Options to increase mother and baby unit capacity: consultation analysis

The Mother and Baby Unit Family Fund (MBUFF)

126. The consultation paper noted that the Mother and Baby Unit Family Fund (MBUFF) was established in 2020 to provide a contribution towards the cost of visiting a mother and baby being treated in an MBU for perinatal mental illness.  This is to facilitate support for the woman and baby in the unit, support continued family bonding and allow staff in the unit to work with the family group.  Partners, fathers and main carers, in addition to existing children up to school leaving age (16), can make claims for reasonable accommodation, travel expenses and a flat rate contribution of £8.50 per person per day for food and non-alcoholic drinks.  Claims can be submitted incrementally during an ongoing MBU stay (e.g. weekly) or in full for the entire stay, up to three months, following discharge.

127. Respondents were asked:

Q10: ‘Are you aware of the Mother and Baby Unit Family Fund (MBUFF)?’ 

128. As Table 6 shows, just under a quarter of respondents (24%) were aware of the Mother and Baby Unit Family Fund, and just over three quarters were unaware.  Awareness levels were highest among organisations and lowest among individuals (69% of organisations compared to 21% of individuals).

129. The Scottish Government was keen to find out how organisations and individuals had heard about the fund and asked:

Q11: ‘If you are aware of the fund, how did you find out about it?’

130. As demonstrated in table 7, clinicians were a key source of awareness, followed by the website and other service users.

131. A range of additional sources of awareness were also cited, each by small numbers of respondents.  These included third sector organisations, from work within a perinatal unit, the Scottish Government and PIMH Programme Board.

132. Respondents were then asked if they or a family member had been treated in an MBU since October 2020, whether the fund was used.  Only four individuals had used this fund and these were all in the Grampian health board area.

133. The next question asked:

Q13: ‘What, if any, are the barriers to using the Mother and Baby Until Family Fund?’

134. A total of 59 respondents opted to answer this question.  The key barrier given – by around four in ten of these respondents – was of a lack of awareness of the MBUFF.  Around a third of respondents felt a barrier to using the Fund was because it is paid in arrears and that not all individuals can afford to make upfront payments from their own pockets.  

135. The cap of £500 was also noted as a barrier by around one in five respondents with comments that this is not enough for those travelling long distances.  Some of these respondents suggested a greater cap than £500.  

136. A smaller number of respondents referred to the application process being difficult to complete, particularly for any individuals with literacy issues or a lack of IT skills.  There were also a small number of references to the use of ambiguous wording such as 'reasonable overnight accommodation'. There were also one or two mentions that there is a need to seek pre-approval for expenditure on some items and a lack of clarity about the criteria to obtain funding.

137. The stigma of having to ask for financial help was noted as a barrier by around one in ten of these respondents.  Other barriers noted by less than one in ten respondents included:

• Problems with fitting visiting around school activities and other school children; and not being able to claim for childcare for other children.
• A loss of earnings for some family members or a lack of capacity to take time off work for visiting an MBU.
• Delays between applying to the Fund and being reimbursed.
• Having to provide receipts for everything.
• Not being informed about the Fund prior to admission to enable families to make informed choices about accessing an MBU.  
• The availability of funds in crisis situations such as an acute admission process out of hours.
• One health board noted that some patients and their families do not like to apply for the fund because of a belief that others are more in need.

138. The final question about the Mother and Baby Unit Family Fund (MBUFF) asked:

Q14: ‘How could the MBUFF be improved?’

139. A total of 55 respondents provided commentary in response to this question and many of these echoed barriers raised in the previous question.  

140. The key improvement identified by around two in five of these respondents was to increase awareness of MBUFF, among both professionals and patients.  The highest numbers of respondents referring to this issue were women with lived experience of mental health problem in pregnancy or after childbirth who received care and treatment in the community and those within the Grampian and Tayside health boards. 

141. Around one in five respondents referred to immediate access to the fund in the form of upfront payments for items such as rail fares or fuel cards.  One individual summarising some of the points raised commented:

“Change it from being a reimbursement system to an upfront grant allowance. So based on location a weekly or monthly allowance could be calculated by the NHS and provided as an allowance. If the worry is this could end up costing a lot more then you could still ask for receipts to be provided post discharge and any unspent money returned. This would make it as easy as possible for families when the issues are acute and switch their admin burden to after discharge where they are likely to have more capacity for it.  Give specifics around how much is acceptable for accommodation costs.  Again be specific about what is acceptable for taxi fares rather than ask for pre-approval. e.g. a taxi between Livingston train stations and the MBU in Livingston is acceptable, a taxi from Waverly station isn't. Or a taxi journey of X miles is acceptable.”

142. A similar number of respondents also referred to changes to the capped amount of £500 and suggested an increase in this amount, with a small number of comments that this should also cover loss of earnings.  Linked to this, there were also some suggestions for flexibility in the operation of the fund, for example, weighting the available funding level or offering a sliding scale based on the distance to be travelled and the length of admission.  One individual suggested this could be offered in the form of a loan to be paid back over time.

143. Informing patients about the fund prior to admission was suggested by a few respondents so that families can make informed choices about whether to access the service.

144. There were also a few suggestions to:

• Clarify the criteria for funding applications. 
• Offer practical support and help to patients and their families in claiming from the MBUFF.
• Timely reimbursement.
• Offering this to all patients to help remove any stigma associated with applying to this fund.

145. An organisation within the NHS suggested the introduction of peer support will help to address issues of stigma and increase opportunities to support patients and their families in accessing the Fund.  

146. The final question in this consultation offered respondents the opportunity to provide any additional comments they had, and asked:

Q15: ‘Finally, is there anything else that you would like to share about this issue?’

147. 98 respondents commented at this question.  A large minority (more than one in three) made or reiterated requests for MBU facilities in other areas of Scotland, almost all of these being for the north or northeast of Scotland, with a small number advocating Aberdeen specifically, and one request for an MBU in Inverness.

148. Similar numbers made more general requests for more MBUs; comments included needs for:

• Greater ease and equity of access to avoid a “postcode lottery” for care. 
• No geographical restrictions, with complaints about having had to travel long distances.
• The importance of MBUs for mother and baby wellbeing, with positive remarks about the vital service provided (e.g. “Many mums will be healthier and happier if they can get the help they need without having to be parted from their baby and put in a general mental health hospital” Lived experience, care and treatment in the community).

149. A small number of respondents recited positive experiences of MBUs, for instance in terms of expert staff.

150. A large minority of respondents (nearly one in three) made requests for more or improved mental health or perinatal mental health services, in terms of awareness of post-natal depression (PND), earlier interventions and knowledge of how to care for pregnant or postnatal women.

151. A significant minority (one in eight) saw a need for a more equitable spread of perinatal care services in order to facilitate access to services needed, with reiterations that distance should not be a barrier.  The north and north-east of Scotland was again singled out (mainly by respondents in the Grampian and Highland Health Boards) as being relatively under-resourced for pre and postnatal mental health care in general. 

152. There were also a few requests for more information and publicity regarding care services and MBUs; and a few mentions of a need to get as much data as possible in terms of user feedback about services.