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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Surveys published by the Royal College of Midwives (RCM) in 2017 reveal some alarming statistics:

  • 49% of Heads of Midwives (HOMs) said they had to close their unit over the year because they could not cope with the demand, a 10.4% increase from 2016.
  • In total, units closed 209 times. Six units closed on ten or more occasions. One unit closing 33 times during the year.
  • There is a current shortage of 3,500 midwives in England. 73% of HOMs reported vacancies in their unit and 63% stated difficulties with recruitment to some or all posts.
  • 35% respondents strongly agreed/agreed with the statement ‘I worry so much about money that it affects my work’.
  • One maternity support worker from England said “As the end of the month approaches my anxiety increases I drive to work with my fuel light on expected to give my all on a twelve hour shift serving the public”.
  • 71% of HOMs said they had to call in agency or bank staff regularly to cover essential services. This costs the NHS huge amounts of money a year.

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.

According to the RCM, there has been a 35% drop in the number of applicants for midwifery courses since 2013. This coincides with a 45% drop in the same period of students over the age of 21 applying for courses.

RCM professional policy advisor Gabrielle Bourke said: “We are not entirely surprised by these figures as the RCM has previously raised concerns about how less attractive midwifery as a profession was becoming, particularly since the midwifery bursary was abolished and tuition fees were introduced in August 2017.”

UCAS figures for 2018 applications show another 13% drop in applications for nursing or midwifery since 2017. Nursing bosses state this could cause “unimaginable problems” within the NHS in the future. The Royal College of Nursing chief executive, Janet Davies said: “Nursing is now a graduate profession but it lacks a graduate salary that compensates for the fees paid,”

Use of agency or bank (temporary) staff

In 2016, the NHS spent over £97.1 million on agency, bank or overtime staff. The hourly rate of agency staff equate to £43.65/hr compared to that of an experienced midwife whose rate is £18.20/hr in England.

Other findings include:

  • The spend on agency midwives doubled from 2010 to 2016 to over £20 million.
  • Over 16 organisations in the UK spent over £1 million on bank staff for maternity services in 2016.
  • England is the biggest spender on agency, bank or overtime staff. There was a 20% increase in spending from 2015 to 2016.
  • The money spent on these staff could pay for 2,731 experienced full-time midwives or 4,391 newly qualified full-time midwives.

Public health cuts

The RCM has criticised the cuts to public health spending in May 2015 and in the November 2015 spending. A report published by Cancer Research UK – Action on Smoking and Health (ASH) 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.

Sean O’Sullivan, Head of Health and Social Policy at RCM, commented: “Access to local stop smoking support services within the community are vital for pregnant women as smoking during pregnancy still remains a risk factor for stillbirths. If we are serious about reducing the negative consequences of smoking in pregnancy, smoking cessation services should be increased, not reduced. Midwives and other healthcare professionals will find it increasingly difficult to encourage and support women to stop smoking if the smoking cessation services they need to refer them to are no longer there.”

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 Royal College of Midwives produced the results of a survey into staff feelings towards their pay, with 61% of respondents stating ‘they were considering leaving the service in the next year one to two years’, but they would stay if their pay increased.

The results also showed that 91% of staff either disagreed or strongly disagreed with the statement ‘there are enough staff at my organisation for me to do my job’. Most alarmingly, 86% of RCM members’ pay survey respondents strongly agreed/agreed with the statement ‘I feel pay restraint is having a negative impact on my life’.

Jon Skewes, Director for Policy, Employment Relations and Communications at The RCM said; “Maternity services continue to rely on the goodwill of midwives and the RCM has warned time and time again that is unsustainable.  The impact that seven years of pay restraint has had on employment relations between midwives, MSW’s and the NHS is now hanging by a thread. It is a completely untenable situation which cannot continue. In 2017 the value of pay for a midwife at the top of band six has decreased by over £6,600 since 2010.”