Birth costs

Summary

A request for birth statistics and costs on the Isle of Man was partially fulfilled, providing data on home and hospital births from 2014-2016 and referencing UK NHS tariffs for costs, while specific data on elective caesarean requests was withheld due to the practical refusal exemption.

Key Facts

• The Department of Health and Social Care does not operate a separate midwifery service, making it unable to distinguish between specific hospital birth units.
• Home birth services were suspended for the 2017-2018 period due to operational reasons and safety balancing.
• Data on the number of elective caesarean sections booked on patient request was withheld as it would require research or analysis.
• Cost figures for births were not held directly by the Department but were estimated using UK NHS 'Payment by Results' tariffs.
• The number of women requesting home births exceeded the number of actual home births in all reported years.

Data Disclosed

• 2014: 8 home births, 788 Nobles Hospital births, 253 caesareans (159 emergencies)
• 2015: 0 home births, 764 Nobles Hospital births, 256 caesareans (142 emergencies)
• 2016: 2 home births, 740 Nobles Hospital births, 223 caesareans (120 emergencies)
• 2014: 12 women requested home birth
• 2015: 8 women requested home birth
• 2016: 7 women requested home birth
• Homebirth cost estimate: £7,000 plus call out
• Hospital vaginal birth cost estimate: £388,406 (519 x £749)
• Caesarean section cost estimate: £379,323 (223 x £1701)
• Midwife on-call cost estimate: approx £3500

Exemptions Cited

• Section 11(3)(b) of the Freedom of Information Act 2015 (practical refusal reason)
• Section 8(3) of the Freedom of Information Act 2015 (undertaking research or analysis)

Data Tables (1)

Full Response Text

Department of Health and Social Care

Rheynn Slaynt as Kiarail y Theay

REQUEST UNDER THE FREEDOM OF INFORMATION Act 2015 (“the Act”) Thank you for your request dated 26th April 2017. You asked for: Question 1 Please could you supply me with the following information regarding the labours and subsequent births of women upon the IOM 1. How many labours were recorded for each of the previous three calendar years for each of these birth options: a) home birth b) birth in Jane Crookall, Nobles Hospital c) hospital birth (obstetrician-led unit) 2. Please list for each category how many labours resulted in caesarean delivery. 3. Of the caesarean deliveries listed above, please state the number which were elective and out of those, which were booked on request of the patient. 4. provide information on the average cost for each birth option for the financial year 2016 - 2017 (home birth, hospital birth and additionally for caesarean). 5. Are expectant mothers still provided a choice of if they wish to elect for a home birth? If not, provide the rationale of why the home birth option was withdrawn.

Chief Executive Malcolm Couch

Department of Health & Social Care Chief Executive’s Office Crookall House Demesne Road Douglas Isle of Man, IM1 3QA

Direct Dial No:

(01624) 686324 Email:

FOI.DHSC@gov.im
Website:

www.gov.im/dhsc Date:

22nd May 2017

FOI Reference: IM85739I

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The answers to your questions are: We enclose a copy of some of the information you requested, however in keeping with the spirit of Freedom of Information, where financial costings are not held by the Department reference is made to the Payment by Results NHS model, full details are provided herein.

Question 1 Please could you supply me with the following information regarding the labours and subsequent births of women upon the IOM 1. How many labours were recorded for each of the previous three calendar years for each of these birth options: a) home birth b) birth in Jane Crookall, Nobles Hospital c) hospital birth (obstetrician-led unit)

The Department of Health & Social Care (the ‘Department’) does not operate a separate midwifery service, expectant mothers are allocated a named obstetrician, and therefore the Department is unable to provide an answer to parts b and c.

However, the Department is able to provide the following information for the total number of births between Nobles Hospital and Home Birth for the years requested:

Year Home Birth Nobles Hospital Birth

2014

8 Women had a home birth 12 Women requested delivery by home birth

788

2015

*0 (Nil) Women had a home birth

*8 Women requested delivery by home birth

764

2016

*2 Women had a home birth

*7 Women requested delivery by home birth

740

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1. Please list for each category how many labours resulted in caesarean delivery. 2014 253 caesarean sections of which 159 were emergencies (in labour) 2015 256 caesarean sections of which 142 were emergencies (in labour) 2016 223 caesarean sections of which 120 were emergencies (in labour)
2. Of the caesarean deliveries listed above, please state the number which were elective and out of those, which were booked on request of the patient. While our aim is to provide information whenever possible, reference to Question 3, the Department of Health & Social Care is unable to provide an answer because an exemption pursuant to the Act, Section 11(3)(b) (practical refusal reason applies); namely; complying with the request for information would require the Department of Health & Social Care to do one or more of the matters mentioned in section 8(3) (things a public authority is not required to do by the Act); namely; undertake research into, or analysis of, information that it holds.
3. provide information on the average cost for each birth option for the financial year 2016 - 2017 (home birth, hospital birth and additionally for caesarean).

The Department does not hold this information, however, to provide further advice and assistance, referencing the UK NHS ‘Payment by Results’ (PbR) standard national cost or tariff pricing guidance, for the financial year 2016 – 2017 the costings were: 1Homebirths

£7,000 plus call out
Hospital vaginal births
£388, 406 (519 x £749) Caesarean section

£379,323 (223 x £1701) 1Homebirth requires two midwives being on call for up to 5 weeks 24 hours per day. The cost is approx... £3500 plus call out costs during the night.

I have provided the following web link for your kind reference:

http://content.digital.nhs.uk/article/2047/Introduction-to-Payment-by-Results

1. Are expectant mothers still provided a choice of if they wish to elect for a home birth? If not, provide the rationale of why the home birth option was withdrawn.

Due to operational reasons Nobles Women and Children’s Division endorsed by the Nobles Heads of Departments Operational agreed to suspend the homebirth service for 2017 – 2018.

The Department fully respect the right for expectant mothers to select a home birth delivery; however this right needs to be balanced against ensuring hospital deliveries are a good and safe experience too.

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The rationale to suspend the homebirth service was not taken lightly, favour for suspension were as follow:

Safety - ensuring that Nobles hospital acute services are safely staffed in order to provide midwifery service and this remains priority.

Newly qualified midwives - who need experienced support to ensure their confidence and competence.

Staff absence – due to mitigating circumstances, current staffing levels would not prove adequate to support the Home Birth Service.

Please note: We provide an on call service for the midwives each night to be called in if required to ensure that we maintain safety within the acute maternity service. We are at present unable to provide an additional on call service for homebirth.

Your right to request a review If you are unhappy with this response to your Freedom of Information request, you may ask us to carry out an internal review of the response, by completing a complaint form and submitting it electronically or by delivery/post to: FOI Co-ordinator, Department of Health & Social Care, Chief Executive’s Office, Crookall House, Demesne Road, Douglas, Isle of Man, IM1 3QA. An electronic version and paper version of our complaint form can be found by going to our website. Your review request should explain why you are dissatisfied with this response, and should be made as soon as practicable. We will respond as soon as the review has been concluded.
If you are not satisfied with the result of the review, you then have the right to appeal to the Information Commissioner for a decision on; 01. Whether we have responded to your request for information in accordance with Part 2 of the Freedom of Information Act; or 02. Whether we are justified in refusing to give you the information requested.

In response to an application for review, the Information Commissioner may, at any time, attempt to resolve a matter by negotiation, conciliation, mediation or another form of alternative dispute resolution and will have regard to any outcome of this in making any subsequent decision. Further information about Freedom of Information requests can be found on the Information Commissioner’s website at: https://www.inforights.im/information-centre/freedom-of- information

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Should you have any queries concerning this letter, please do not hesitate to contact us. Yours Sincerely Freedom of Information Team Department of Health and Social Care

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