The MatNeoPREM project is co-developing a new questionnaire with women and birthing people to accurately measure their experiences of care in maternity and neonatal services. It aims to fill a critical gap by creating a robust and reliable instrument that captures what matters to service users and generates scores that can be meaningfully compared between stages of care, across sites or over time. NHS England plan to use the new MatNeo PREM to drive improvements in care.
The project is commissioned by the Department of Health and Social Care/NHS England.
This project is funded by the NIHR Policy Research Programme (NIHR206612). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
The MatNeoPREM project has a multidisciplinary team from across the UK, led by senior researchers at the London School of Hygiene & Tropical Medicine and in collaboration with University of Oxford, Royal College of Obstetricians and Gynaecologists, NHS clinicians & people who have experienced services.
When the new MatNeoPREM questionnaire is ready, information about how to access and use it will be available here.
We understand that reflecting on maternity and neonatal experiences can sometimes be challenging, this section provides a list of independent organisations that offer confidential support and care.
Project aim
The MatNeoPREM project aims to develop and evaluate a new Patient-Reported Experience Measure (PREM) for maternity and neonatal services. The instrument will be relevant, psychometrically robust, technically feasible, and accessible to women and birthing people from a diverse range of backgrounds.
Our core objectives are:
- To determine a conceptual framework that comprehensively describes the experience of women and birthing people across all stages of maternity (antenatal, intrapartum, postnatal) and neonatal care.
- To develop questionnaire items that accurately reflect every component of the conceptual framework, ensuring content validity.
- To establish the psychometric robustness of the new instrument using modern analytical methods, including Rasch Measurement Theory.
- To develop an implementation framework to guide the practical application of the new PREM within routine NHS maternity services.
Project background
The quality of a service user's experience in maternity and neonatal care has a profound and well-documented impact on the health and well-being of them and their families. A robust Patient-Reported Experience Measure (PREM) is therefore essential for understanding what matters to service users, enabling meaningful comparisons, and driving quality improvement.
However, the UK's National Health Service (NHS) currently lacks a single, validated PREM for maternity and neonatal care that meets contemporary methodological standards. Recent reviews of existing instruments highlighted significant weaknesses: many are not based on a clear conceptual framework, lack adequate psychometric validation, and fail to cover the entire maternity care pathway. Consequently, their results can be difficult to interpret and may be imprecise or misleading.
This project addresses this critical gap.
We will employ a rigorous, multi-phase methodology to develop the new PREM. The process will begin by establishing a conceptual framework grounded in both existing literature and new qualitative data from a diverse sample of service users. Following this, we will generate and pre-test items before conducting a large-scale psychometric evaluation to ensure the instrument is valid, reliable, and free from differential item functioning across key demographic groups. The final phase will focus on developing an implementation strategy in collaboration with key stakeholders to ensure the PREM can be effectively integrated into routine practice.
Project plan and timeline
Our project is structured in four phases over a period of 18 months. Each phase focuses on a key objective, from initial concept development to implementation planning.
- Phase 1: Building the Foundation (Nov24 – May25)
The first phase is dedicated to developing a conceptual framework that fully captures the experiences of women and birthing people in maternity and neonatal care. To achieve this, we will combine a "top-down" approach, reviewing existing literature and analysing archived in-depth interviews, with a "bottom-up" approach of conducting new semi-structured interviews with women from diverse backgrounds. The final framework will be reviewed with our Lay Advisory Group to ensure it is grounded in lived experience.
- Phase 2: Developing and piloting the Questionnaire (Jun25 – Oct25)
In phase two, we will create the questionnaire items. Working closely with our Lay Advisory Group, we will develop short, simple questions that reflect every component of the conceptual framework. These items will be based on the exact wording from our interviews whenever possible to keep women's voices central. The draft questionnaire will then undergo cognitive interviews to ensure the questions are clear, unambiguous, and understood as intended by a diverse sample of women.
- Phase 3: Scientific Testing & Validation (Nov25 – Apr26)
This phase focuses on ensuring the new PREM is psychometrically robust and ready for routine use. We will recruit a large, cross-sectional sample of participants for each stage of care (antenatal, intrapartum, postnatal, and neonatal) from 10 NHS Trusts across England. Participating NHS Trusts will be carefully selected to ensure that all geographical regions, neonatal / maternity unit types and sizes, and diverse maternity populations are represented in the sample. We will use modern psychometric methods, including Rasch Measurement Theory, to rigorously evaluate the questionnaire's measurement properties and ensure it functions consistently across diverse groups.
- Phase 4: Planning for Implementation (Jan26 – Apr26)
The fourth phase involves developing an implementation framework to support the PREM's practical application across maternity and neonatal services. This will involve creating a user manual and facilitated workshops with key stakeholders, including service providers, user groups, and national organisations. These workshops will address routine data collection, integration with national datasets, and strategies for linguistic and cultural inclusion to support the use of the PREM with as many communities as possible.
MatNeoPREM project team includes psychometricians, social scientists, clinicians and people who have experienced services, ensuring our research is scientifically robust, relevant, and grounded in real-world experience. The project team is supported by an advisory group, a lay advisory group and a steering group.
Project team
Dr Sarah Smith (co-PI). Sarah is an Associate Professor at the London School of Hygiene & Tropical Medicine (LSHTM) and is a psychologist and psychometrician. She has extensive experience developing and evaluating outcome measures across a wide range of clinical conditions in both health and social care. She has expertise in using both classical and modern psychometric methods and is committed to clear communication of these methods to users.
Dr Ipek Gurol-Urganci (co-PI). Ipek is an Associate Professor at the LSHTM with a research focus on improving the quality of healthcare for women across the life course. Her expertise is in the curation and use of complex linked datasets for research on determinants of variations in healthcare access, provision and outcomes across the UK. She is a methodology lead in large scale programmes such as the National Maternity and Perinatal Audit and the NIHR Maternity Disparities Consortium.
Dr Lisa Hinton (Qualitative Research Lead). Lisa is a senior social scientist in the Nuffield Department of Primary Care Health Sciences at the University of Oxford. She leads applied qualitative and mixed-methods research aimed at improving healthcare, with a focus on women’s health, patient experiences, inclusion, and diversity.
Dr Fran Carroll (Site Co-ordination Lead). Fran is the Head of Projects in the Clinical Quality department of the Royal College of Obstetricians and Gynaecologists (RCOG). She has a broad range of experience in national audit, quality improvement, and research projects aiming to improve maternity services for women, birthing people, and their families.
Kerrianne O’Rourke (Patient & Public Involvement Lead). Kerrianne is the Head of Patient and Public Involvement at the Royal College of Obstetricians and Gynaecologists (RCOG). She has extensive experience working with people with lived experience to ensure that research and decision-making is shaped by those who use obstetrics and gynaecology services.
Dr Christine Ekechi (Obstetrics). Christine is a Consultant Obstetrician and Gynaecologist and Co-Chair of the RCOG's Race Equality Taskforce. She is particularly interested in the social drivers that underpin inequity in health outcomes and in improving healthcare delivery.
Dr Sam Oddie (Neonatology). Sam is a Consultant Neonatologist in Bradford and the clinical lead for the National Neonatal Audit Programme and the National Maternity and Perinatal Audit. He has diverse research interests within neonatology and is committed to the integration of research into clinical care.
Dr James Harris (Midwifery). James is a clinical academic midwife, combining frontline leadership with research expertise. He has led national and regional programmes in maternity, published widely, and specialises in co-design, improvement science, and advancing equity and safety in care.
Ms Freya El Baz (Lay Co-applicant). Freya is the Vice Chair of the RCOG Women’s Network and a social researcher. Her work focuses on improving personalised care, informed decision-making, and equitable access to care, drawing on her extensive advocacy for women and families.
Ms Susanna Stanford (Lay Co-applicant). Susanna is a patient safety advocate with wide-ranging experience of Patient and Public Involvement within the NHS. Following her personal experience of severe pregnancy morbidity, she has provided patient representation in the development of multiple national standards and guidelines.
Chloe Wong (project team member). Chloe is a Research Fellow at LSHTM. She brings psychometric expertise from experience in educational psychology. She has experience in applying modern psychometric methods to validate measurement instruments and perform analyses of measurement function across diverse groups.
Dr Ruth Willis (project team member). Ruth is an Assistant Professor at the LSHTM. She is a social scientist who leads applied research to improve effectiveness and equity of health care. Her research focuses on social dimensions of health, patient experiences and implementation of health care.
Advisory group
MatNeoPREM project Advisory Group is co-chaired by Jane Plumb MBE and Lisa Hinton. The group consists of Dr Bill Kirkup CBE and representatives from professional and third sector organisations who support women and birthing people with lived experience of using maternity and neonatal services. The organisations represented in the advisory group are:
- Maternal Mental Health Alliance
- Tommys
- Sands
- Bliss
- Birth Companions
- Motherhood Group
- Five X More
- Interlink Foundation
- Muslim Women’s Network UK
- LGBT Mummies
- Royal College of Obstetricians and Gynaecologists (RCOG)
- Royal College of Midwives (RCM)
- Royal College of Paediatrics and Child Health (RCPCH) / British Association of Perinatal Medicine (BAPM)
Lay Advisory Group
The Lay Advisory Group is carefully convened to include a diverse group of women with recent experiences of maternity and neonatal care across England and is co-chaired by our two lay co-applicants, Freya El Baz and Susanna Stanford, supported by Kerrianne O’Rourke. The group includes women and birthing people of different ages and ethnic backgrounds; experiences of induction of labour, vaginal birth, planned and unplanned caesarean birth, or home birth; and those with mental health conditions, labour and birth complications and experience of neonatal care.
Steering Group
The Steering Group consists of representatives of the project team, NHSE, DHSC, academia (methodology), academia (maternity research), obstetrics, midwifery and neonatology. The Steering Group provides high-level oversight and strategic guidance to the project team.
Thank you for your interest in using the MatNeoPREM to measure and improve experience of care. Developed with women, birthing people, and clinicians, our instrument is designed to capture what truly matters in maternity and neonatal care.
When the new MatNeoPREM questionnaire is ready, information about how to access and use it will be available here.
We understand that reflecting on experiences of pregnancy, labour, or birth can sometimes bring up difficult emotions. If you’re feeling unsettled or would like to talk to someone, please consider contacting the organisations below or speaking to your GP or midwife for personalised support.
You deserve support and care.
- Birth Trauma Association
- MASIC
- Tommys
- Mind
- Pandas Foundation
- Maternal Mental Health Alliance (regional support signposting)
If you need to speak to someone, the following may be helpful:
- Samaritans (UK): 116 123 – Free 24/7 helpline
- Mind: www.mind.org.uk
- What does the MatNeoPREM score mean?
When the pilot testing and validation process is complete, the score from the MatNeoPREM questionnaire will indicate a person's experience on a continuous scale from best to worst, much like a ruler measures length. A key feature of the score is that it is designed to be comparable, so scores can be compared regardless of which hospital a person receives care in or at what stage of their journey they are at. To make it easy to understand, the project team will also develop clear guidance and descriptions to help users understand what different scores mean in a practical way.
- Who can the tool be used with?
The MatNeoPREM is being designed to be used by women and birthing people who use maternity and neonatal services. We are in the process of validating the questionnaire with people from a diverse range of backgrounds, and it was co-designed with their extensive input to be as inclusive as possible.
- When will it be ready?
The draft questionnaire is currently being pilot tested with women and birthing people to ensure it is clear, relevant, and easy to use. Once this is complete, we will conduct the final scientific validation. The new MatNeoPREM questionnaire will be ready in April 2026.
- Who is involved in developing the instrument?
The MatNeoPREM questionnaire was co-designed with women and birthing people as lay co-applicants, advisors and participants during all phases. This has ensured that the final instrument is grounded in lived experience. The questions in the MatNeoPREM questionnaire were developed from a review of high quality, peer reviewed scientific literature, secondary analysis of existing qualitative data and new qualitative interviews with a carefully sampled diverse group of women and birthing people with recent experience of maternity and neonatal services. Every idea in this conceptual framework is represented in the questions in the questionnaire. This ensures that we have content validity. The draft questions are carefully tested through cognitive interviews with women and birthing people who have recently used maternity and neonatal services to make sure that they are understood in the way that was intended. The questionnaire is validated with data from a representative sample of women and birthing people from across England.
You can learn more about the project team on our About the Team page.
New PREM is currently being piloted with a diverse group of women and birthing people. In this phase we use cognitive interviews to ensure questions and response options are understood in the way that we intended before we start field testing.
Draft questionnaire being developed based on the conceptual framework.
Conceptual framework finalised. This is a systematic description of the construct that we want to measure (in this instance "patient reported experience of maternity and neonatal care"). Our framework consists of 10 high level domains and smaller components within each domain. Each smaller component is directly mapped to become a question on the new PREM questionnaire.