Nine years ago, in resonse to Changing Childbirth, the DOH offered a small
grant to all matenity services to develop a model of care that would provide
continuity of carer to 'low risk' women. We applied for this and used it to
develop our partnership caseload team. An accurate economic evaluation of
the service is very difficult as many of the costs/benefits are difficult to
quantify, but where it has been attempted caseload service is believed to be
cost neutral. The 6 midwives on our team were core staff before the team
was set up so the total number of midwives employed by the trust was
unchanged, it is only the manner in which the midwives work that is
different. The number of women we look after has been determined by the
Dept of Manpower Services who advise that 1 full time equivalent midwife is
employed for every 35 women booked. There are undoubtably additional costs
but they are small e.g.
1 All midwives were employed at a higher grade. (I suspect AforC, when it's
eventually implemented, will neutralise this benefit.)
2 All midwives are paid an on-call allowance.
3 All midwives have mobile phones provided by the Trust.
4 All midwives claim a mileage allowance for home visits.
To counter these costs I suggest you argue that all evaluations of caseload
teams have consistently shown:
1 An increased normal delivery rate.
2 A reduced epidural rate and a reduction in other interventions in labour.
3 Shorter stays in hospital.
4 An increased breastfeeding rate.
5 Increased satisfaction with the service.
It will be argued that in these evaluations the benefits did not reach
statistical significance, but this was often only because the sample sizes
were of necessity small and many studies had insufficient power. Also no
studies focused on the problems of practicing normal midwifery in a
consultant-led labour ward. In the recent national audit the RJMS had the
distinction of having the highest c/s rate in the UK. Rome wasn't built in
a day but it was built!! Unfortunately, as you can see, the costs are
easier for an accountant to quantify than the benefits.
Trusts in N. Ireland have the same economic constraints as the rest of the
NHS, but the RJMS is still able to offer one to one midwifery support for
all women in labour. If I was you I would argue that a woman may as well
have a midwife she knows as one she doesn't - the cost to the NHS is exactly
Royal/Jubilee Maternity Service
>From: Sarah Hunt <[log in to unmask]>
>Reply-To: Caseload midwifery <[log in to unmask]>
>To: [log in to unmask]
>Subject: Re: [MCVic] Caseload models
>Date: Fri, 13 Oct 2006 08:15:10 +0000
>We would very much like to set up a Caseload scheme here in Gloucestershire
>but our managers and employers tell us that it is not cost effective as our
>hospital is already staffed and having your own midwife with you during
>labour means your are potentially paying 2 midwives. How was your scheme
>set up and how have you overcome the 'costs' argument? I wonder whether
>Northern Ireland Maternity Service is in the same grip of financial cuts as
>we are in England?
>Sarah Hunt, Community Midwife, Gloucestershire
>>From: Jean Greer <[log in to unmask]>
>>Reply-To: Caseload midwifery <[log in to unmask]>
>>To: [log in to unmask]
>>Subject: Re: [MCVic] Caseload models
>>Date: Thu, 12 Oct 2006 22:12:27 +0100
>>I am one of a team of 6 caseload midwives working in the Royal/Jubilee
>>Maternity Service, Belfast, N. Ireland. We all work full time and each
>>carry a personal caseload of 35 - 38 women per year. We work in pairs
>>sharing the on-call with our work partner. The service is targeted at
>>'low risk women' and is midwifery-led, but we continue to provide
>>midwufery care for the women on our caseloads who develop complications
>>and whose care becomes consultant led. Antenatal and postnatal care can
>>be provided at home or in hospital. All babies are born in hospital.
>>This service has been up and running for 8 years now, and is very popular
>>- with all midwives fully booked.
>>Good luck with the research and ler us know if we can be of any
>>>From: Marlene Gryesten / Aalborg Sygehus <[log in to unmask]>
>>>Reply-To: Caseload midwifery <[log in to unmask]>
>>>To: [log in to unmask]
>>>Subject: [MCVic] Caseload models
>>>Date: Thu, 12 Oct 2006 07:35:55 +0200
>>>On a note from Denmark.
>>>Currently I am one of the two midwife team in a 120 cases caseload, all
>>>women living in the same district and doing birth at our local university
>>>hospital or at home. We have worked since june 1, 2004; We have made a
>>>peticulous evaluation on all work time through two years as we started
>>>this model as a work load project. Now in Denmark there is three other
>>>teams working and on our National Midwifery Congress November 6, we will
>>>debate, amongst other stuff, wether Caseload midwifer needs to be
>>>implemented as a part of the care offered from most midwiferycenters.
>>>Ou first report was on client satisfaction, second on work envirenmental,
>>>and the final one soon to be published is including a focus interview
>>>regarding some of the fun sideeffects! Like a rise in Homebirth, and
>>>again the final count up on oncall hours versus actual work hours - all
>>>The things we discuss in Denmark now is, first and foremost:
>>>- How it is possibel to work being on call 50% of your life, and still
>>>function well! The evaluation of our workstudy shows, that the quality of
>>>work life will increase for certain midwifes as the above quality and
>>>selfsatisfaction of the continuity of care is a strengthener in it self,
>>>and with a caseload of 120 women, our average oncall load is 3 and a half
>>>our per 24 hour oncall period.
>>>-Since we know this model will never be a possibility for all pregnat
>>>women, then how do we decide who should have the possibility /choice ?
>>>All for now, good luck
>>>Birralee Maternity Service at Box Hill hospital has a small caseload
>>>Maternity Coalition published an article about it Birth Matters Vol 10.1
>>>March 06 'Know your midwife at Birralee' (authors Melody Bourne, Alice
>>>Barden and Helen Gordon.) Nic Dutton is one of the midwives in KYM there
>>>could fill you in with more information.
>>>My (very biased) observation:
>>>Most of the hospital midwives I have spoken to about caseload seem to
>>>it's a dirty word. Midwifery managers seem to like to stick to rosters,
>>>talk about their wonderful team models.
>>>There is a UK email list Caseload midwifery
>>>[log in to unmask]
>>>It has been quiet lately, but would be a link with international work. I
>>>have put a cc to that list - I think I'm still on it.
>>>You always come up with interesting big words. I learnt reciprocity from
>>>you, and now you'll have me talking about interdisciplinarity!
>>>All the best
>>>From: Karen Lane [mailto:[log in to unmask]]
>>>Sent: Wednesday, 11 October 2006 1:23 PM
>>>To: [log in to unmask]
>>>Subject: [MCVic] Caseload models
>>>Hello out there,
>>>I was wondering if people could advise what hospitals are using
>>>caseload models or preparing to install caseload?
>>>I want to construct a national research study of interdisciplinarity
>>>in health care using caseload in maternity care as an case study.
>>>If you are aware of international cases, I would also be grateful for
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