Birth budgets for nhs- what do you think?

[ReallyTired]

www.bbc.co.uk/news/health-35634524

Somethings that women might want are nice, others are life saving. The passage of pregnancy, childbirth and motherhood are unpredictable. I am not sure that budget idea will work. If a woman blows her budget on one to one care does that mean there will be no budget left to support her with postnatal depression? There are women who have the perfect birth experience, but still get very ill because of their genetic make up.

Costs vary from woman to woman. Not all women need a budget of 3k. Do you think that giving every woman a budget of 3k will mean that some woman are allocated too much and other women don't get enough care.

[PausingFlatly]

Good questions about costs varying, and what will happen once the "personal budget" is spent.

This is actually part of a vouchers system being rolled out slowly and eventually intended to cover most or all healthcare, called personal healthcare budgets: you get a fixed amount of healthcare a year (segment by segment).

I note this maternity tranche is being rolled out under a banner of "to improve patient safety".

I wonder what mechanism they are claiming will achieve this?

The most likely one is what we have now in schools in England: there'll still be shit schools, kids will still have to go to them, but The Naice People will spend months of their lives sharp-elbowing their way into the better ones.

[PausingFlatly]

(The actual aim of personal healthcare budgets, of course, is to facilitate privatisation: the consumer shops from lots of different competing companies, like buying shoes.)

[ProbablyMe]

I'd like to know how this will affect care in more complicated pregnancies - I have an under active thyroid which requires more blood tests, I have to inject myself daily with anti clotting drugs from 28 weeks, have anaemia and have just been diagnosed with Gestational Diabetes. Will the higher cost to the NHS of my pregnancy mean I have no funding for other things such as breastfeeding support? Or will additional care needs be dealt with separately?

[BombadierFritz]

Why a budget? When i have a budget, say in my household money, it involves not being able to do some things, having to save up, make sacrifices, live within my means. I dont think any of those things should apply to healthcare - unless they apply to non health related issues like champagne breakfasts vs a nice cup of tea

[heavenlypink]

I find it very worrying and a means to back door privatisation. As Pausing said what happens when it is all spent? Imagine labour isn't going as planned and you are yet to give birth, will some 'accountant' pop up and say "Okay, you've spend your 3K in order to proceed we need payment. Cash and cards accepted? Can you just pop your card in the slot please"

[Hamsolo]

This is a bad idea. Firstly, it's part of getting people prepared to pay for NHS care which I oppose in principle. I am very suspicious that it will improve safety. Why would it?

I also suspect it's part of trying to reduce costs generally. What is included in this £3k? What happens if I budget for gas and air, then need an epidural? Will I be told I can't have one? What if I don't go in for monitoring because I've already been in twice and I'm worried about going over the cost? I don't think itemising the costs of birth and making women responsible for them will lead to safer deliveries, or increased choice.

Having prepared for a drug-free water birth first time around and ending up with an emergency section, I'm also very aware of how things can go differently than you expect. And I'm very glad that there wasn't a worried administrator with an excel spreadsheet trying to move funds around to get me the extra care that I needed.

[Bluelilies]

I think it's supposed to be about low risk births - so presumably c-sections, etc come outside the budget.

But isn't NHS heathcare supposed to be providing things that you need - so if you need more than £3000 worth, then you need it, and should get it. And if you don't need that much - say because you have a really straightforward birth - then you don't need it and shouldn't have it to spend on non-essentials either. How can £3000 be the right amount for everyone?

And how can you know what you'll need further down the line? Spent it all on a water birth and extra midwife, but then you hit problems breastfeeding and it's all gone, so no extra support for you? Budget to have extra breastfeeding support, so dispense with one to one midwife to save money, but then you get into difficulties so need one to one care - what then?

There was someonen on the news this morning saying women want continuity of care - so the same midwife from start to finish. But I was in labour over 24 hours - Can hardly expect the same poor midwife to cover that shift can I?

[namechangingagainagain]

Its all a bit of a worry isn't it....
I had 4 very straight forward births and healthy pregnancies..... however this is down to luck more than anything else. Would I have had a cash bonus... or be able to "spend my budget on baby massage or some such thing which would have been superfluous. Meanwhile my poor friend two had 2 very complicated pregnancies with lots of complication.... would she have had to stump up her credit card in labour once the cash ran out? The NHS is there to provide (ideally) an equal level of care for everyone. We are so lucky that when health-wise the shit hits the fan we don't have t worry if we van afford the c section or the long stay in hospital or the postnatal support.
This is obviously a way to privitise things so we can spend our "budgets" with dfferent "providers" i.e. companies. Fans of privitisation will claim this will drive up standards... Im not convinced that for the majority of people in tis country that will be true.
Interesting that already the spin is about how the hospitals are in debt, rather than that there is not enough funding to do the job they are meant to do.

[namechangingagainagain]

FWIW I don't think it matters a jot whether we think it is a good or bad idea..... the NHS is already privitised in parts and this is just an extension of this.

[SmallGreenBouncyBall]

I don't think it's a good idea.
how do you know as a lay person what you need?
I see that services have (great) room for improvement but this is nit the right way to go about it.

[Backingvocals]

It's crap. I don't want a sodding budget. I want to be looked after by people whose job it is to know what they are doing and who have the resources to do so effectively and with care.

[PausingFlatly]

Direct payments of various forms have been used in social care for a while, eg Disability Living Allowance (now PIP).

DLA/PIP is not even intended to cover the full costs - it's a contribution towards the additional costs of being disabled. It's expected from the outset that the disabled person will make up the shortfall. (Or keep the change, if their circumstances mean lower costs.)

[Bluelilies]

I think it works with DLA/PIP because disabled people are, generally, able to know what they need and make decisions about costs. They know, for instance, how far they can walk and whether today they need a taxi. And it's quite hard to separate what exactly is a disability-related expenditure, best just to give them more money to make their own decisions. Disabilities are long term too and people have time to learn about what their disability means for them.

Women in labour are dealing with something much more medical, more urgent, more unknown (most of us have at most 2 or 3 births), very often more frightening and more painful. And where the consequnces of bad decisions can be life-changing. How can that be a good environment to exercise meaningful choice? I'd like choice over what I eat for dinner in hospital, and what music I have playing. Beyond that I want medical practioners who understand the risks to tell me what medical care I need, or at least advise me of the options from the point of view of medical pros and cons, not the need to balance a budget.

[PausingFlatly]

Completely agree, Bluelilies.

I was just highlighting that, once personal budgets are established as a concept, an expectation that the user will pay to "top-up" follows almost immediately.

[ReallyTired]

I can see sense in a mother having a budget/ voucherfor antenatal classes and choosing from a list of approved providers. Some women would be happy with a weekend course and other women like a weekly course.

However women do not have equal needs when it comes to healthcare. There is no simple way of determining someone's need for healthcare when they are pregnant. I can see a situation where a woman is forced to pay for an epidural because she has gone over her budget.

[Maryann1975]

This is a dreadful idea. I was lucky, I've had one normal hospital birth, one straightforward homebirth and one homebirth that nearly ended with me being transferred to hospital. I'm guessing each of them cost less than £3000. But what about my friend who went into labour, her appendix burst while she was labouring and due to other complications she needed an emergency hysterectomy, her and her baby both ended up in intensive care while they recovered. That cost way more than £3000 i imagine. Does that get taken out of the budget too or would she have had to top up to get adequate care? There is no way I would want her care to have been cut short while I didn't need all of my allocated £3000.
Those of us lucky enough to have easy straightforward deliveries need to thank our lucky stars we did and those who need extra medical help deserve to get it, however much it costs.

[IceBeing]

I think this idea is bollocks from beginning to end.

When are people going to understand that it is isn't women's choices but random eventualities that control the level of care needed?

[Graciescotland]

My last pregnancy was twins so fortnightly scans from 14 weeks and a 13 day stay in SCBU at the end dread to think at what it cost the NHS tbh. I think the point of the NHS is that you get what you need when you need it.

[Terramirabilis]

Dreadful, dreadful idea. Care should be about clinical need.

[IAmNotAMindReader]

Bad idea. As pp have said no consideration has been given to clinical need. It will go the way of payments for care. Carers used to be drafted in on a per hour basis. So you would need x hours of care throughout the day. Now even if that still occurs the result is oh we can't offer x hours and its judged on what the person needs help with and crammed into 15 minutes.

[ReallyTired]

Maybe we need a mumsnet campaign against this stupid idea.

[BikeRunSki]

Of course it's privatisation by stealth.
In both my pg I would have blown £3K on my hospital admissions for hyperemisis by the second semester and I certainly wouldn't have known what services to choose to spend my budget on, this is what I want advice from medical professionals on. Then there's the GA, crash section, week in hospital afterwards.....

Ridiculous idea, open to abuse and poor decision making from uninformed people with little understanding of their needs. I wanted a water birth and to be home for tea. I got a crash section and week in hospital.

[lynholmerpark]

Although I don't know all the facts, to me this is looking very much like the end of equality of care for all. I was on a maternity unit in Africa a few years back (where basic cover is included for maternity care) and was present when a labouring woman's husband had to find the money in order to proceed with a C-section due to obstructed labour. Needless to say the outcome was poor for all concerned. Pregnancy and labour cannot be assumed to go to plan. Also, intrigued to see how safety will improve...

[RandomMess]

Proposal terrifies me. My childbearing days are over but the thoughts for the next generations if this goes ahead