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

Independent advocacy in maternity services in England: a budget impact analysis | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 19 January 2026 V1 Latest version Share on Independent advocacy in maternity services in England: a budget impact analysis Authors : Kevin Herbert 0009-0008-4354-7811 [email protected] , Nadia Crellin , Emma Dodsworth , Julie Hartley , Holly Walton , Nina Hemmings , Rachel Lawrence , … Show All … , Chris Sherlaw-Johnson , Sarah Fisher 0009-0001-9233-4862 , Naomi Fulop J , Saheli Gandhi 0009-0000-9850-5370 , Cate Maddison , Raj Mehta , Sonia McLeod , Ben Wills , Steve Morris , Pei Li Ng , and Jenny Shand 0000-0002-4899-795X Show Fewer Authors Info & Affiliations https://doi.org/10.22541/au.176883917.78664911/v1 161 views 93 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract 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. Supplementary Material File (1_manuscript_submit.docx) Download 463.73 KB File (2_tables_submit.docx) Download 88.64 KB Information & Authors Information Version history V1 Version 1 19 January 2026 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords health economics health economists maternity services paediatrics: neonatal Authors Affiliations Kevin Herbert 0009-0008-4354-7811 [email protected] University of Cambridge Department of Public Health and Primary Care View all articles by this author Nadia Crellin Nuffield Trust View all articles by this author Emma Dodsworth Nuffield Trust View all articles by this author Julie Hartley Stillbirth and Neonatal Death Charity View all articles by this author Holly Walton University College London Research Department of Behavioural Science and Health View all articles by this author Nina Hemmings Nuffield Trust View all articles by this author Rachel Lawrence University College London Research Department of Behavioural Science and Health View all articles by this author Chris Sherlaw-Johnson Nuffield Trust View all articles by this author Sarah Fisher 0009-0001-9233-4862 University College London View all articles by this author Naomi Fulop J University College London Research Department of Behavioural Science and Health View all articles by this author Saheli Gandhi 0009-0000-9850-5370 University College London Research Department of Behavioural Science and Health View all articles by this author Cate Maddison University College London View all articles by this author Raj Mehta University College London View all articles by this author Sonia McLeod Stillbirth and Neonatal Death Charity View all articles by this author Ben Wills Stillbirth and Neonatal Death Charity View all articles by this author Steve Morris University of Cambridge Department of Public Health and Primary Care View all articles by this author Pei Li Ng University College London Research Department of Behavioural Science and Health View all articles by this author Jenny Shand 0000-0002-4899-795X University College London Research Department of Clinical Educational and Health Psychology View all articles by this author Metrics & Citations Metrics Article Usage 161 views 93 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Kevin Herbert, Nadia Crellin, Emma Dodsworth, et al. Independent advocacy in maternity services in England: a budget impact analysis. Authorea . 19 January 2026. DOI: https://doi.org/10.22541/au.176883917.78664911/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . 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