17

We use both PERSON ID (MOTHER) and UNIQUE PREGNANCY ID to count unique pregnant women. Both of these are derived as we have seen previously.

Next, we consider only those who reached 29 weeks gestation 4 months prior to the chosen month. We will count this in days, and 29 weeks gestation is 203 days. To calculate this, we take the Gestational age at Booking then add on the number of days between the antenatal appointment date, which is when the gestational age was estimated, and the start of the reporting month, Reporting Period Start Date.

We will do the same calculation but for the reporting period end.

We are interested in only those who reach 203 days gestation between the start and end of the month.

We then consider only women who have been placed on a continuity of carer pathway, who are identified through having an ‘05’ Care Plan Type, a ‘Y’ in the Continuity of Carer Pathway Indicator, and both Care Professional and Team Local Identifiers are populated.

We then look to use the Discharge Date from maternity services to check the woman has not been discharged, or if she has, it was after she reached 203 days gestation.

This is the denominator, all the women who reach 29 weeks gestation 4 months prior to the chosen month who have been placed on a continuity of carer pathway.

Slide 18

We will now look at how the numerator is calculated. We will be looking for women who reach 29 weeks gestation 4 months prior who have been placed onto a continuity of carer pathway by 29 weeks gestation, this is from the denominator. Then we retain only women discharged from Maternity services at some point in the following 4 months.

Slide 19

We use the cohort of women we found for the denominator

We include only those from this group who were discharged from Maternity services at sometime within the next 4 months.

Slide 20

The final step is to take the numerator and the denominator and to create the measure as a percentage. we simply divide the numerator by the denominator and multiply by 100 to get a percentage.

Slide 21

Next, we will look at COC_DQ07. This data quality threshold measure is assessing, of women who reached 29 weeks gestation 4 months prior and were placed on a continuity of carer pathway, how many have at least 3 care contacts recorded since their care plan date.

Slide 22

We will start with the denominator: All women who reached 29 weeks gestation 4 months prior to the chosen month who were placed on a continuity of carer pathway.

Slide 23

The denominator for COC_DQ07 has same build as the denominator for COC_DQ06, i.e., all the women who reach 29 weeks gestation 4 months prior to the chosen month who were placed on a continuity of carer pathway

Slide 24

Next, we will look at the build of the numerator.

Slide 25

For the numerator, we will be looking for women who reach 29 weeks gestation 4 months prior and who were placed on a continuity of carer pathway, this is from the denominator. Then we retain only women with at least 3 care contacts recorded after their continuity of carer plan date.

Slide 26

The final step is to take the numerator and the denominator and to create the measure as a percentage. we simply divide the numerator by the denominator and multiply by 100 to get a percentage.

Slide 27

Next, we will look at the third DQ measure COC_DQ08. This data quality threshold measure is assessing for women who reach 29 weeks gestation 4 months prior and were placed on a continuity of carer pathway, of all the care contacts since their care plan date, the number of those care contacts which were attended and included care professional identity and staff group information.​

Slide 28

We will start with the denominator: Number of care contacts since the care plan date for women who reached 29 weeks gestation 4 months prior to the chosen month, who were placed on a continuity of carer pathway.

Slide 29

For the denominator, first we will identify all the women who reach 29 weeks gestation 4 months prior to the chosen month, who were placed on a continuity of carer pathway. For this we use the same logic used for other DQ measures as explained in the previous slides.

Then we get the number of care contacts recorded for the women since their care plan date by ensuring the care contact date is on or after the care plan date, and the discharge date is not populated or is greater than or equal to the Care Contact Date for each of the care contacts.

Slide 30

Next, we will look at the build of the numerator. Number of care contacts for women who reach 29 weeks gestation 4 months prior, where the care contacts were attended and included care professional identity and staff group information.

Slide 31

For the numerator, first we will be looking at the number of care contacts recorded since their care plan date for the women who reach 29 weeks gestation 4 months prior, this is from the denominator. Then retain only those care contacts which were attended and included care professional identity and staff group information.

We do this by only looking for care contacts where the attend code is 5 or 6 and the staff group is between 01 and 16, or 98, as shown in this slide.

Slide 32

The final step is to take the numerator and the denominator and to create the measure as a percentage. we simply divide the numerator by the denominator and multiply by 100 to get a percentage.

Slide 33

Next, we will look at the fourth and final DQ measure COC_DQ09. This data quality threshold measure is assessing, of all the women who reach 29 weeks gestation 4 months prior, who were placed on a continuity of carer pathway with a labour recorded at some point in the following 4 months, how many had care professional information recorded for labour​.​

Slide 34

We will start with the denominator: Number of women who reach 29 weeks gestation 4 months prior to the chosen month, who were placed on a continuity of carer pathway, with a labour recorded at some point in the following 4 months.

Slide 35

For the denominator, first we will identify all the women who reach 29 weeks gestation 4 months prior to the chosen month, who were placed on a continuity of carer pathway. For this we use the same logic used for other DQ measures as explained in the previous slides.

Then we retain only those women who had a labour recorded at some point in the following 4 months. By looking for a record for pregnancy in MSD301 Labour Delivery.

Slide 36

Next, we will look at the build of the numerator. Number of women who reach 29 weeks gestation 4 months prior, who were placed on a continuity of carer pathway, with a labour recorded at some point in the following 4 months and had care professional information recorded.

Slide 37

For the numerator, first we will be looking at the number of women who reach 29 weeks gestation 4 months prior and were placed on a continuity of carer pathway and had a labour recorded at some point in the following 4 months, this is from the denominator. Then retain only those who had care professional information recorded in MSD302 Care Activity (Labour and Delivery).

Slide 38

The final step is to take the numerator and the denominator and to create the measure as a percentage. we simply divide the numerator by the denominator and multiply by 100 to get a percentage.

Slide 39

Providers need to pass all the four data quality thresholds COC_DQ06, COC_DQ07, COC_DQ08 and COC_DQ09 at greater than 5%. We will now look at how this is showing up in published data

Slide 40

We will use data published for July 2021, the link for this available from the transcript below this video. We will look at two randomly selected organisations.

• First, we will look at R0A, we can see from this image that R0A have passed only COC_DQ07 with 85.1% of women who reached 29 weeks gestation 4 months prior has at least 3 care contacts recorded since their care plan date. However, they have not passed COC_DQ06, COC_DQ08 and COC_DQ09 as the corresponding rate is not greater than 5%.
• Next, we will look at RA2, here we see they have passed all four data quality thresholds with rate greater than 5%.

We will next look at what this means for the measure COC_receiving_ongoing that these thresholds are supporting .

Slide 41

As R0A did not pass all data quality thresholds their data is not published in the final measure of COC_receiving_ongoing and does not feature in the national or sub national figures either

As RA2 have passed all four data quality thresholds their data for COC_receiving_ongoing is published and will contribute to national and sub national figures

Slide 42

Let’s look at the overall picture. For July 2021, 124 providers submitted data to MSDS. Looking at COC_DQ06, 39 providers passed this threshold with an average pass rate of 29%. Meaning that for approximately 29% of women who reached 29 weeks gestation 4 months prior, were discharged from maternity services after being placed on a continuity of carer pathway. 85 providers have not passed this 5% threshold yet as they are not supplying required information.

Similarly looking at COC_DQ07, 112 providers passed this threshold with an average pass rate of 71%. For these providers this means that for approximately 71% of the women who reached 29 weeks gestation 4 months prior to the chosen month has at least 3 care contacts recorded since their care plan date. 12 providers have not passed this 5% threshold based on their data submitted to MSDS.

Note that the threshold of 5% could alter in future as providers start to improve data quality and providers should be aiming to pass a completion rate of much higher than 5% for both data quality thresholds

Providers can access a Data Quality Submission Summary Tool designed to help them understand the validation reports provided after a submission on SDCS cloud portal, please use the link in the transcript to access this.

Slide 43

This brings us to the end of the video.

Thank you for watching this video demonstration we hope you found this useful. This video is part of a suite of videos to help you understand key measures in MSDS.

We value your feedback, please use the email address here if you wish to get in touch: [email protected]

Thank you.