AIBU to think that the £3000 budget for births is potentially a misleading con.

[RedToothBrush]

Women to be offered their own £3,000 'birth budgets' announced today.

Sounds great in principal. But it worries me too.

The way it sounds is that the idea is to let low risk women choose the care they receive. My worry with it though is it will mean that women are pushed into the low risk category even if not appropriate. I think it could have real implications for VBAC v ELCS. I note that no where does it say anything about choosing an ELCS. Would there be concerns where someone has 'used up' their budget and then couldn't afford pain relief? (Incidentally the cost of an ELCS was estimated as £2,369 by NICE in 2011 guidance). What if the hospital closest to you and your preferred choice is too expensive so you have to go to the unattached birthing centre otherwise you won't get breastfeeding support?

Also when its being described in the article, I get the impression that one to one care, home births and extra breastfeeding support are being framed as extras or expensive options rather than basic bog standard choices. Given that a homebirth is the CHEAPEST option, I find this misleading. Given each of these has proven long term health benefits which make them cost effective and indeed economically preferable it makes me raise my eyebrows.

The NHS patient charter states that all patients should get the most appropriate care for them already. This just appears to be a media headline grabbing stunt, which in practice could in fact be a way of LIMITING options rather than expanding the idea of raising the baseline for ALL care.

It strikes me as really smoke and mirrors to look good and win support. Its being heralded as empowering women. I personally think that empowering women with regard to childbirth isn't about budgets but attitudes within society and within medical circles. (Again going back to the article the fact that ELCS are not mentioned highlights the point to me)

(Incidently as an aside, the NICE guidelines for CS are due for review this year. I know there are a lot of women on MN who are pro-choice for ELCS for various reasons. I have grown alarmed in the last 6 months that there seems to be an increase in rationing ELCS going by the posts on MN. MN could in theory register as a stakeholder to represent some of our views. I would be over the moon if they could as there are very few organisations that directly represent the experiences of women in this area).

Currently the government pays a maternity "tariff" to hospitals for each pregnant woman they book, approx £1250 as far as I can recall. This covers all their maternity care, however complex, so if a woman needs repeated admissions, medical assistance or a long stay in hospital, the Trust effectively loses money. And they wonder why hospital trusts are haemorrhaging money hand over fist!
When I was in New Zealand (a fair while ago now) women could chose who their main maternity provider would be, whether independent midwifery practice or hospital-based, and the government funds followed them accordingly. From this point of view I think it could be a beneficial system, but otherwise I think it sounds like a poorly thought out disaster.

Looks like we can get the answers straight from the horse mouth tomorrow morning at 11am! www.mumsnet.com/Talk/guest_posts/2577351-Guest-post-and-Q-A-The-National-Maternity-Review-ushers-in-a-new-era-of-care

Picking up on Queen's post if the maternity budget per woman is going up from £1250 to the £3000 mentioned, then maybe that heralds a good and overdue improvement to maternity services in this country?
Obviously PP have raised a number of concerns about the detail of the proposal though.

Juggling in answer to your question on the other thread. MNHQ Rowan was on the Review Panel.

I think Katy Perry is a very talented and inspirational woman, I really dont get the vile some people give her. THe song firework is particularly good.

List in full in addition to Baroness Cumberlege.

National Maternity Review Team Members:
• Professor Sir Cyril Chantler, Vice Chair

• Alison Baum, Best Beginnings
• Dr Jocelyn Cornwell, The Point of Care Foundation
• Dr Catherine Calderwood, Chief Medical Officer for Scotland
• Rowan Davies, Mumsnet
• Elizabeth Duff, National Childbirth Trust
• Sir Sam Everington, GP and Tower Hamlets Clinical Commissioning Group
• Dr Alan Fenton, Newcastle NHS Foundation Trust
• Annie Francis, Neighbourhood Midwives
• Professor Dame Donna Kinnair, Royal College of Nursing
• Dr Bill Kirkup, Chair of the Morecambe Bay Investigation
• Sarah Noble, Birmingham Women's NHS Foundation Trust
• Melany Pickup, Warrington and Halton Hospitals NHS Foundation Trust
• Dr David Richmond, Royal College of Obstetricians and Gynaecologists
• James Titcombe OBE, Morecambe Bay parent and Care Quality Commission adviser on safety, (until September 2015)
• Janet Scott, Sands, the Stillbirth and Neonatal Death Charity, (after September 2015)
• Professor James Walker, University of Leeds
• Professor Cathy Warwick, Royal College of Midwives

Oh, that's great to hear RedToothBrush, thanks.

I think there have been so many great discussions on Mumsnet over the years about maternity care and pregnancy and birth experiences. I'm glad to hear this experience has been tapped into, contributing to the review, and our voices have been so well represented. Thanks Rowan

So basically Baroness Cumberlege dodged most of the questions on the £3000K.

Although she did say "I can assure you there is no hidden agenda to privatisation." [my bold]

Make of that what you will!

She also said: "Although it is based on a number of assumptions and different challenges are likely to occur in different parts of England, it suggests that a significant increase in the midwifery workforce is not required."

Which seems contrary to the views expressed on this and other threads.

('Scuse me copying from the Q&A thread, but her statements seem relevant to this one.)

I thought independent midwifes in Britain could not get insurance? So surely the NHS should not fund care that is uninsurable?

This article talks about the cost of giving birth in some other countries.

www.bbc.co.uk/news/business-31052665

Yeah that article is full of shit regarding the cost of delivering a baby here in the Us. I know exactly what was invoiced and what was paid. Yes you get invoiced for ludicrous amounts but that isn't what is paid. On a $200k pregnancy (ie care from first appointment where pregnancy is confirmed through to appointment 6 weeks post delivery) the amount paid out would rarely be over $25k with the insurance company paying the vast majority of that amount. The insurance company pays a package price for your whole care through your pregnancy. It's about $10k. If you need specialist care the price goes up but not by that much because most pregnancies cost less than $10k.

What gets really expensive here is fertility treatment. It's not uncommon to spend $30-50k and friends of ours spent about $100k. They had twins and as it was a high risk pregnancy they had every specialist under the sun. Their copay was about $5k (six years ago) and total bill paid was about $22k.

Damn right there isn't a 'hidden' agenda pausing. It's blatantly got 'future privatisation' written all over It in red pen hasn't it.

Two tier maternity services coming up folks. Mangers out the back if you don't have the cash or sharp elbows to fight your corner for decent care and support .

Excellent piece in the Independent today, that really sums up how I feel about this.

www.independent.co.uk/voices/the-idea-of-personalised-maternity-budgets-might-sound-attractive-but-mothers-should-resist-the-a6891871.html

The other thing missing from that BBC article is the amount of taxes paid. We pay very high rates in the UK on a personal level. Both Singapore and the Us have significantly lower tax rates in comparison.

However I do think healthcare is underfunded in the UK. Care is patchy and shouldn't be.

I don't think I'm any wiser after the Q & A than I was after reading the report to be honest. I think it leaves me with more worries if anything.

Yes, it wasn't the most interactive webchat ever was it Red?

Though I guess there were a few words addressing the most major concerns raised at least to some degree?

I think it's ridiculous and can't see how it will work. No two births are the same and you never know what is going to happen. My 'birthplan' for ds1 involved a home birth and all sorts of rubbish, had an emcs. With ds2 it was simply 'have baby, remain alive, keep baby alive'.

I can't see how you can know what to spend it on. I'm a lefty cynic and can't see any government policy being about doing anything other than money saving and sneaky privatisation. I think they're trying it with the prisons too.

Actually I disagree Juggling.

I don't feel any of my concerns particularly answered.

In particular there was one thing that really troubled me. I perhaps should give the benefit of the doubt and say she merely didn't understand my question under the time constraints but I'm worried.

Given that there was a huge emphasis on mental health in the report, the fact she didn't properly understand my concern regarding the lack of recognition and classification of mental health leaves me somewhat aghast.

If there are two pots of money and you don't get recognised as needing the second pot of money for an important part of the process (the actual birth bit) then women are going to fail in between the gaps even more.

The fact that the language rather than the content of the NICE guidelines themselves are not reflecting mental health accurately is cause for concern, and the fact this doesn't appear to be being picked up on given the context of the report being about bringing about exactly that type of change.

Anyway, I ranted at length about it on the other thread...

Well, I actually disagree with very little of what you say Red - but perhaps you think I was a bit over generous to Julia

I guess I felt mildly reassured by a couple of comments she made, for example there is some provision envisaged for those who's care may go over this £3000 budget. It still seems quite a two tier approach though so I don't see that as addressing the long-standing existing split between care under midwives and by hospital doctors. I'd like to see a more seamless joined - upness in care for the benefit of all women, especially as birth is an inherently unpredictable process, where care needs can quickly change.

I guess I'm probably slightly more hopeful than you that this review might bring in some long overdue positive changes to maternity services in the UK, especially if they are to be better resourced - but I know that's a very big IF

BTW I read your excellent post on the other thread about your specific but important concerns around ELCS and mental health and think you very clearly put forward a compelling argument for the proper recognition of mental health needs in relation to this.