The LSSI4 Version 2 framework has been developed as a national maternity early warning system, designed to identify where services are under pressure today, where they are beginning to deteriorate, and where support is needed next — enabling earlier, targeted intervention before risks escalate.

It moves beyond traditional retrospective reporting by helping NHS systems answer a critical strategic question:

Where are maternity services likely to come under pressure next?

The framework is built around four clinically credible indicators drawn from national maternity safety datasets

• Severe Perineal Trauma — CQIMTears
• Postpartum Haemorrhage — CQIMPPH
• FGR Surveillance Compliance — Saving Babies' Lives (SBL) Element 2
• Emergency Caesarean Rate — Mode Caesarean Emergency

Each metric is recognised within established national maternity safety frameworks, and together they provide a stable, comparable and improvement-oriented index for benchmarking, system support and longitudinal monitoring.

Crucially, LSSI4 Version 2 has not been designed as a performance ranking, league table or regulatory judgement. Instead, it has been built from the outset as:

• A clinically meaningful intelligence framework
• A transparent and improvement-focused methodology
• A policy-aligned, ICB-level system support tool

The strategic intent is not to judge organisations, but to anticipate pressure earlier — so that support can be targeted before risk becomes critical.