• The number of women to be put on intensive care pathway is expected to rise from 7.1 per cent to 11.3 per cent
  • The number of women put on standard care pathways is expected to drop from 65.5 to 50 per cent
  • Six additional conditions to be added to intensive and intermediate pathways

Spending on maternity services could rise by £221m next year, an increase of 8.3 per cent, under national tariff proposals published today by NHS Improvement.

The regulator has also proposed changes to the case mix for each of three maternity care pathways in the tariff, in order to ensure that providers are paid more accurately for the care they provide.

Under existing policy providers are paid according to which care pathway an expectant mother is assigned to.

In order to assign pregnant women to the right care pathway, clinicians identify which “clinical complexities” and comorbidities a woman may develop prior to birth.

Women are they then assigned to standard, intermediate or intensive care pathways, with trusts paid more for the most complex cases.

However, national tariff consultation documents show trusts do not believe they have always been reimbursed correctly for the work done.

In response, NHS Improvement is proposing four additional conditions be added to the “intensive” care pathway, including women with a high body mass index or with a serious neurological condition, and two to the “intermediate” pathway.

As a result of this change, the proportion of women put on pathways providing “intensive” care is expected to rise from 7.1 per cent of the total to 11.3 per cent, while the 38.7 per cent of women on maternity pathways will be classed as “intermediate” – up from 27.3 per cent at present.

This approach will change the relative weightings between the standard, intermediate and intensive prices, says NHS Improvement.

Consequently the proportion of women put on maternity pathways classed as “standard” – the cheapest tariff – is expected to fall from 65.5 per cent to 50 per cent.

However the change in maternity pathways will not increase or decrease the total amount of money allocated to the antenatal stage of care, NHS Improvement said.

It said the net effect overall would be an increase of around £221m on overall maternity spending, or around 8.3 per cent, in maternity spending.

The total impact of all the new proposed tariff changes would be a change of income within 1 per cent for 73 per cent of providers, and a change within 2 per cent for 94 per cent of providers, it said.

Although spending on maternity is expected to increase the most, there are also proposed increases on emergency care and nervous system procedures and disorders, of more than 6 per cent each. Meanwhile outpatient care, eye disorders and interventional cardiology are all earmarked for decreases in the amount paid to trusts.

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