The NHS in England is to offer pregnant women their own “personal budgets”, worth at least £3,000, so they can pick and choose the care they receive.
Women will be able to use it to pay for anything from one-to-one midwifery care to home births, the use of birthing pools and hypnotherapy.
The move is part of a shake-up in maternity care unveiled by NHS England to increase the choices women have.
The overhaul is also aimed at improving safety in maternity services.
It has been agreed to on the basis of recommendations from an independent review of services.
This was set up by NHS England in the aftermath of the inquiry published last year into the failures that led to the deaths of babies at the University Hospitals of Morecambe Bay NHS Trust.
The review – chaired by Conservative peer Baroness Julia Cumberlege – said while it had never been safer to give birth in England, improvements still needed to be made to ensure care was “world class”.
Births and safety
- The numbers of stillbirths and deaths soon after birth have fallen by over a fifth in the past decade to 4.3 per 1,000 births and 1.8 per 1,000 births respectively
- In half of all stillbirths, there are elements of care that if improved could have made a difference
- Nearly half of all inspections of maternity services resulted in safety assessments that were either “inadequate” or “requires improvement”
- In about one in 17 births, there are incidents that result in some level of harm to either the baby or mother
The review’s report said while the numbers of still births and deaths shortly after birth had fallen by over a fifth in the past decade, about one in 17 births resulted in some level of harm.
It also highlighted the £560m spent each year by the NHS on clinical negligence cases relating to maternity care.
The review took evidence from thousands of families about their experience of maternity care and found they “did not always have confidence” that complications would be picked up or problems investigated properly.
To improve care, the review has called for:
- better data collection
- speedier referral when problems arise
- a nationally-agreed way of investigating care that goes wrong
Women also complained about the lack of choice they were given, despite existing policy stating they should be able to choose where they give birth.
Nearly nine in 10 women give birth in hospital, but just one in four says this is where she would want to have a baby.
Births and choice
- 664,543 births in England in 2014
- 87% of births took place in hospital
- 11% in midwife-led units
- 2% at home
The review team felt personal budgets, already used by the elderly, disabled and those with long-term conditions such as heart disease, would help empower women.
The system, to be piloted later this year before a national rollout in 2017, would give women a notional budget they could then use on whichever NHS-accredited services they liked.
These could include:
- private midwifery services providing one-to-one support during pregnancy and labour
- a home birth
- the use of a birthing pool
- hypnotherapy to relieve anxiety and pain
- extra breastfeeding support after birth
The review authors said low-risk, standard births cost the NHS about £3,000, so women could expect that sum at the very least.
Baroness Cumberlege said: “To be among the best in the world, we need to put women, babies and their families at the centre of their care.”
NHS England chief executive Simon Stevens said the review had set out a five-year strategy the health service could now work towards.
“The NHS could and should raise its game on personalised support for parents and their babies,” he said.
Health Secretary Jeremy Hunt said the publication of the review was a “significant moment” and would give women more choice and make services safer.
Royal College of Midwives chief executive Cathy Warwick said she was “delighted” with the plans, but warned more midwives would be needed to deliver the ambitions.
There are currently 21,500 working in the NHS, but the college believes another 2,600 are needed.