MNVPs Are Not an “Engagement Extra” — They Are a Critical Safety Mechanism

When maternity failures are investigated across the NHS, one phrase appears again and again: “services did not listen.”

The problem identified in major maternity inquiries has not only been a failure of individual clinicians to listen during care. It has also been a system failure: the absence of credible, trusted, independent mechanisms for aggregating service user insight and translating it into meaningful assurance, escalation and change.

This is precisely the gap that Maternity and Neonatal Voices Partnerships (MNVPs) exist to fill and why MNVPs must be understood not as an optional engagement structure, but as part of a Trust’s core and valued safety and assurance infrastructure.

Inquiries such as Reading the Signals: East Kent, Ockenden: Shrewsbury and Telford, Morecambe Bay and Mid Staffordshire, show remarkable consistency.

Women and families raised concerns. Patterns of harm were visible over time. Signals existed well before chronic catastrophic outcomes.

What failed was not the existence of voices, but the ability of organisations to hear, interpret, escalate and act on those voices collectively.

These inquiries describe Boards receiving positive assurance while frontline experience was deteriorating. They show warning signs scattered across complaints, experience of care feedback, bereaved families’ accounts and community concerns — yet never brought together into a form that could disrupt false reassurance.

MNVPs exist to do what Trust’s assurance systems alone cannot

MNVPs are designed as an independent, service user led engagement and coproduction model. Their role is not to purposelessly collect individual stories, nor to replace complaint processes. It is to do something much more difficult, and arguably much more important.

MNVPs:

• aggregate lived experience across pathways and populations
• identify recurring patterns rather than isolated incidents
• surface cultural and relational risks invisible on data dashboards
• triangulate provider data with independent community intelligence
• escalate persistent concerns that do not resolve through routine routes
• provide a direct lived experience presence and authentic perspective in governance and decision making
• provide insight around how the decisions made by the service may impact those receiving care

This work operates at the same level as part of embedded quality, safety and governance — not alongside them as a “nice to have”.

In safety and quality terms, MNVPs function as a leading indicator system. They detect early signs of deterioration long before they show up in outcomes data, mortality reviews or performance metrics.

Why independence matters

Research into service user led engagement, coproduction and assurance is clear on one crucial point: independence changes both what can be heard and what can be said. 

When engagement is mediated or controlled by providers or systems, uncomfortable truths are softened, filtered or delayed, often unintentionally. When the response to this engagement happens solely in-house, it is naturally harder to develop solutions that challenge the status-quo – either because of how the institution shapes our perspectives, or because of the challenges of a hierarchical system. Power matters. So does trust.

Independent, service user led models consistently enable people to raise concerns they would not raise directly through provider structures. They create psychological safety for communities who have previously felt ignored or harmed. They are better able to persist with challenges that haven’t yet been resolved. 

MNVPs are intentionally designed to be alongside Trusts, not absorbed into them. When that independence is undermined, the system loses its capacity to hear what it most needs to hear and to find creative solutions to the challenges it faces.

For MNVP leaders to have the independence they need to be impactful they must have:

Freedom from the service pressures and controls, and freedom to challenge without fear of penalty

Tokenistic engagement and involvement weaken safety and don’t act to neutralise risk.

Coproduction research repeatedly warns that voice without power is not safe.

Bill Kirkup (Reading the signals: East Kent) noted that when a service user raises a concern it is often called a complaint. 

This can inadvertently create a position of defensives rather than learning within an organisation. Seeing MNVP Leads as equal partners is critical for an organisation to be able to view service user voice feedback as a valuable learning opportunity. When this power dynamic is unbalanced, it becomes all too easy to view the insight and concerns raised differently.

Under resourced engagement structures do not simply fail to deliver benefit. They actively create risk

By systems under resourcing MNVP’s, the very function they are there to provide is weakened, by: 

• offering illusion of listening
• providing false reassurance to Boards
• exhausting service user representatives
• and allowing unsafe patterns to continue unchallenged

If MNVPs are funded precariously, treated as marginal, excluded from assurance conversations, or expected to operate on goodwill alone, the model becomes symbolic rather than functional.

At that point, the Trust is not “investing less in engagement” - is weakening a critical safety control.

Sarah Wall, Service User Voice Representative, June 2026

References

Department of Health and Social Care (2025).
Review of patient safety across the health and care landscape.  
www.gov.uk/government/publications/review-of-patient-safety-across-the-health-and-care-landscape/review-of-patient-safety-across-the-health-and-care-landscape

Kirkup, B. (2015).
The Report of the Morecambe Bay Investigation.  
www.gov.uk/government/publications/morecambe-bay-investigation-report

Kirkup, B. (2022).
Maternity and neonatal services in East Kent: “Reading the signals”. 
www.gov.uk/government/publications/maternity-and-neonatal-services-in-east-kent-reading-the-signals-report

Martin, G., Stanford, S. and Dixon‑Woods, M. (2023).
A decade after Francis: is the NHS safer and more open? BMJ, 380, p.513.
www.bmj.com/content/380/bmj.p513

NHS England (2023).
Maternity and Neonatal Voices Partnership (MNVP) guidance.  
www.england.nhs.uk/publication/maternity-and-neonatal-voices-partnership-guidance/

National Maternity Voices 
About MNVPs and the role of independence.
www.nationalmaternityvoices.org.uk

Ockenden, D. (2022).
Final report of the Ockenden review: Independent review of maternity services at the Shrewsbury and Telford Hospital NHS Trust.  
www.gov.uk/government/publications/final-report-of-the-ockenden-review