NHS Maternity Statistics, England, 2023-24

Official Statistics

The MSDS data included in the Summary tables (and underlying data in  the main MSDS CSV file) are now badged as Official Statistics (formerly Experimental Statistics). This covers the following information: 

• Apgar score for live born term babies
• Skin-to-skin contact for live born term babies
• Live born term babies receiving breast milk as first feed
• Deliveries by mother’s smoking status at booking appointment by age

These measures have undergone the same assessment as the measures in the Monthly publication which have been badged as Official Statistics since the release of Final March 2024 data.  More information about this change can be found in Relevance section of the Data Quality Statement for the monthly publication. More information about Official statistics can be found on the UK Statistics Authority website. 

Data on Maternity services has been collected through the Maternity Services Dataset (MSDS) since 2015. This dataset covers all activity relating to the mother and baby (or babies), from the point of the first booking appointment until mother and baby (or babies) are discharged. The MSDS dataset is the most comprehensive source of data available regarding the pregnancy pathway and maternity care received by women in England and has been managed by NHS England since its introduction in 2015.

Monthly publications have been available using MSDS since November 2015 when it was voluntarily badged as Experimental Statistics due to its infancy and relatively lower levels of coverage and completeness. Therefore, the Experimental statistics badge was added to alert users so that findings were used appropriately. Over time, the scope and coverage of the data has improved.

Considerable work has been done to understand which providers should be submitting to the MSDS each month, and to on-board providers and support them to submit data. Targeting of key areas to improve data quality has been achieved through a dedicated data quality mailbox, provider support, communications via newsletters and updating of guidance which all continue as a part of routine work within the current analytical team. This last item includes the more recent development of a guidance hub which is a collection of documents, videos and useful links to support providers and users of MSDS data. We are now at a stage where we have a consistent number of around 120 providers submitting to the MSDS dataset each month.

Official Statistics in Development

These were previously known as Experimental Statistics. There are a couple of measures in the annual publication badged as Official Statistics in Development. These are: 

• CQIM Breastfeeding at 6 to 8 weeks  - due to the reliance on linking MSDS data to the Community Services Dataset (CSDS) data where data coverage and completeness needs significant improvement. Please note this measure is badged as Official Statistics in the Maternity Services Monthly Statistics as data quality metrics have been factored into the derivation of these estimates which strips out any poor data submitted by Trusts.
• Smoking at Time of Delivery - the status of this measure will be reviewed once the Smoking at Time of Delivery (SATOD) data collection becomes retired and data quality reconciliation work with MSDS has been completed at a local level.  In the meantime, data from the SATOD collection remains as the Official Statistic.

Accuracy

The MSDS is a rich, person level data set that records packages of care received by individuals in contact with NHS-funded maternity services. NHS England provides a number of different reports at different stages in the data flow to ensure that the submitted data reflects the services that have been provided:

For data suppliers only:

At the point of submission:

• Providers receive immediate feedback on the quality of their submission through a validation file. This file includes record-level reports of any submission errors, giving the data providers detailed information about which records produced which errors.

On receipt of processed data by NHS England:

• A variety of data quality checks are run as part of the validation and load process for monthly data, prior to production of the monthly release. Where there are concerns about data quality we contact providers directly so that any issues with local data extraction processes can be addressed for a future submission.

For all users:

As part of the monthly MSDS publications and this annual maternity statistics publication, we publish a CSV file of the data quality of submissions from maternity service providers.

Users of the data must make their own assessment of the quality of the data for a particular purpose, drawing on these resources.

In addition, local knowledge, or other comparative data sources, may be required to distinguish changes in volume between reporting periods that reflect changes in service delivery from those that are an artefact of changes in data quality.

Reliability

Coverage – are all eligible providers submitting data?

All providers of NHS-funded maternity services should submit MSDS data. We are now at a stage where we have a consistent number of around 120 providers submitting to the MSDS dataset each month. However, at present not all providers are making full submissions.  Detailed information on submission completeness can be found in the accompanying data quality file.

This publication reports on activity that was submitted for the April 2023 to March 2024 reporting period. As a national level data set there are a number of issues in terms of data completeness from providers for some of the tables which in turn has an impact on the geographical coverage expected of the data set. Hence, caution should be taken when interpreting some of the data at levels higher than individual provider level.

Because of this, no figures derived from the MSDS data have been presented as England totals, rather they are presented in terms of all providers who submitted data to the MSDS for the reporting period in question. While the number of submitting providers is all we expect, the number of providers submitting valid data for each data table and data item varies widely. Totals therefore continue to be presented as 'all submitters' values, and users of the data should consider the coverage for the relevant analysis when interpreting the data.

Coverage – is data for all eligible people included in the submission?

Local knowledge may be required to assess the completeness of a submission, based on information about local caseload. This publication provides detailed information about activity and providers and commissioners are encouraged to review this to ensure that submissions accurately reflect the local situation. Providers should also use all the aggregate record counts produced at the point of submission as part of the Data Summary Reports to check coverage in key areas (e.g. number of booking appointments.)

Duplication

Validations are in place to ensure that there is only one booking appointment for each woman submitted to NHS England per organisation for the particular reporting period. It is possible that one woman may have multiple booking appointments recorded for the same pregnancy for different providers. For any calculated total figures presented in this report, a woman is only counted once in relation to the activity related to the booking appointment. For example, if a woman is reported for a booking appointment by two separate organisations within the same NHS England Region, then they would be counted in both totals for each of these providers but would only be counted once for the overall NHS England Region. However, if the woman was reported by two separate providers within two separate NHS England Regions then they would be counted twice in each overall NHS England Region but once at national level.

If a woman is reported for a booking appointment by two separate organisations within the same NHS England Region and different data are submitted by each provider then this woman may be counted twice for the overall NHS England Region total. For example, where a woman has an age recorded as 39 by one provider and 40 by another provider this woman would be counted in the NHS England Region total twice, once in the '35 to 39' age group and once in the '40 to 44' age group.

Similarly, a baby reported by two separate organisations within the same NHS England Region with an Apgar score at 5 minutes of 6 recorded by one provider and 8 by another provider, this would be counted in the NHS England Region total twice, once in the '0 to 6' group and once in the '7 to 10' group.

Timeliness of recording events on local systems

Whilst local systems may be continuously updated, the MSDS submission process provides a time-limited opportunity for data relevant to each month to be submitted. The submission window opens the day after the reporting month and remains open for two months. This means that the timeliness of recording all relevant activity on local systems has an impact on the completeness of the MSDS submission. For example, a booking appointment made in May 2023, but not entered onto the local system until August 2023, will not have been included in the May 2023 submission (deadline end of July 2023). Providers should use the data summary reports produced at the point of submission to ensure that all relevant data has been included.

The submission requirements for MSDS are that all appropriate activity (e.g. booking appointment, dating scans, etc.) be included in the submission for each month in which they start, continue or end. It is important that data providers ensure that NHS numbers are submitted consistently because this is a key piece of information for creating the person identifiers in our records.

Quality of analysis

In previous editions of NHS Maternity Statistics, all data from MSDS were classified as Experimental statistics. Measures from MSDS  included in the Summary tables are now badged as Official Statistics. This change follows the similar change for the Maternity Services Monthly Statistics publication with effect from the Final March 2024 release. More information about this change can be found in the Data Quality Statement for the monthly publication. More information about official statistics can be found on the UK Statistics Authority website. Reference should be made to all accompanying footnotes and commentary when using these statistics.

Annual analysis from the MSDS is published alongside annual HES data, which are published as early as possible after the annual HES submission deadline. This report will be published on the pre-announced publication date.

NHS England also publishes maternity data from HES as part of this release.

As the number of deliveries recorded in the MSDS for 2023-24 is 96 per cent of the number of deliveries recorded in HES, some differences are likely to be found when comparing analysis common to both sources. This report contains some comparisons between certain data, common to both data sets. In April 2019, the MSDS transitioned to a new version of the dataset. Due to this change, data from 2019-20 onwards are not directly comparable to earlier years of MSDS data

Breastfeeding 

NHS England have a historical data collection on mothers initiating breastfeeding by NHS Trust and by CCG, which went up to March 2017. The MSDS reports the baby's first feed, which differs from the definition of initiation in the NHS England collection, so data is not exactly comparable between the two sources.

The official statistics for breastfeeding prevalence at 6 to 8 weeks after birth are produced quarterly and annually by the Office for Health Improvement and Disparities (OHID). This aggregate data is collected through an interim reporting system set up to collect health visiting activity data at a local authority level and is submitted by local authorities on a voluntary basis.

NHS England publish CQIM Breastfeeding at 6 to 8weeks data in the monthly Maternity Services Monthly Statistics using record level data from the (CSDS) and the (MSDS) to produce a comparable and more powerful statistic to that currently published by OHID. The CQIM Breastfeeding 6 to 8 weeks was first introduced in the publication of March 2022 data. An annual figure is also produced for this publication. Record level data supports reporting on inequalities such as deprivation and ethnicity. The longer-term strategic solution for data collection and reporting for these metrics is the Community Services Dataset (CSDS) which will eventually replace the statistics currently published by OHID. While the CSDS is operational and reporting is underway, providers remain at different stages of maturity with their submissions and additional time is needed for this dataset to reach sufficient coverage. For this reason, it has been agreed that OHID’s interim reporting arrangements will continue for now and the CQIM Breastfeeding at 6 to 8 weeks measure remains as Official Statistics in Development.

Office for National Statistics

The Office for National Statistics (ONS) also publishes annual data on births (live births and stillbirths) in England and Wales. These data are collated from local registrar records and are the most complete data source available. The latest publication for these data can be found here. ONS data is published by calendar year.

A comparison of the number of births (live births and stillbirths) recorded by ONS, HES, and MSDS for 2023 shows that both HES and MSDS do not capture as many births as the ONS annual data. It is always expected that there will be a small difference in total birth counts as the ONS figures will include births not taking place in NHS Hospitals and those not taking place under the care of NHS Maternity Services, however the scale of the difference suggests that there is under-recording taking place possibly in both healthcare datasets and particularly in MSDS. The ONS are the official source of National Statistics on birth counts in England.

All figures shown are for England and for the year 2023. These are for counts of births (babies born) to enable comparisons to be made with ONS figures, and are different to the counts of deliveries which form the majority of the content published in this report for HES and MSDS datasets.

For both ONS and MSDS data, births are reported based on whether the date of birth falls within the time period given. For HES data, births have been counted based on whether the start of the birth episode falls within the time period given. However, episodes are included in HES data based on when the episode of care finished. Therefore there may be a very small number of births in 2023 for which the care episode ended after 31 March 2024 that have not been included in this total.

Accessibility

Alongside this data quality statement, some narrative text and accompanying charts are made freely accessible via this NHS England website (former NHS Digital website) in HTML format with supporting MSDS data in Excel files or machine-readable format (with an accompanying metadata document). It also comprises a dashboard allowing users to access data in an interactive manner, including breakdowns by geography.

Re-use of our data is subject to conditions outlined here: https://digital.nhs.uk/about-nhs-digital/terms-and-conditions

Data Services for Commissioners Regional Offices (DSCROs) can obtain a record level extract of data relevant to the commissioners that they support and can share data with these commissioners subject to the relevant data sharing agreements being in place. Information about DSCROs is available from https://digital.nhs.uk/services/data-services-for-commissioners-dsfc 

Clarity

Three CSV files are available, with an accompanying metadata file in MS Excel format. A broad definition of each measure, including the data items used in the analysis and constructions and current or intended uses are provided. Terminology is defined where appropriate.

Full details of the way that MSDS returns are processed, which will be of use to analysts and other users of these data, are provided in the MSDS User Guidance, available on the NHS England website (former NHS Digital website): https://digital.nhs.uk/data-and-information/data-collections-and-data-sets/data-sets/maternity-services-data-set 

In order to prevent disclosure of identities or information about service users, all figures for all organisations which submitted, are rounded to the nearest 5. All figures between 1 and 7 are rounded to 5. Percentages are calculated from rounded figures.

The aggregate underlying data provides a much greater scope of analysis and will support a variety of local uses as well as meeting our obligations under the Code of Practice for Statistics and the Transparency Agenda.

NHS England is publishing the information in a HTML format, whilst supporting the Open Data initiative by also publishing data in a machine-readable format. By publishing a range of clearly defined measures in a timely fashion we hope to support discussions between providers and commissioners about caseload and activity and promote a virtuous cycle of improving data quality, through use.

For MSDS version 2.0 analysis, we have stopped producing the basic suite of data tables as part of this publication. However, the machine-readable data file is very detailed and allows data users to easily produce custom tabulations as required for their own analytical purposes. Some figures are also produced in an interactive dashboard accompanying this publication.

NHS Digital, prior to the merger with NHS England in 2023, held a number of workshops for maternity service providers and system suppliers, providing updates on the development of the data set and allowing clinicians, system administrators and informatics staff to provide feedback during the development stage. NHS England continues to hold regular workshops and webinars with service providers and system suppliers, providing updates on data quality and future development of the data set, and obtaining feedback on use of the data. 

NHS Digital also held workshops with analysts who used MSDS data and other maternity data to seek feedback to inform further development of reporting from MSDS to encourage wider use of MSDS data.

We welcome feedback on any data releases from the MSDS, which can be sent to us via [email protected].

As a 'secondary uses' data set, the MSDS does not require the collection of new data items by maternity providers. It re-uses existing clinical and operational data for purposes other than direct patient care.

Providers are not required to submit data held only on paper records as no provision has been made in the MSDS for the cost of transcribing these records to an electronic format.

Only three of the data tables are required to flow in every MSDS submission (MSD001, MSD002 and MSD101); completion of the remaining tables is only necessary when activity has occurred that is captured within these tables.

All publications are subject to a standard NHS England risk assessment prior to issue. Disclosure control is implemented where deemed necessary.

Please see links below to relevant policies, these will be replaced with new combined NHS England policies in time:

Statistical governance policy [Archive Content]

Freedom of information process

A guide to confidentiality in health and social care

Privacy and data protection