- What does the evidence tell us about the choices women currently have and their awareness of their choices?
- What is the evidence underpinning the move to use Personal Maternity Care Budgets (PMCBs)?
- What is the intended aim for Personal Maternity Care Budgets?
- When will PMCBs be launched and be available to women?
- How do the Pioneers relate to the Early Adopters?
- Do I get choice if I am outside of a Pioneer area?
What does the evidence tell us about the choices women currently have and their awareness of their choices?
Better Births, a five year forward view for maternity care, highlighted two key pieces of evidence in relation to choice:
- A 2015 Care Quality Commission (CQC) maternity services survey.
- A 2014 survey by the National Perinatal Epidemiology Unit (NPEU) at Oxford University entitled Safely Delivered.
16% of respondents to the CQC survey reported that they had not been offered a choice of where to give birth.
25% of respondents to the NPEU survey reported that they were aware of all four possible choices of birthplace, 40% were aware of two or three options, and 33% were only aware of one option.
There are key differences in the methodologies and sample sizes used for these two surveys, so they should not be used for like for like comparisons. In particular:
- the CQC Maternity Survey asks women a number of questions about what choices they were actually offered
- the NPEU survey asked women about their awareness of their choices, rather than what they were actually offered.
This means that the NPEU survey could include women who are aware of their options for reasons other than having been offered the choices, for example from their own research or advice from friends.
The value of the two sets of survey results, however, is in their combined coverage of women’s reported awareness, and experience of being offered, choice.
The National Maternity Review showed clearly that in some parts of the country, women are finding it difficult to make choices about their care. Research commissioned as part of the review from the NPEU showed that most women do not feel that they have control over the choices they make about where and how to have their baby.
In light of this, the review recommended that future maternity care should be:
- centred on the woman, her baby and her family
- based around their needs and their decisions, where they have genuine choice
- informed by unbiased information.
The review team considered different options to enable choice and it was agreed that the NHS Personal Maternity Care Budget (PMCB) could be one way of doing so.
The review recommended that PMCBs are tested and evaluated first, to establish whether they achieve their goals and whether they should be rolled out across the country. The Maternity Choice and Personalisation Pioneers are undertaking this testing.
PMCBs will provide a tool for women to choose where they wish to receive their antenatal, intrapartum and postnatal care (in line with NICE guidelines) and may increasingly provide an opportunity to facilitate the flow of money between providers, to support these choices. They will be a mechanism put into women’s hands to actively empower their choices.
Through PMCBs, the Pioneers will increase the visibility of:
- the choices put in place by CCGs
- the choices actually offered to women
- the choices that women exercise
- how each of these is recorded and acted upon as women progress through their pregnancies.
PMCBs will be a notional budget based on the current maternity pathway payment system and will not provide a direct payment to the woman. More information about the payment system is provided in the tariff questions below.
Pioneers will begin to pilot PMCBs with pregnant women in their localities from December 2016, with all Pioneers having launched by the end of the 2016/17 financial year. Each Pioneer area has developed an individual piloting approach and details of the women eligible for the pilot in each Pioneer will be available as Pioneers launch their PMCB offer. Women will be offered a PMCB if they fall within one of the test areas at the start of their antenatal care pathway.
The Pioneers are focused on the recommendations in Better Births that talk about choice and personalisation. Early Adopters are looking at all the recommendations in Better Births.
NHS England welcomes the fact that two of the Maternity Choice and Personalisation Pioneers are also Early Adopters and believe this provides us with an exciting opportunity to work on the full range of recommendations from Better Births in these areas.
The Pioneer programme is a pilot that is exploring the extension of choice beyond what is outlined under the NHS Choice Framework. The Framework represents the current underlying NHS position and continues to apply in non-pioneer areas, NHS service users’ ‘legal right to choice’ remains as described in the Framework.