The midwives view

Midwives in the NHS are struggling due to underfunding - maternity units regularly have to close, staff shortages are widespread, budgets for training have been cut and services have been reduced - but demand has increased.

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The latest surveys of senior midwives by the Royal College of Midwives was published in February 2020 and November 2020. It revealed some alarming statistics:

  • There has been an increase in the number of HOMs telling the RCM that they have had to reduce services,
    17% answered yes to this question in 2019 compared with 7% in 2018.
  • Almost three quarters (74%) reported having to redeploy staff at least once a week to cover essential services this is
    compared to 62% in 2018.
  • 31% of HOMs have had to reduce training in the last twelve
  • 8 out of 10 midwives (83%) do not believe their NHS Trust or Board has enough staff to operate safely.
  • 42% report that half of shifts are understaffed and a third say there are significant gaps in rotas.
  • 54% of senior midwives said their funded staffing is below recommended levels. 80% have midwife vacancies with the number doubling from 611 in 2018 to 1056 in 2019. In addition, 17% said they had to reduce services in 2019/20 compared to 7% in 2018.

A report released in May 2018 revealed that UK health spending would need to increase by £95 billion in 2033/34 to maintain current service levels.

In response to this, an RCM director, Jon Skewes said “Demand on the NHS and its maternity services is increasing yet funding for it, as this shows, has not been enough to meet that demand. We have recently had a commitment from the government to fund more midwifery training places, which is very, very welcome after over a decade of midwife shortages. But that is only half of a solution and the NHS needs enough money to be able to employ these new midwives when they qualify.”

Student midwives: the impacts of bursary cuts

The cuts to student bursaries for midwives were implemented in 2017. Prospective midwives are now saddled with the burden of potential debts of over £60,000.

Following the decision, there were significant drops in the number of midwifery applicants for many years. UCAS figures in 2018 applications show another 13% drop in applications for nursing or midwifery since 2017.

However, in the last two years there have been positive increases in the number of applicants. In 2019 there was a 6.4% increase on the previous year and in 2020 there was another 16% increase in applications in England.

The Royal College of Midwives have said they are encouraged by these figures but cite caution on the need to retain these midwives in the NHS. They commented:

“Our midwifery education is world-leading and a measure of excellence across the globe, and our graduates and new entrants to the Register are a testament to that. However, we still do not have enough midwives to cope with demand.

“We know that reliance on homegrown talent isn’t enough, and that we have always looked to Europe to build our capacity. Ongoing uncertainty around Brexit has undoubtedly caused a steep decline in midwives coming to the UK from the countries in the EEA.”"

Public health cuts

The RCM has criticised the cuts to public health spending over the years. After the speech by Matt Hancock in 2020 revealing plans to axe Public Health England, the RCM commented:

"There is a big risk in what the Secretary of State has put forward today that, as we ramp up our ability to fight COVID 19, we forget that there are significant risks already endemic in this country. Cutting levels of obesity and smoking not only makes us healthier as a nation, it also reduces a significant burden on the NHS...

"What we need is more money on the frontline so we can afford more midwives to help women stop smoking and start breastfeeding.  That’s how you have an impact on public health in the long term."

A report published by Cancer Research UK – Action on Smoking and Health (ASH) in 2016 shows that around 40% local authorities in England are cutting budgets to stop smoking services. These cuts reduce the support midwives have in encouraging safe pregnancies. A follow up study by ASH in 2017 show that the cuts to stop smoking budgets reached 59% in 2016.

Moreover, within midwifery services there continues to be shortages of specialist midwives despite increasingly complex care required by women. 58% of midwifery units do not employ a smoking cessation midwife (44% have never employed) and 58% do not employ a substance misuse specialist midwife.

Stressed and demoralised staff

Underfunding and a long period of the NHS pay cap has led to high stress levels amongst midwives and feelings of underappreciation. The RCM renewed their calls in 2020 for a pay settlement alongside the Royal College of Nursing after it was revealed that upwards of 250,000 nursing staff consider quitting due to low pay.

Despite praise and claps for NHS staff over 2020, the government have yet to produce a pay rise for hardworking nurses and midwives across the country.

Commenting, the RCM’s Executive Director of External Affairs and lead negotiator on pay, Jon Skewes, said:

“Our members deserve a substantial consolidated pay rise. We’re not looking for a one-off bonus payment as a thank you for their work during the pandemic, but proper recognition of their hard work, day in day out. Crucially we want a deal for our members that doesn’t defund other vital NHS services..."

Moreover, despite the increases in midwifery applicants at university in the last couple of years a survey in 2019 revealed nearly half of students were considering leaving due to finances. This highlights the continued problem faced by the NHS in both the recruitment and retainment of vital staff.