The economic climate in England over the next decade presents greater challenges than ever before for health and social care services. It is estimated that if the current model of health care provision continues, the NHS will face a funding gap of around £44–54 billion by 2020/21 (Nuffield Trust, 2012). This is based on the gap between the projected spending requirements and available resources. Many midwifery managers and leaders are faced with making tough financial decisions about how they ensure the safe provision of high quality maternity care, while meeting Trust requirements for efficiency savings.
Why does it feel like it's time to ‘batten down the hatches’?
Despite financial challenges, leaders and managers continue to ensure that their services provide dynamic, integrated models of care that respond to the changing health and social care needs of women and their families. The recent Department of Health investment to improve birth environments in England has resulted in redesigned/refurbished maternity care environments that midwives and women who use these services can be proud of. Sadly such investment is unlikely to continue as austerity plans influence the way forward.
The new financial year 2015/16, will create unprecedented challenges for managers and leaders of maternity services, who must ensure that they make informed decisions about efficiency/cost improvement plans. They should not be made to feel pressured into agreeing a plan that is unrealistic or compromises safety. Standing up for what is right takes courage and can feel like a lonely place to be. It is, however, important to remember that the involvement of the midwifery team and peers can be invaluable in critiquing and validating efficiency plans.
Responding to the current financial challenges
For many services there is a requirement to ‘do more with less’, ‘work differently for less’ or ‘cost less but generate more income’. Whatever the approach, it is important that the contribution required from maternity services to meet the Trusts efficiency savings is agreed between the head/director of midwifery, general managers and the finance team. Without this agreement, the savings required may exceed the efficiencies available. This may result in an undeliverable efficiency/cost improvement, or the manager feeling pressured into meeting an unrealistic request. The latter may result in vacant posts being removed from budgets, resulting in a healthy vacancy rate for the service, but a poor midwife:woman ratio.
The ‘do's’ and ‘don'ts’ when planning efficiency savings
Do's
- Ensure that the woman/baby and quality are at the heart of all that is planned
- Understand your community, demography, service demand, birth rate projections
- Seek mutual agreement of the efficiency/cost improvement with the general management and finance colleagues
- Ensure that professional standards/guidance are followed or there are established agreed plans in place to meet these standards (e.g. midwife:woman ratio, supervision ratio, integrated models of care, choice of place of birth, responsive education programme)
- Find innovative, efficient and, where possible, evidence-based ways of doing things differently without compromising safety
- Review your risk register for associated interdependencies of the item you are choosing to change/give up as a saving
- Develop credible and defensible efficiency plans
- Develop the efficiency plans with the midwifery team and seek critical review/endorsement from peers
- Where the efficiency/cost improvement plans relate directly or indirectly to midwifery practice, ask the supervisors of midwives to critically review the plans
- Undertake a quality impact assessment of all plans and adjust/reject plans that fail the assessment.
Don'ts
- Agree to an unrealistic efficiency target
- Compromise professional standards/guidance in the name of ‘efficiencies’
- Work in isolation, a ‘problem shared is a problem halved’
- Be afraid to reject an efficiency plan that has not withheld the scrutiny of an quality impact assessment.
While maternity services may be a small ‘cog’ in a very big NHS wheel, the financial contribution toward the overall NHS deficit is significant. Although this requirement has stimulated leaders to find ways of doing things differently to improve productivity and make efficiency savings, the provision of high quality maternity care should remain paramount. The presence of strong leaders is evidence that their contribution is necessary. Therefore, managers and leaders should: stand up for what they believe to be right, be courageous and remain steadfast. The journey won't be easy, but it will be worth it!