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The Maternity Review – Where are we now?

In February the Department of Health announced the new Maternity Budget. There were many aspects of the proposed changes to the way in which maternity services are provided, however the press quickly homed in on the ‘Birth Budget’. This budget would allow women to choose their provider of maternity care by giving them control of their own personal ‘birth budget. This, it was felt, would encourage those providers who lack personalised, women centred care to improve their level of service provision, for women and their families thus lifting the overall level of service offered by the NHS.

Since this announcement there have been many changes rumbling through NHS Trusts’. In June NHS Trusts’ will be asked to formally announce their expressions of interest in becoming early adopters of this initiative, with the early adopter sites going ‘live’ in September. In order to become early adopters they require to show their commitment to personalised care. Many NHS Trusts have been carrying out consultations with service user groups and staff to illuminate possible changes that can be made to the way that services are provided. Many NHS Trusts’ are seeking to provide more continuity of carer by adopting a caseloading model of midwifery care.

In contrast to the excitement around women being offered their choice of care packages from their choice of care provider it seems that the early adopter sites will comprise mainly of NHS Trusts. There will undoubtedly be private maternity care providers, already commissioned to provide NHS maternity care who will attempt to unlock this cartel, however those private providers who are smaller, perhaps independent providers may find the costs of enrolling in this scheme prohibitively expensive.

So where does that leave us? We may well see a gradual increase in the number of private maternity care providers but that may take years. In the meantime we hope to see an improvement in the overall level of care offered by NHS providers; greater access to antenatal education; choice over who your midwife may be; improvement over Trusts facilities such as birthing pools, active birth suites etc.

The illusion that women will be able to interview a number of private, or ‘independent’ midwives and engage their services is just that, an illusion. However, in time many independent midwives may well apply for enrolment in the scheme thereby increasing the choice for women. There are many bureaucratic hoops to jump through, all of which will be costly but this is aimed at ensuring that anyone providing care under the umbrella of the NHS offer standardised levels of safety and care. Spending all of the budget on hypnobirthing classes and massages will just not be possible.

Most importantly, for other private providers, if the budget isn’t massively increased from what is currently offered it will not be financially viable to offer the level of service currently being promoted. Caseloading midwifery, where each midwife has the responsibility for antenatal, birth and postnatal care is expensive; it takes many more midwives to offer this kind of care because this model of care takes far more time, and midwives cost money.

In the UK, independent midwives thrive because they offer women and their families a level of service that is not offered by the NHS. In order for the NHS to offer a comparative service it will need massive amounts of investment. So, will independent midwives enrol in this scheme; they’d have to carry much larger caseloads to make this a financially viable prospect and larger caseloads mean less time for women.  Savings would need to be made and with it compromises to each midwife’s ethos of care.

At the end of the day, it’s like every other business model, if you don’t invest appropriately you will be unable to provide the service promised. Women will walk…but how far? To the nearest other NHS provider? Is that really change, or just rhetoric?