Learning from a Rapid Health Impact Assessment of a proposed maternity service reconfiguration in the English NHS

<p>Abstract</p> <p>Background</p> <p>Within many parts of the country, the NHS is undertaking reconfiguration of services. Such proposals can prove a tipping point and provoke public protest, often with significant involvement of local and national politicians. We undertook a rapid Health Impact Assessment (HIA) of a proposed reconfiguration of maternity services in Huddersfield and Halifax in England. The aim of the HIA was to help the PCT Boards to assess the reconfiguration's possible consequences on access to maternity services, and maternal and infant health outcomes across different socio-economic groups in Kirklees. We report on the findings of the HIA and the usefulness of the process to decision making.</p> <p>Methods</p> <p>This HIA used routine maternity data for 2004–2005 in Huddersfield, in addition to published evidence. Standard HIA techniques were used.</p> <p>Results</p> <p>We re-highlighted the socio economic differences in smoking status at booking and quitting during pregnancy. We focused on the key concerns of the public, that of adverse obstetric events on a Midwife Led Unit (MLU) with distant obstetric cover. We estimate that twenty percent of women giving birth in a MLU may require urgent transfer to obstetric care during labour. There were no significant socio economic differences. Much of the risk can be mitigated though robust risk management policies. Additional travelling distances and costs could affect lower socio-economic groups the greatest because of lower car ownership and geographical location in relation to the units. There is potential that with improved community antenatal and post natal care, population outcomes could improve significantly, the available evidence supports this view.</p> <p>Conclusion</p> <p>Available evidence suggests that maternity reconfiguration towards enhanced community care could have many potential benefits but carries risk. Investment is needed to realise the former and mitigate the latter.</p> <p>The usefulness of this Health Impact Assessment may have been impeded by its timing, and the politically charged environment of the proposals. Nonetheless, the methods used are readily applicable to assess the impact of other service reconfigurations. The analysis was simple, not time intensive and used routinely available data. Careful consideration should be given to both the timing and the political context in which an analysis is undertaken.</p

Why Women Earn Less Than Men in Self-Employment

Data from a sample of 659 self-employed individuals are used to evaluate explanations for the large earnings differential between self-employed men and women. A significant portion of the differential is attributed to differences in the industrial distribution of businesses and to the differential effects of housework and family responsibilites on the earnings of males and females. Differences due to industry position are traced to the lower proportions of women in the relatively rewarding areas of construction and professional practice and their greater representation in the relatively unrewarding personal services sector. Women in self-employment appear to be burdened by housework and childrearing in ways that limit the scope of their self-employed businesses and the intensity of work effort in them. If self-employed women were to have their total hours of labor redistributed between market work and house work in the same manner as men, their self-employed earnings would be substantially increased. A portion of the differential is traceable to differences in financial capital (female-run business have smaller capital stocks) and differences in specific human capital (female self-employed have less experience in running their business).

The Effects of Comparable Worth in the Public Sector on Public/Private Occupational Relative Wages

If, as appears likely, comparable worth programs are confined to the public sector, the level of public/private relative pay may change, and the structure of public/private relative wages within occupations will almost certainly change. The nature of these changes will determine the degree to which public wages conform more or less closely to the prevailing wage standard which requires that wages for public jobs be equivalent to wages for similar private-sector jobs. Thus, there will be implications for economic efficiency. This study analyzes alternative scenarios involving comparable worth in the state and local government (SLG) sector. The results suggest that when comparable worth is implemented through special wage increases, public-sector wages are moved further from compliance with the prevailing wage standard. This is because public wages are, on average, already on a par with private-sector wages. However, comparable worth tends to provide larger wage increases to those occupations where public/private wages are relatively low. And, when the payroll budget under comparable worth is fixed at the same size as the payroll budget before comparable worth, public wages could be moved closer to compliance with the prevailing wage norm.