Midwives could play a key role in deciding how much money hospitals are paid for maternity care under plans to modernise “payment by results” – the system though which hospitals are funded for providing treatment by NHS commissioners.
Health secretary Andrew Lansley revealed his vision for reforming the current system in a speech to the Nuffield Health Trust annual summit last week, using maternity services as an example.
He said the current system rewarded trusts for “processes and ticking boxes” and not necessarily for delivering the best possible patient care. It has also been criticised for encouraging trusts to carry out unnecessary hospital procedures, as they will benefit financially.
Instead, a new “pathway-based” tariff would see trusts get an amount of money up front based on initial assessment of care needs by health professionals such as midwives. For example, newly expectant mothers would first see a midwife to discuss their options.
Mr Lansley said: “The midwife would also carry out a risk assessment and consider factors such as whether there are any underlying health issues or previous birth complications. Depending on the results, the provider would receive a fixed amount up front, possibly for the entire pathway, based on the relative risks of the pregnancy.”
He said this system meant it was in the service provider’s best interests “to be as proactive as possible for that mother, to manage any other conditions and to prevent the need for any other interventions”.
It is the first time Mr Lansley has gone into detail about “pathway-based” tariffs – the introduction of which is being considered by the Department of Health.
Royal College of Midwives’ head of policy Sean O’Sullivan said: “Using an initial assessment as the basis for payment would be simpler and free up time that’s otherwise spent coding and doing paperwork.”
But he pointed out that risks could change over the course of a pregnancy, so there had to be some kind of mechanism to adjust payments to trusts. He said: “If they can crack that then in principle we think it’s a good way forward.”
It could also remove “perverse incentives” to do more maternity care in hospitals rather than community settings, he added.
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