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Tariff proposal would see maternity spend increase by 8%

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Spending on maternity services could rise by £221m next year, an increase of 8.3%, under national tariff proposals published by NHS Improvement.

The regulator has also proposed changes to the case mix for each of three maternity care pathways in the tariff, in order to ensure that providers are paid more accurately for the care they provide. Under existing policy providers are paid according to which care pathway an expectant mother is assigned to.

“We are in favour of the money following the woman”

Sean O’Sullivan

In order to assign pregnant women to the right care pathway, clinicians identify which “clinical complexities” and comorbidities a woman may develop prior to birth.Women are they then assigned to standard, intermediate or intensive care pathways, with trusts paid more for the most complex cases.

However, new consultation documents on the national tariff for 2017-18 and 2018-19 – the set of prices that commissioners pay providers for NHS services – show trusts do not believe they have always been reimbursed correctly for the work done.

In response, NHS Improvement is proposing four additional conditions be added to the “intensive” care pathway, including women with a high body mass index or with a serious neurological condition, and two to the “intermediate” pathway.

As a result of this change, the proportion of women put on pathways providing “intensive” care is expected to rise from 7.1% of the total to 11.3%, while the 38.7% of women on maternity pathways will be classed as “intermediate” – up from 27.3% at present.

This approach will change the relative weightings between the standard, intermediate and intensive prices, said NHS Improvement.

Consequently the proportion of women put on maternity pathways classed as “standard” – the cheapest tariff – is expected to fall from 65.5% to 50%.

However, the change in maternity pathways will not increase or decrease the total amount of money allocated to the antenatal stage of care, NHS Improvement said.

The regulator predicted the net effect overall would be an increase of around £221m, or around 8.3%, in overall maternity spending.

The total impact of all the new proposed tariff changes would be a change of income within 1% for 73% of providers, and a change within 2% for 94% of providers, it said.

Although spending on maternity is expected to increase the most, there are also proposed increases on emergency care and nervous system procedures and disorders, of more than 6% each.

Meanwhile, outpatient care, eye disorders and interventional cardiology are all earmarked for decreases in the amount paid to trusts.

Sean O’Sullivan, head of policy at the Royal College of Midwives, said: “This is encouraging news which suggests that the funding will hopefully catch up with the real cost of providing maternity care for women.

“For too long this has not been the case, leaving trusts struggling to provide the highest quality care, or having to take money from other parts of their budget to fill the funding gap,” he said.

“Senior midwives are telling us that care is becoming increasingly complex and the amount trusts receive should reflect the actual costs of delivering the increasing demands on services,” said Mr O’Sullivan.

He added: “We are in favour of the money following the woman, and reflecting the level of care she needs and receives, so these are positive proposals.”

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