Fair Shares for All

Chapter 10

Maternity Services

10.1 Introduction

1. Maternity services are one of the five hospital care programmes covered by the proposed formula, along with hospital acute services, mental illness services, care of the elderly services, and specialist services for learning disabilities. The maternity programme accounts for some 3% (£151m) of the total Health spend in Scotland

10.2 Adjustments to account for age-related needs

2. The SHARE formula currently weights maternity services across seven age bands:

15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49

3. Table 10.1 shows the average cost per birth across these age bands. For each Health Board an age weighting is derived by taking the birth rate within each age band and comparing the local pattern of inpatient maternity activity across the bands with the national average use of maternity services.

4. It is proposed that this weighting be retained, given that the age bands remain as valid today as before, and the fact that there are no refinements relevant to this programme which would add any precision to these weightings

Effect of the age cost weightings

5. The first percentage column in Table 10.3 shows the variation in Health Boards' relative needs for maternity services (compared to national average needs) arising from the age structure of their female populations. This indicates, for example, that the age structure of Shetland's female population is such that its resource needs for maternity services are 7% above the national average. This compares with the age structure of the population in Western Isles Board, which is such that the Board has 13.4% less need for maternity services than the national average.

6. The proposed system of age cost weights would lead to minor changes in allocations compared with the current adjustment for age in the SHARE formula

10.3 Adjustment to account for needs arising from morbidity and life circumstances

Current position under SHARE

7. The SHARE formula makes no morbidity and life circumstances adjustment for maternity services, relying on the pattern of the birth rate (shown in Figure 10.1), adjusted for age, as an overall indication of the resource needs for this care programme.

Proposed morbidity and life circumstance needs adjustment

Introduction

8. The differences between Health Boards' needs for maternity services are largely determined by the variation in the birth rate. These birth rate-related needs are already picked up in the age weightings described above, which reflect local birth rates sub-divided by age

9. SHARE did not attempt to go beyond reflecting this birth rate driven pattern of need. However the Steering Group has been able to improve on this by assessing, over and above the birth rate, the influence of morbidity and life circumstances on the need for maternity services

10. Chapter 5 described the decision tree within which adjustments for morbidity and life circumstances across all the care programmes have been developed. This underpins all the morbidity and life circumstance adjustments with a consistent evidence-based rationale running throughout the formula, based on the links between patterns of health service use and indicators for health need derived from population characteristics. At the same time the model developed for each care programme can reflect the different indicators that influence the need for services, following the particular path which available knowledge and evidence suggest is best for that element of care

11. The route taken through the decision tree by the maternity programme is shown below in bold italics. For this programme a disease-specific sub-division does not apply, so the options were between a whole maternity programme model based on the full range of needs indicators and a whole maternity programme model using a group of indicators identified by a literature review. On balance the model using the smaller group of indicators suggested by the literature review is recommended as the preferred approach. The process by which this conclusion was reached is explained in the following two sections (and more fully in the Technical Report).