place of birth facilitating change through sharing research and good - PowerPoint PPT Presentation

Midwifery-led care and choice of place of birth facilitating change through sharing research and good practice Thursday 2 nd July 2015 University of Birmingham #copobconf

Commissioning a home birth service Diane Reeves Accountable Officer Birmingham South Central CCG

Why we commissioned the service • For mothers with a Why now? • Patient choice not previous uncomplicated birth, homebirth is available preferred option for • Patient experience optimum clinical and • Clinical commissioners psychosocial outcomes • Evidence base • Maternity capacity • Giving birth outside an obstetric unit review substantially and significantly lowers the risk of episiotomy, CS and instrumental delivery for multips

Commissioning a home birth service • Long history of trying to get it off the ground • Finance and tariff issues- introduction of more granular tariff • Lack of published evidence-Birthplace study endorsed the safety- published 2011 BMJ • Interaction of evidence with clinical commissioning • Increasing population, young city, high birth rates- links to capacity • Under-used home birth service because not dedicated - leading to patients not satisfied (promised service not happening). Not promoted as a result

What made it happen? Key success factors • Evidence, data, choice and capacity issues creating a mandate • Enthusiastic provider team, enthusiastic (female) GP commissioners- desire to improve choice and reduce interventions for low risk women • Non recurrent spending requirements- initial pump priming • Work to promote it to GPs- educational events, GP networks • MSLC support • “Big social conversation” engagement events - reaching diverse communities (but BSC patients only at present)

What were the GPs concerns about the service? GP survey circulated in July 2013 42 surveys completed Main concerns: • Medications • Attendance • Transfers • New baby checks

First Year • Was operational every day of the first year • 2013 : 0.31% of planned deliveries were home birth • 2014-15: slightly over 1% (target) (88 births v 80) • 2015-16: target 2% • 2016-17: target 3% • Great user feedback • Transfer rate for multips 14% cf 12% in Birthplace study • GPs concerns not realised

Commissioning for Quality • Intra-partum transfer review and benchmarking • Continuity of care: 3 or fewer midwives through whole package of care • Breastfeeding rates 75% • Incident reporting and monitoring • Diversity of users

What are the commissioning barriers? • Funding-3 rd year should be self funding through tariff 240 births (breakeven point) • GP uncertainty • Cultural beliefs amongst professionals and public • Equity of provision • Sustainability • Capacity expansion needed for roll out • MSW and development of new professional roles

For more details contact… Charlotte Barry email: charlotte.barry@nhs.net