Baby Lifeline has contributed to a BBC Panorama documentary called ‘Midwives Under Pressure’, which airs at 8pm on BBC One on 29th January 2024.
The documentary highlights “serious concerns” about maternity services in one NHS trust, after whistleblowers approached the BBC.
Baby Lifeline’s research on wider national issues in maternity services has been included in the documentary to highlight a broader need for investment and change. This documentary is also another devastating example of the critical need to listen to families and staff who are concerned about their local service, especially where it poses a risk to the lives of mothers and babies.
Baby Lifeline’s analysis on funding in maternity services
Analysis of NHS cost data by Baby Lifeline* illustrated that whilst spend on maternity services has steadily increased, this increase was lower as an overall percentage of NHS spend over a ten-year period (from 2010 – 2020). If proportions had been maintained at the 2010/11 level then we would be spending hundreds of millions more each year on maternity services, and depending on the calculation method this could be as much as half a billion (a note on this analysis below).
This suggests that the £200-£350 million recommended by the Health and Social Care Committee is an appropriate figure and may well be an underestimate of what is required. This is particularly true if we hope to achieve the national ambition and deliver the improvements in maternity care that mothers and babies deserve.
Equipping maternity professionals to improve care
Baby Lifeline’s series of work Mind the Gap showed gaps in ongoing training for professionals on the frontline in maternity services at three timepoints including, crucially, training relevant to the main causes of harm and death for mothers and babies. The most frequently identified barrier to both attending and providing training locally related to a lack of resource: staffing, access to equipment, and access to venues.
The latest MBRRACE-UK report, which looks at the deaths of mothers in the UK, shows that there has been an increase in the number of mothers dying, and that stark inequalities persist.
Baby Lifeline has mapped the MBRRACE-UK data with its own analysis on training provision during the same period examined by MBRRACE-UK (2020/21). We found that training priorities in the period 2020/21 did not reflect leading causes of death in 2019-2021. For example, fewer than 40% of organisations trained staff in managing blood clots, which is the leading cause of death for mothers. As maternity care becomes more complex and tools to support care become better (and in many cases more costly), funding needs to be increased to provide the level of care that mothers and babies need and deserve.
*More detail on the cost data analysis
There are several ways to estimate what we spend on maternity services. One method is to analyse the National Cost Collection data, which are a key source of information about the cost of providing healthcare to NHS patients in England.
In 2010-11, core maternity services (delivering babies and providing a range of ante- and post-natal procedures) accounted for around 4.0% of the total value of NHS provider costs. If elements such as neonatal critical care, community midwife visits, and outpatient attendance are included then this figure rises to 7.3%.
By 2019-20 – i.e. the last year before the figures were distorted by expenditure related to the Covid-19 pandemic – these figures had dropped to 3.5% and 6.5% respectively. Spend on maternity services increased above inflation during the period – as it did for the NHS as a whole – but if these proportions had been maintained then we would be spending hundreds of millions more each year, and depending on the calculation method this could be as much as half a billion.
Of course, other areas of healthcare also require prioritisation as we deal with the changing needs of the population. However, maternity care itself has become more complex during this period and the NHS has initiated several quality improvement measures to reduce avoidable harm, both of which require significant investment.
Such methods of calculating the total spend on maternity care can at times be crude, and we must be aware of factors that can impact the figures and exercise caution when discussing in absolute terms. However, this research is an indication that the £200-£350 million recommended by the Health and Social Care Committee is an appropriate figure and may well be an underestimate of what is required. This is particularly true if we hope to achieve the national ambition and deliver the improvements in maternity care that mothers and babies deserve.