GIVING birth at Buxton’s Corbar Birth centre costs NHS Derbyshire County just over £2000 per birth, a meeting of the health trust heard last week.
This figure is compared to the £1,200 cost to the trust for women who give birth at Stepping Hill or Macclesfield hospitals. However, it is well below the almost £5,000 cost per birth at the Darley Birth Centre, which is also being reviewed by the trust.
The numbers were revealed at a meeting of the NHS Derby City and NHS Derbyshire County cluster last Wednesday, when board members agreed to go ahead with a full engagement process looking at the future of Corbar Birth Centre, which is based at Buxton Hospital.
Sally Savage, assistant director of commissioning with responsibility for children’s and maternity services, told the meeting: “There is no evidence to show giving birth in these birthing centres is safer than a home birth or more clinically effective and there is no evidence that stand-alone birthing centres can produce better birth outcomes.
“The location of the birthing centres means these services are not available to all the population in Derbyshire, they are only available to a relatively small proportion of Derbyshire residents. The number of births at both centres is less than the 300 a year figure which is seen as being a viable figure.
“Significant improvements have recently been made to the maternity facilities in Derbyshire and that includes the birthing centre at Chesterfield Royal Hospital. There are also new facilities at Stepping Hill, Macclesfield and the Royal Derby Hospital.
“Because of the nature of birthing units only low risk births are able to take place at the two units so we are in effect paying an additional price for the least complicated births.
Low risk births are costing a significant amount more money than other births – and even assuming these costs don’t increase, the ongoing cost of providing births at the two centres is just short of £3 million over a five year period. This money could clearly be invested in other services.”
She added that as part of the process, the PCT had to meet Health Secretary Andrew Lansley’s four tests as part of the NHS operating framework.
The first is support from GP commissioners, and the PCT have had initial discussions with the two relevant GP consortia with further discussions being planned, Mrs Savage told the meeting.
The second test is public and patient engagement which Mrs Savage said was “fundamental to what we are trying to achieve.” Clarity on clinical effectiveness is the third test about which Mrs Savage said: “There is no evidence this process would have any detriment in terms of outcome.”
And the final test is consistency with current and prospective patient choice. Mrs Savage said: “If the birthing unit were to close there would be some impact on choice but there would still be a whole range of choices available to local women. Women will still be able to choose home births or access birthing services in an adjacent midwife unit. Obviously they will still be able to have their baby at a consultant led midwife unit.”
She then went on to explain how much births at Corbar, and the Darley Birth Centre in Darley Dale, cost the trust.
“In terms of cost for births at the two units we pay a set tariff for an uncomplicated delivery of just over £1,200,” she said. “That is the amount we pay for each normal birth. At Corbar we pay an additional £1,116 on top of that figure and at Darley we pay an additional £3,750 each.
“In terms of trends, numbers have not significantly changed. We’re looking around the 150 mark per year at Corbar and slightly less than that at Darley, about 120 (number of births taking place).
“In terms of looking at what is happening elsewhere at other units, there is this figure of 300 births which is viewed as the viable figure.
“In terms of the travel issue we have specifically spoken to providers about what happened last winter because last winter was a particularly bad winter. None of the providers are aware of any lady in labour having to travel unnecessarily in order to access services but obviously we need to look at that as part of the engagement process.”
Dr David Black, Director of Public Health, said: “I think what this is really about is making some tough choices to make sure we get the resources for the people of Derbyshire.
“Although these units are very appreciated by the population we know they don’t lead to improved outcomes from births.
“Because only low risk births take place at the units, people with high risks need to travel whatever the weather and that is important.
“It is also worth emphasising that we are very committed to offering good access to home delivery and that doesn’t involve them having to travel at all.
“I think it is worth bearing in mind that many women from these areas do travel for their deliveries.”
And Non Executive Director Pauline Ambrey added: “Through this consultation process I hope we will get some information about patient experience. We also have to take into account levels of congestion on the approach to Stepping Hill because that road is enormously congested.”
Board members then agreed to go ahead with a period of public engagement on the future of the two birthing centres.
The pre-engagement phase will take place until July 20 and involve speaking to key stakeholders such as the Maternity Services Liaison Committee and the development of a formal engagement document.
The next phase will be formal engagement, which will run from August 1 to October 23 and involve members of the public responding to the engagement document.
A final decision on whether to close Corbar Birth Centre is expected in November.