• London CCGs warn funding for fetal medicine services is “insufficient”
  • Five groups say current arrangements could “impact on equitable provision”
  • Comments follow HSJ investigation that revealed babies were “dying unnecessarily” due to flawed funding system

Clinical commissioning groups in London have said funding for fetal medicine services is “insufficient”, and warn that unless current arrangements are improved it could “impact on equitable provision”.

Fetal medicine is a highly specialised service involving the diagnosis and treatment of complications that can arise in unborn babies.

In June HSJ revealed consultants in the capital had warned that babies were “dying unnecessarily” because local hospitals have a perverse financial incentive to “hold on” to patients rather than make a referral to a specialist unit.

The warning was set out in a letter circulated by leading consultants at London’s specialist fetal medicine units, and included anonymised examples of patients being mismanaged and in some circumstances experiencing harm as a result.

HSJ’s story prompted a letter from the London maternity clinical network to the capital’s CCGs on 30 June asking about their arrangements for ensuring women and babies have access to the services.

HSJ has obtained the CCGs’ responses under the Freedom of Information Act.

While the groups who have so far responded said they were assured about the safety of women and children in their area, a number raised concerns about the funding system.

Barnet and Haringey CCGs, which are both part of the north central London maternity clinical network, said “funding is insufficient in some cases, and changes to the tariff to enable more appropriate funding arrangements are awaited”.

Five CCGs in south east London went further and said there were “not fully robust inter-provider arrangements” in place in their patch, and the existing system risked the “equitable provision” of fetal medicine services.

Under current arrangements, rather than having a dedicated budget like most specialised services, fetal medicine is funded through the money allocated for general maternity services via the “maternity tariff”.

Where complications arise requiring a referral to a specialist fetal medicine unit, the unit is expected to recoup its costs by billing the district general hospital which made the referral.

However, because of the highly specialised nature of fetal medicine, the cost of procedures frequently far exceeds the money local hospitals receive through the tariff – HSJ revealed that tertiary units are haemorrhaging money, with less than 10 per cent of bills for referrals being paid.

In their responses to our request for information, Bromley, Greenwich, Lambeth, Lewisham and Southwark CCGs raised concerns with the inter-trust charging system.

“South east London commissioners and providers… collectively recognise that unless robust inter-trust charging arrangements (that are seen as equitable to all providers) are agreed, the financial implications of the current arrangements could potentially impact on equitable provision in the future,” they said.

An NHS England spokeswoman said proposed tariff arrangements for 2017-19 would increase spending on maternity services by £332m (13 per cent).

“Trusts are responsible for ensuring women receive clinically appropriate antenatal care and should recoup the money from other hospitals when a woman receives treatment elsewhere,” she said.

“We will consider what changes may need to be made to current reimbursement arrangements in the future for maternity care following the recommendations made in the maternity review.

“We will also look into the possibility of ‘unbundling’ the costs of fetal medicine activity from the pathway tariff, so it could be separately reimbursed.”