Better Choice for a Better Birth

The NHS in England provides great maternity care. But it is continually looking to provide even better new and improved care. Tim Straughan, Head of Patient Choice at NHS England, takes a look at some of the challenges ahead.

Many women are not being offered real choice in the services they can access, and are too often being told what to do, rather than being given the meaningful information they need to make their own decisions. Quite often women are provided with a random selection of information and options that are not clear or easy to understand.

In February 2016 Better Births set out a vision and approach for improving maternity services in England and in her latest blog, one year on, Sarah Jane Marsh, Chair of the Maternity Transformation Programme,  describes how this ambitious vision can only be delivered by local transformation and sets out the approach and the progress being made to make a real difference to maternity services.

Essentially Better Births identified two fundamental principles – the importance of women being able to make choices about their care, and the paramount importance of the safety of mother and baby.

These are indeed two sides of the same coin – safe care is personalised care.

So what do we mean by personalised care? Every woman’s care should fit around and respect her, and her baby’s needs and circumstances.

Next question – how do we achieve personalised care? In December 2016 Jennie Walker provided an update in her blog, Personal Maternity Care Budgets: A new way forward,  on the work we are doing with seven Maternity Choice and Personalisation Pioneers in work stream three, to improve choice and personalisation using Personal Maternity Care Budgets (PMCBs).

This new way forward is based on an approach that gives women more control of their care, in partnership with their healthcare professionals, by giving them a PMCB. This approach includes deepening the range of choice within current settings, expanding choice across CCG boundaries and widening choice by providing opportunities for new providers or services.

So what is a Personal Maternity Care Budget (PMCB)? It can be explained simply as making personalisation happen.

There are four essential ingredients that form part of a PMCB:

  • Plan – A woman creates a personal care plan, owned by her, which records her choices in each stage of maternity care and she feels empowered to make these choices.
  • Meaningful Information – A woman has easy access to high quality unbiased information explaining her choices and providing her with the information she needs to support her in this choice.
  • Choice – A woman has choice of services and /or providers in each stage of the maternity journey.
  • Budget – A woman’s choices are supported by payment flows that help reshape services so they become more aligned with needs and requirements.

A PMCB is a way to ensure that the funding of maternity services follows the choices that a woman makes. They are also very flexible and recognise clinical needs and individuals wishes do change.

Each of the seven Maternity Choice and Personalisation Pioneers has developed their own version of a PMCB offer and we now have women trialling PMCBs in several of the pioneer areas and initial feedback is very encouraging .

The Next Steps on the NHS FYFV delivery plan published on 31 March 2017 supports the need for improvements in personalised care and support and reaffirmed the commitment to deliver 10,000 PMCBs by the end of March 2018. Our work aims to demonstrate that PMCBs deliver better outcomes by improving experience, enhancing safety by increasing continuity of carer rates, and increasing efficiency by supporting more women to have normal births closer to home. Based on this evidence we expect to roll out across England in 2018/19.

We believe that PMCBs will become the recognised approach for safe and personalised care and help ensure that every woman in England has a ‘better choice for a better birth’.

If you are interested in finding out more we have published some national FAQs to address some of the questions people have about PMCBs and how they will work.

Tim Straughan

Tim is the Head of Patient Choice which is part of the Personalisation and Choice Group at NHS England, working within the Commissioning Strategy Directorate and leading on the development and implementation of new models of delivering Patient Choice.

Tim joined the team in November 2016, and was formerly Chief Executive and Accounting Officer for the Health and Social Care Information Centre (now NHS Digital). Tim is also qualified dentist and chartered accountant and has also held a number of other national and local senior leadership roles within health and social care.

You can follow Tim on Twitter @timstraughan.


  1. Pauline Hull says:

    Can NHS England confirm whether the Personal Maternity Care Budget can be used by women who are requesting a planned caesarean birth?

    As I’m sure you’re aware, there are a number of NHS Trusts and hospitals that are not following NICE guidance and supporting caesarean requests.

    Thank you

    • NHS England says:

      Hi Pauline,

      Thank you for your comment.

      A Personal Maternity Care Budget supports a woman to make choices between what locally commissioned providers offer in her locality. The PMCB itself does not alter the offer for the woman, but is a tool which makes clear the choices that are available to her. As part of Better Births transformation, local maternity systems are asked to consider and improve the choice offer for women in their geography.

      To understand the local position on planned caesarean birth, discussions should take place with the local providers and clinical commissioning group.

      Kind regards
      NHS England