As part of our research focusing on maternity services, we will be investigating the drivers of increasing Caesarean section rates in England. In the first of a series of reserach extracts, we describe our findings using crude unadjusted Health Episode Statistics, before setting out our plans for a longitudinal study, investigating the links between incidence of c-section rates, maternal characteristics and maternity staffing levels.
The rising rates of caesarean sections have become a hot topic in the news. Efforts are being made in order to reduce them and promote normal births instead, as the latter are believed to result in improved outcomes for patients and lower costs for the health provider. For the UK, a prominent example is the “Focus on Normal Birth and Reducing Caesarean Section Rates Rapid Improvement Programme" which began in April 2008. Yet, as in many other countries, caesarean section is becoming an increasingly popular method for delivering a baby. According to calculations using the maternity tail of the Hospital Episode Statistics (HES) data, the total caesarean section rate has increased from 21.8% in 2000 to 25.1% in 2013 (first quarter) in English NHS trusts, while it was lying around 12% in 1990 for the UK as a whole.
NHS finances are severely strained. As often stated in the press, this is mostly due to the rising demand for the services it provides as well as to some major budget cuts. At the same time, a ‘’hidden’’ workforce crisis is also reported in the media, which call for action against workforce understaffing. Yet, there is much to learn regarding the relationship between staffing levels and outcomes, especially from specialized settings within the English NHS. Although adequate staffing levels are important, outcomes are also affected by the staff mix and the skill mix. Yet only recently these points have started making their way to the press, as alternatives to the minimum staffing levels practices.
Hospital cancellation rates are regularly splashed across front pages, claiming to demonstrate lack of beds, staff and faulty equipment. There is one factor, however, that doesn’t make it onto the front page of the Daily Mail, that of incentives to cancel.
People and organizations tend to respond to incentives. Monetary or not, they can be important determinants of their behaviour. One of the most prominent examples in the field of economics is the downward slopping demand curve. People tend to consume more of a product when its price goes down in the same way a firm seeks to employ more workers when the wage level decreases. Yet the nature of the incentive and the way in which agents respond to it may vary substantially. Therefore, it is important to identify the existence of an incentive and then evaluate whether there was a response in the behaviour of the underlying agents.
This website provide a launch pad for the dissemination of research, comment and publications for the Delivering Better for Less: Improving Productivity in the Public Services research team.
This £1million Leverhulme funded project will look to interrogate four underlying assumptions of recent public service reforms.
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