Graphic: rising birthrate

Two thirds of NHS trusts are unable to cover the cost of providing maternity services as the birthrate rises, with little evidence that £330 million of extra funding is improving care for mothers and babies, The Times can disclose.

Chronic underfunding of midwifery and obstetrics care has produced deficits that run into millions of pounds in some trusts. Money is being taken from other hospital departments to cover the shortfall. Other trusts have the opposite problem, with up to £15 million of maternity funding remaining on their balance sheets at the end of each financial year.

The figures, obtained by The Times under the Freedom of Information Act, come as statistics show that the birthrate is at its highest level for 36 years.

Medical leaders warned that the quality of care for mothers and babies could be the first to suffer as the NHS is asked to make £15 billion of “efficiency savings” in the next three years.

The extra money pledged by the Government to improve maternity care over three years risks being squandered because of inefficient NHS accounting or could be diverted to fund other loss-making services, the Royal College of Midwives (RCM) said.

The £330 million funding was announced by ministers in January last year. But anecdotal reports to the college suggest half of the local heads of midwifery in England have yet to see the extra money make an impact.

Louise Silverton, the RCM deputy general-secretary, said that the continuing baby-boom was piling pressure on midwives and “pushing maternity services beyond their limit”.

“The effects of this on the quality of service for women and babies are obvious,” she said. “The Government is putting money into maternity services but still this is too often not reaching the front line. I am pointing the finger at the people who control the purse-strings at the regional and local level.

Overall, the health service is enjoying a period of record funding and achieved a surplus of £1.7 billion in 2007-08, yet the share of the NHS budget spent on maternity has fallen from 3 per cent to 2 per cent since 1997.

The Times questioned 148 trusts that provide obstetric and maternity services in England about their funding in recent years. A total of 87 trusts replied, a 58 per cent response rate.

Of these, 60 trusts (68 per cent) reported an overspend on their budgets in 2007-08, creating a total deficit of more than £103 million. A total of 24 reported a surplus, totalling £65 million, while three trusts broke even.

Less data was supplied for 2008-09 (52 responses), but the trend looked to have continued last year, with a gross deficit of £58 million in 31 trusts and 18 trusts reporting a surplus of £41 million. This is despite having to deliver 708,708 babies in England and Wales last year — the highest number since 1972 and a rise of more than 19 per cent on 2001. Nearly one in four births were to mothers born outside the UK. In 1998, only 14 per cent of babies were born to foreign-born mothers.

The largest deficit reported in 2007-08 was £7.7 million at Barking, Havering and Redbridge NHS Trust, London, although 17 other trusts overspent by more than £2 million. The largest surplus for maternity was £14.9 million at Heart of England NHS Foundation Trust, Birmingham.

Belinda Phipps, the chief executive of the National Childbirth Trust, said the findings were “extremely worrying”. She said: “It means money which is desperately needed to invest in improving maternity services is not getting through to the families who need it.”

The Department of Health has taken steps to reform the “payment by results” system of funding maternity services, under which hospitals are paid a set tariff for the different courses of treatment that they provide. But the RCM said that surpluses could be a result of unfilled staffing posts. The college says 5,000 extra midwives are needed but the Government has promised to recruit only 3,400 by 2012.

A Department of Health spokesman said: “We have increased the national tariff for maternity services for 2008-09 and 2009-10 by around 8 per cent compared to 2007-08, so the money flowing to primary care trusts is greater than ever before.”

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