Independent advocacy in maternity services in England: a budget impact analysis

Objective To estimate the one-year budget impact of a new Maternal and Neonatal independent Senior Advocate (MNISA) service in England. Design A budget impact analysis incorporating costs and service activity, using service staff surveys and interviews, and data obtained from the sample ICBs. Setting National Health Service (NHS) maternity services in England. Population or Sample Six MNISAs, from five NHS England pilot programme Integrated Care Boards (ICBs). Methods We collected MNISA service costs and resource use data using service staff surveys and interviews, and data obtained from the sample ICBs. Based upon estimates for eligible adverse maternity outcomes in England, we calculated total budget impacts for different independent advocacy service deployment scenarios. Main Outcome Measures Incremental costs per MNISA service referral, one-year NHS budget impact. Results Total MNISA service costs per referral were £14,853 (standard deviation £8,402), including £13,183 personnel costs (£9,311) and £1,670 local expenditure (£1,147). Training costs per MNISA were £6,812 (£4,364). At a maximum annual operational caseload of 15 family referrals, total costs per referral were £5,841 (£1,383), including £4,754 personnel costs (£1,458), and £1,088 local expenditure (£1,210). Service rollout options up to full coverage of all 7,154 eligible adverse perinatal outcomes in England annually, resulted in estimated one-year budget impacts of between £2.3 million and £41.8 million. Conclusions The cost per referral for independent advocate support is £14,853, reducing to £5,841 at a maximum assumed operational caseload. Coverage of eligible adverse outcomes in England would cost between £2.3 million and £41.8 million, with £3.2 million training costs.