Berwick DM, Nolan T, Whittington J. The triple aim: care, health, and cost. Health Affairs. 2008; 27:(3)759-69

Department of Health and Social Care. Compassion in Practice: Nursing, Midwifery and Care Staff—Our vision and strategy. 2012. (accessed 8 January 2018)

Moore LG, DeBuono B. Total cost of care: a discipline that leads to better care. Journal of Ambulatory Care Management. 2013; 36:(3)193-8

National Maternity and Perinatal Audit: Clinical Report 2017.London: Royal College of Obstetricians and Gynaecologists; 2017

NHS England. Five Year Forward View. 2014. (accessed 8 January 2018)

NHS England. Leading Change, Adding Value: A Framework for Nursing, Midwifery and Care Staff. 2016. (accessed 8 January 2018)

NHS England. What is NHS Rightcare?. 2018a. (accessed 8 January 2018)

NHS England. Commissioning for Value. 2018b. (accessed 9 January 2018)

NHS England. CCG data packs. 2018c. (accessed 9 January 2018)

Royal College of Obstetricians and Gynaecologists. Patterns of Maternity Care in English NHS Trusts 2013/14. 2016. (accessed 8 January 2018)

Unwarranted variation in the provision of midwifery care

02 February 2018
Volume 26 · Issue 2


Ian Peate reports on the roundtable discussion on the ‘Leading Change, Adding Value’ framework, which took place in December 2017 to address inequalities in health and social care

There are a number of examples of unwarranted variation in healthcare, both in the UK and globally. Unwarranted variation has the potential to divert resources to areas where they are uncalled for, and is a source of concern, as it suggests that the care women are receiving may depend upon where they live. It also implies that NHS resources are not being used in the most efficient way (Royal College of Obstetricians and Gynaecologists, 2016).

The term ‘postcode lottery’ is often used in the UK to describe unwarranted variation, and midwives are aware of these often unjust variations in care provision. Some variation in care is normal and to be expected; yet, there is much that is ‘unwarranted’ and cannot be explained, justified or even defended. Identifying the variation in care settings can provide opportunities for improvement. As the NHS continues to face challenges, understanding where variation in care and outcomes occurs, and what this variation means, is needed more than ever if the quality and safety of maternity services and the experience of mothers are to be improved (National Maternity and Perinatal Audit, 2017).

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