Pregnant women should be given a personal budget which could allow them to appoint their own midwife, a major review into maternity services has concluded.
Soon-to-be mothers should be given a budget of around £3,000 to be spent on NHS services to ensure they get the care they desire, the authors said.
The quality of maternity services has been improving but not all are provided to a consistent, high level of qualityNational Maternity Review report
Under the proposed scheme, women would be told about all local providers of NHS care and the services they offer. They would then make decisions about how and where they receive care. For instance, women may chose a provider which ensures continuity of care from the same midwife throughout pregnancy, birth and postnatal care, the authors said.
Women would also be able to pick between a number of providers, for instance, they could pick a hospital near their workplace for routine scans and a hospital closer to home for the birth of their child.
The authors of the National Maternity Review likened the scheme to personal health budgets, where people with long-term conditions and disabilities are given a say over how NHS money is spent on them.
Some have criticised the personal health budgets scheme for being open to abuse, with reports of people using their budgets to buy holidays or computer consoles, but the review’s authors said only accredited providers would be eligible under this scheme.
Officials say the proposed move aims to give women more choice over how and where they have their babies - a key decision considering half of maternity services in England are deemed “inadequate” or “require improvement” in terms of safety.
The review highlights some concerns over the safety of maternity services, even though there have been drastic improvements in the last decade.
At present, hospitals are not always admitting when something has gone wrong, the authors said.
“It is clear that under-reporting of safety incidents is widespread”, they said.
“Safety is inconsistent across maternity services, and there is scope for significant improvement in many.”
They added: “The quality of maternity services has been improving but not all are provided to a consistent, high level of quality. The safety of maternity services must be improved.”
The review calls for a national standardised investigation process so lessons are learned after things go wrong.
Many families who lose a child feel as though they have to go through litigation channels to get answers about their baby’s death, the authors said.
They called for a “rapid redress” scheme where families whose babies suffered harm could make a claim without the need to go through the courts.
The review also called for better continuity of care across the NHS. It said every woman should have one midwife who is part of a team of four to six, who can provide care throughout pregnancy, birth and afterwards.
The authors also called for more resources for postnatal care, saying many women feel that services are “inadequately resourced for midwives to provide empathetic and comprehensive care”.
“Women have told us they want to be given genuine choices and have the same person looking after them throughout their care,” said Baroness Julia Cumberlege, chairwoman of the review.
“We must ensure that all care is as safe as the best and we need to break down boundaries and work together to reduce the variation in the quality of services and provide a good experience for all women.”
Simon Stevens, chief executive of NHS England, said: “The independent review ... rightly argues that the NHS could and should raise its game on personalised support for parents and their babies, better team working, better use of technology, and more joined-up maternity and mental health services.”
Royal College of Midwives chief executive Cathy Warwick said: “The review contains some radical elements, amongst these are the concept of providing far more care in community settings outside our acute hospitals, the introduction of NHS personal maternity care budgets, a rapid resolution and redress scheme for birth injuries and a discussion of how the maternity tariff may be constructed differently.
“All of these have the potential in different ways to make a significant difference to the way maternity services in England are delivered and will be taken forward in the implementation phase of the review.”