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More midwives could work in community

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New changes to the way maternity care is funded could see increased numbers of NHS midwives working in the community.

A new tariff for maternity care based on a pathway payments model has been launched in shadow form and is expected to come into force in 2013-14.

The new model moves away from the traditional payment by results system which paid hospitals for each episode of care or medical intervention.

This led to what the Department of Health has called “pervese incentives” with hospitals financially better-off by avoiding proactive community based care in favour of more hospital visits for patients.

Under the new system, a commissioner will pay a provider for all the pregnancy-related care a woman may need for the duration of her pregnancy, birth and postnatal care. In general there will be no further payments, apart from a series of defined exceptions.

This means the financial reward for providing care in a hospital setting will be removed paving the way for providers to look at more community based services.

Overall the funding of maternity care in the NHS will remain the same at £2.5bn.

The new tariff also makes no difference between a normal delivery and a delivery with intervention such as a caesarean section in a bid to help encourage more normal births.

John Appleby, chief economist at the King’s Fund, said there was no evidence to show the current payment system was damaging the quality of care.

“There have been tremendous problems with PBR systems and getting the right figures. In my experience with any payments system you can identify what you think might be all the incentives and the perverse incentives and you put it out there and you can be completely surprised by how people behave,” he said.

“They have presented the upside but we don’t know what all the downsides might be. The hospitals will focus on financial sustainability  and when they are given one price they are going to try and make sure costs stay within that. We will have to wait and see how this pans out.”

Sean O’Sullivan, head of policy at the Royal College of Midwives, welcomed the changes adding: “It’s right to say the previous system rewarded hospitals for procedures, regardless of quality. This is a simpler system based on paying for the care at the original booking.

“Our view is that more midwives are needed but also if you do more community services it can reduce the workload on existing staff. The more medicalised the care the more midwifery care is required.”

He added: “90 per cent of births take place in a hospital setting so we think there is scope for more births in midwifery led units or at home. Home birth rates have dropped in the last year and we know more women would like to give birth at home.”

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