Birth Budgets – A new way of improving maternity services

Posted 29/02/2016

The Independent Review of NHS England’s maternity provision released this week has made wide ranging proposals designed to improve safety for mothers and babies and give women greater control and more choices.

The review which was led by independent experts and chaired by Baroness Julia Cumberlege acknowledges that there are huge discrepancies in maternity care across the country with 38% of maternity services rated inadequate or requiring improvement by the Care Quality Commission. It highlights a number of key areas to drive improvement and ensure women and their babies receive the same standard of excellent care wherever they live.

Rosaline Wong, specialist medical negligence lawyer at Ashtons Legal, welcomes the National Maternity Review which proposes that women are empowered to choose where and how they want to give birth. With personalised support for parents and their babies, better team working, and more joined-up maternity and mental health services, it is hoped that future maternity care will be safer. Rosaline is pleased that the Review recommends greater accountability, transparency and trust between medical professionals.

She says: “To give mothers-to-be a personal birth budget of £3,000 to be spent on the NHS care they choose regardless of their choice of birth has generated a lot of interest and questions. Under the proposed scheme, women would be told about all local providers of NHS care and the services they offer. They would then make decisions about how and where they receive care. For instance, women may choose a provider which ensures continuity of care from the same midwife throughout pregnancy, birth and postnatal care. They may choose to have home birth, water birth or complementary therapies such as hypnobirth or acupuncture.

However I am concerned about the speed of implementation. My understanding is that four pilot schemes to test the plan are expected to launch next year with full roll out to all expectant mums due in 2018/19.

I can envisage circumstances in which choice would be very limited by availability. We know one in five pregnant women find it difficult to get the type of birth they want. If shortage of midwives is not addressed, then mothers-to-be will find it difficult to get the type of birth they want because their local maternity service simply cannot facilitate it.

The Royal College of Midwives reported there are currently 21,500 midwives working in the NHS, but another 2,600 are needed now to deliver safe maternity care. As birth rates and complex care continue to rise, many of our maternity units struggle to cope under immense pressure.

We know the quality of maternity care varies across the country. My experience of handling birth injury claims affirms that failing to adequately care for expectant mothers will cause needless harm to mothers and babies. Therefore the top priority of NHS England is to train and recruit more midwives before this ‘birth budget’ scheme is fully rolled out to all expectant mothers.

There are also a number of questions that spring into my mind which need answering. What if the hospital closest to you and your preferred choice is too expensive? What would happen if you have serious medical complications and the budget has already reached £3,000? Who would fund the additional and unexpected costs of care? Would this nominal budget turn into an actual cost limit? Would this scheme be treated as ‘cost neutral’ meaning that no new money will be set aside for its implementation? Would the less popular maternity units lose out or close down? Is every mum-to-be able to handle finance? Who would help them out in working out exactly how, when and on what they should spend the budget?

To some first-time mothers to choose is empowering but for others particularly those with language barriers or health issues it opens up all manner of anxieties. We do not want to raise hopes of mums-to-be only to disappoint them at the end. It would appear that a lot of work will need to be done by our health professionals within and across various organisations to turn this ambitious personalised care into a reality”.