Women should be given their own budgets to spend on their maternity care, a national review has said, as part of a series of recommendations to increase the proportion of births outside of hospital settings.
The National Maternity Review, published today, also calls for new community hubs and for commissioners and providers to establish local areas covering populations of between 500,000 and 1.5 million people.
“The whole purpose of this report is absolutely not to drive women out of hospitals into the community for the sake of sustaining the NHS”
The review, chaired by Baroness Julia Cumberlege and commissioned by NHS England, placed an emphasis on meeting women’s choice, which will increase community births and help the NHS save money.
It stated: “If we match services to meet women’s choices more clearly, it will result in a significant increase in the proportion of births at home, in a freestanding midwifery unit and in an alongside midwifery unit.
“As well as reflecting what some women want, care in these settings costs less when accompanied by service transformation across the local health economy,” it said. “This would need to be carefully managed by local maternity systems but is essential to meet the coming efficiency challenge.”
The focus of the review was not to “drive women out of hospital” but was about ensuring their choices were acted on, said Sir Cyril Chantler, vice chair of the review, in an interview with Nursing Times’ sister title Health Service Journal.
According to the review, a personal maternity care budget will give women “direct control over which provider receives money for their maternity care”.
This would be used with accredited local providers who would be approved by the Care Quality Commission and meet key quality and governance rules in similar contract arrangements to GPs.
The review said this will allow women to choose a wider range of providers including independent midwifery practices. Four pilot sites are expected to launch in September backed by £8m from NHS England over three financial years.
A significant increase in the midwifery workforce is not required to meet the recommendations of the review, according to the report.
Sir Cyril said the review’s recommendations were driven by “what women want”.
“The whole purpose of this report is absolutely not to drive women out of hospitals into the community for the sake of sustaining the NHS. The review needs to be read as a whole,” he said.
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He said it was for “patients to make the choice”, adding that they needed to be properly informed.
On the proposal for a personal budget for maternity, Sir Cyril said the recommendation was not pre-determined before the review started, as has been claimed by some. He added that it was part of NHS England’s Five Year Forward View.
“It was not given to us and told it had to be in the review; that is absolutely not the case,” he said. “Was it suggested? Yes it was. It was discussed and some people were keener on it than others… but we worked it through to become a recommendation with very defined terms.”
He said the personal budget was a way to help women make their choices stick and any providers being part of the system would need to meet criteria similar to that for GPs.