Rationale: With over 650k births in England each year and an estimated NHS cost of almost £5bn, maternity services represent a major component of health care provision in the UK. Whilst the large majority of births are safe when things do go wrong the consequences in terms of health foregone and long-term medical need and costs can be substantial. The National Maternity Review (2016) estimates that £560 million is spent every year as a result of compensating families for negligence during maternity care – 1 case in every 600 births.
One reason for adverse events occurring may be a difficulty in managing variation in demand. Unlike many NHS activities, births are not amenable to management by waiting times and obstetric units may only have limited strategies available to them to accommodate exceptional demand, such as drafting in additional staff, closing units or otherwise transferring/directing patients to alternative units.
Our objective is to take routinely collected data over the course of a year from Leeds Teaching Hospital Trusts (which has two obstetric units) to gain a greater understanding of variation in demand, labour supply and mother and baby outcomes and the relationships between these parameters.
Overall Plan: Quantitative analysis of routine healthcare data will be undertaken to answer the following three interlinked research questions:
- What is the variation in acuity adjusted demand for maternity services over time at the intrapartum stage?
- What are the obstetric unit responses to variation in demand?
- What are the consequences of the demand/supply relationship in terms of patient safety?
The findings will inform a broader programme of research which accommodate patient choice and the National Maternity Review including revisions to the maternity payment system.
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