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Analysis of Maternity Services Funding Allocations in Hertfordshire Healthcare

A review of maternity services funding in Hertfordshire, including the weighted capitation formula, actual funding distribution, payment systems, quality improvement initiatives, and market forces factor.

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Analysis of Maternity Services Funding Allocations in Hertfordshire Healthcare

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  1. REVIEW OF MATERNITY SERVICES TOPIC GROUP4th November 2009 FINANCE

  2. PCT FUNDING • Weighted capitation formula sets target allocation – to reflect relative population needs • Actual current funding is largely historical • Distance from target taken account of • Along with Pace of Change policy • To determine % growth

  3. Weighted Capitation Formula • Population – all registered with a GP and non-registered within geographic boundary • “Weighted” to take account of: • Age • Additional need • Health Inequalities • Unavoidable geographical variations in costs

  4. As a Result • Hertfordshire’s allocation in 2009/10 £1.533 billion • Actual funding per head of £1390 (9.8% less than England average of £1540) • Target funding per head of £1357 (11.9%) less than England average of £1540) • Hertfordshire over-funded compared to the formula by £36m (2.5%)

  5. Analysis of 2008/09 Expenditure

  6. How Trusts are Paid • “Payment by Results” activity : National Tariff • In maternity services this is applied to • ante-natal clinics held in hospitals, • deliveries in hospitals or at home, • post natal clinics in hospitals • All Other Activity : Local Prices • In maternity services this is all other services, mainly community midwifery, payment made on a “block” basis, moving towards activity-based contracts

  7. Payment by Results Activity • Payment for this activity is: • National “tariff” • Plus “CQUIN” (Commissioning for Quality and Innovation) linked to quality improvements • Plus “Market Forces Factor” to cover geographical differences in cost

  8. National Tariff Maternity Services

  9. Payment by Results Activity • National tariff is based on historical average = “reference costs” of Trusts, so reflects actual costs • Payment related to volume • Updated annually • Money follows the patient

  10. Payment by Results Activity • Patient has choice of place of delivery and type of delivery • PCTs work with local providers to ensure good quality services provided

  11. CQUIN (Commissioning for Quality and Innovation) 0.5% of Tariff Reflects a move towards payments related to quality. In 2009/10 this included improvements to the experience of patients for maternity services at local hospitals West Herts and E&N Herts Trusts: 25% - 30% of the 0.5% (c.£250k-£300k per Trust) Related to : • Increasing the number of midwives to provide 1:1 care for women in labour • The ante-natal pathway must adhere to NICE guidance, i.e. maximum of 8 contacts for normal pregnancies and 11 for high risk. • A 0.5% reduction in the proportion of all births by caesarean section Trusts have to demonstrate compliance

  12. Market Forces Factor • Cambridge University Foundation Trust 13.9% • East and North Herts Trust 15.5% • Princess Alexandra Hospital Trust 16.0% • West Herts Hospitals Trust 17.8% • Barnet and Chase Farm Hospitals 20.3%

  13. East and North Herts PCT : Spend per head of weighted population on maternity services 29.9% higher than cluster average

  14. West Herts PCT : Spend per head of weighted population on maternity services32.8% higher than cluster average

  15. Total £80million

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