How are Maternity Services paid for?


Liverpool Women’s Hospital treats far more than maternity care but maternity is a key service. It is the largest maternity hospital in Europe, and a very good one.

How are maternity services paid for ?

The government pays Hospitals for different kinds of treatment. This payment is called the Tariff. The tariff for maternity is, nationally, far too low. There is a published recognised ratio of midwives to women giving birth. The government does not pay enough for maternity care to meet this ratio.This tariff has caused serious problems for the Liverpool Women’s Hospital.

The maternity tariff – the Trust maintains that the current national maternity tariff is insufficient for the complexity of patients served, leading to a maternity service line deficit of £5.8M in 2015/16. As a standalone Trust the organisation is unable to compensate for or cross-subsidise this from other services, unlike other typical multi-speciality trusts that include maternity services.”

A five-year financial forecast shows a deteriorating position over the next five years; with a forecast deficit of £7.3 million for 2015/16 which rises to an annual deficit of £22.6M in 2020/2. This assumes a 4% annual efficiency target. The recent planning guidance indicates a lower target may be applied; however, the Trust would remain in a financially unsustainable position.

The primary financial issues facing the trust are recognised to be beyond its influence to change significantly. The Trust has demonstrated good financial control and is exploiting all appropriate cost improvement opportunities.”

There are problems for maternity units and wards in many parts of the country because the government does not pay enough for maternity care.

Since 2010 and the coalition Government and this current government there have been the following closures or down grading. This at a time of rising birth rates

7 consultant led units closed since 2010

5 more replaced by midwife led units

7 midwife led units closed

3 maternity unit closure now planned or under consideration

10 consultant led units proposed to be replaced by midwife led units

In Liverpool 2016

The suggestion that the Liverpool Women’s hospital should be relocated to the Royal Liverpool new hospital has complications of its own. Taking all the Liverpool Women’s Hospital  beds into the Royal is not feasible..A new building on that site, which is far from an appropriate site, would cost tens of millions at a time when the NHS is short of money.

Why can we have a multi million new build but not sufficient midwives to  meet Royal College Standards of staffing? Why do midwives have to  have a pay freeze and the bursary be cut, if there are tens of millions in the pot?

“The exact number of beds at the current Royal can change daily based on demand, but the new hospital will have exactly 646 single-patient, en suite rooms when it opens in 2017, with no shared wards…” (Liverpool Echo)

The Royal Liverpool recently went public asking families to take patients home because they were full.There are big issues behind the idea of moving the Liverpool Women’s Hospital. There is a fake cheerfulness in the presentations and press statements around the suggestion. The gloss hides the big issues.

The extent of the problem is a shock to many people.

So we have a range of issues, all sprouting out from the situation of Liverpool Women’s Hospital in 2016

  • An inadequate maternity tariff
  • An under funded NHS
  • Government attempts to reduce the numbers of women using hospitals for birth, as a cost saving mechanism
  • A national move away from local consultant led care in childbirth.
  • The introduction of for profit private providers.
  • A national shortage of midwives  employment posts (There could be unemployed midwives but no paid positions available in some places)
  • A shortage of neo natal nurses.
  • The abolition of the midwives bursary.



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