|Date:||11 September 2017|
|Authors:||Elaine Kelly and Tom Lee|
NHS Maternity Units are more likely to close towards the end of the week and during holiday periods, pointing to staff availability as a source of pressure. This is a key finding of new research by the Institute for Fiscal Studies (IFS), funded by the Economic and Social Research Council (ESRC), examining sources of short-run and long-run pressures on maternity units in England.
Admission to hospital to give birth is the single largest cause of admission to NHS hospitals in England. In common with many NHS services, providers of maternity care are reporting pressures from increased demand, staffing shortages and programmes to improve the quality of care. How units respond to these challenges carries important implications for the health of mothers and babies, and the finances of NHS Acute Trusts.
This briefing note reviews the evidence on the long-run pressures faced by maternity units (MUs) from changes in the number of maternity admissions and the case mix. While the number of maternity cases has remained largely constant since 2010, the case mix continues to change, with women giving birth later in life and with more complex health conditions. There are implications for MUs if this evolving case mix of mothers requires more care in terms of staffing or other resources.
In addition to long-run pressures, MUs also face pressure from daily variations in admissions to MUs and (presumably unexpected) peaks in demand. This work also focuses on one potential consequence: whether the MU decides to close temporarily for new admissions to ensure the safety of mothers and babies currently on the unit. Volumes of temporary closures and their distribution across hospitals have been published elsewhere. The authors provide evidence on what may cause these closures, and what action may be needed to avoid the need for closures, as well as addressing wider pressures on MUs.
As expected the research shows that closures are related to the volume of admissions, both on the day of closure and on the day before closure. However, patterns of closure by day of the week and by month highlight that some of the factors that cause closures are predictable and extend beyond the inevitability of occasionally busy days. Closures are more likely on a Thursday, Friday and Saturday, but spikes in admissions are spread evenly across the week. Closures are also more likely to occur in the summer months and in December, the principal holiday periods.
Given that the number of beds is fixed across the week, the most likely explanation for variation in closures by day of the week and by month is the availability of staff. However, using the data available, it is not possible to say whether these patterns are attributable to difficulty in filling planned rosters, as many staff balance other caring commitments, or to ineffective planning and management. It is therefore hard to propose actions that could be taken to eliminate the day-of-the-week or seasonal effects, to estimate how much those actions would cost and to assess whether the cost would be justified given the potential benefits to women.
Finally, the note shows that hospitals that close more often are also more likely to breach their four-hour waiting-time targets, suggesting that the pressures felt by Acute Trusts extend beyond the maternity unit.