The Royal College of Midwives has called for an “urgent” review of maternity funding after its research revealed a £340m gap in the money given to providers by commissioners for these services.
Data analysed by the RCM shows that during 2012-13 commissioning organisations in England – the former primary care trusts – reported using £2.58bn on maternity services, while providers reported spending £2.92bn.
The college said this suggested that some providers – especially those that deliver specialist services – are spending more money on maternity care than they are given.
The RCM said it feared the financial shortfall was causing some providers to deliver sub-standard services, as a result of attempts to make efficiency savings.
It warned that there were limits to how quickly services could become more efficient and pointed out the long-term damage to the NHS through cost-cutting measures, such as staff reallocation away from postnatal wards, birth centres and home birth services to ensure essential cover on labour wards.
“The costs of keeping services running is being pushed onto trusts, midwives and other NHS staff”
The findings have been published in the union’s latest report from its Pressure Points campaign, which calls for better funding and more resources in postnatal care.
The report – called Postnatal care funding: The case for better resourced maternity care – also includes results from a survey the RCM conducted last year, which found only 40% of midwives and maternity support workers reported having enough time to assess the emotional wellbeing of women after birth. This is despite the majority (60%) of mothers taking part in the survey saying they felt down or depressed during this period.
Around a third of midwives said new mothers were “rarely” or “never” given enough advice to spot potentially life threatening signs and symptoms in the 24 hours after birth, and more than 40% of new mothers thought that they were not given enough information about breastfeeding.
Meanwhile, the report noted the amount of funding per birth provided by commissioners fell from £3,931 in 2011-12 to £3,912 in 2012-13 – and when comparing funding for the different aspects of maternity care, postnatal services were allocated a “woefully inadequate” amount by commissioners.
Commissioners gave providers between £237 and £805 per woman for postnatal services, depending on the complexity of the mother’s care needs. Therefore, postnatal care cash equates to only between 8.5% and 13.8% of the woman’s total maternity care funding, said the report.
The college called on NHS England and healthcare regulator Monitor must review the costs of maternity care. They must also adjust the size and allocation of the maternity payment section within the NHS tariff system, which sets national prices for service commissioners, it added.
The RCM has called for more midwives and maternity support workers to be employed so that providers meet recommended staffing levels. It urged commissioners and providers to invest in long-term service reconfigurations, with a greater focus on midwifery-led and community-based models of care.
Cathy Warwick, chief executive of the RCM, said: “It’s shocking that funding for maternity has not increased to keep pace with the baby boom and the rising demands on services.
“The costs of keeping services running is being pushed onto trusts, midwives and other NHS staff. Midwives and maternity support workers have already contributed so much – they are being paid less in real terms, and they skip breaks and work overtime unpaid.”
Professor Warwick added: “The government must urgently review the level of funding for maternity services, commit to ending staffing shortages and invest in genuine improvements that will make the service more efficient, more effective in the long-term and deliver the level of postnatal care that women and babies need.”
The release of the report was timed to coincide with the college’s annual conference, which is taking place in Telford this week.