The view from midwifery

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.

The October 2015 survey of Heads of Midwifery (HoMs) reported some alarming statistics from the frontline:

  • Over two-fifths of maternity units had to close during the last year because they couldn’t cope with the demand – 32.8% in 2014 and 41.5% in 2015. Units closed their doors on average on 6.6 separate occasions in 2014 and 4.8 in 2015.
  • More than a quarter of HoMs – 29.5% in 2014 and 29.6% in 2015 ­– said that they simply did not have enough midwives. The shortage of midwives in England remains critical with the country still short of 2600 full-time midwives.
  • In 2014, 10.9% of HoMS reported that they had to reduce services in the last year, and in 2015 it was 11%. This included reductions in specialist midwives, fewer parent classes and less bereavement and breastfeeding support.
  • Two-fifths – 21.9% in 2014 and 20.3% in 2015 – of HoMs had to reduce training for their staff.
  • In both years, three-quarters of those surveyed said they had to redeploy staff to cover essential services either very or fairly often.

RCM chief executive Cathy Warwick said: ‘Our maternity services are overworked, understaffed, underfunded and struggling to meet the demands being placed on them. This is deeply worrying for the quality of care women are receiving, and the safety of services.

The government is responsible for this and it is they who are letting down women, babies and their families, as well as the staff they purport to value. This is simply not acceptable.

Bursaries cut

To make matters worse in the spending review in November 2015, the Chancellor George Osborne announced that student midwives would stop receiving bursaries. The RCM said this move was ‘extremely worrying’ and ‘another blow’ to the profession.

The cuts are likely to deter many potential students from entering the profession, which is not good news for the future of midwifery in the UK. Cutting public funding to train frontline staff in an already struggling and understaffed maternity service just doesn’t make sense,’ said Jon Skewes, Director of Policy, Employment Relations and Communications, at the RCM

The RCM has noted that midwives who begin their training in autumn 2017 potentially graduating with debts of over £60,000, while student midwives who already hold a degree could face combined debt of up to £100,000.

Use of agency staff

A lack of staff is a serious problem for maternity units and has led trusts to spend millions on agency staff; an RCM report found that NHS trusts in England pay almost fifty pounds per hour for agency midwives when the normal rate of pay for a Band 6 midwife with ten years’ experience is £17.84 an hour.

Other findings included:

  • The spend on agency midwives increased from over £10 million in 2012 to almost £18 million in 2014; an increase of almost 76%.
  • There were eleven trusts that spent over £1 million on agency midwives in the three year period with one trust spending almost  £4.5 million on agency midwives between 2012-2014.
  • The spend per hour of £49.01 is more than 2.7 times the amount for a permanently employed midwife and more than 1.8 times the amount of paying overtime.
  • Over 73% of trusts in London with maternity services rely on agency midwives to staff their services.

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.

Janet Fyle, Professional Policy Advisor at the Royal College of Midwives, said, ‘The Government have recently announced a welcome and ambitious plan to reduce the rate of stillbirths. Smoking during pregnancy is a risk factor for stillbirths. These cuts quite simply are counter-productive to the Government’s ambition. Midwives will find it difficult to encourage and support women to stop smoking if the smoking cessation services they need to refer them to are not there. If we are serious about reducing the negative consequences of smoking in pregnancy, smoking cessation services should be increased, not reduced.’

Stressed staff

Underfunding has led to less than ideal working conditions, so it is not surprising that according to the latest NHS staff survey in March 2016, almost 50% of England’s midwives have suffered from stress in the previous year.  The results also revealed that 69% of midwives had felt pressure in the last three months to attend work when they were feeling unwell, and 43% of them had witnessed potentially harmful errors, near misses or incidents in the last month alone.

RCM director for policy, employment relations and communications Jon Skewes said, ‘These latest NHS staff survey results are shocking but not surprising, midwives day in, day out face enormous pressure due to understaffing and an increased birth rate….We hear daily from our members of their frustrations and fears about delivering a high-quality safe service with inadequate levels of staffing at their units, this is undoubtedly one of the primary causes of work-related stress.