Senior midwives report falling budgets despite rocketing birthrates

Despite the rapidly rising birthrate* well over a third (40%) of Heads of Midwifery (HOMs) say they have not had any budget increases in the past year. Worryingly, nearly a fifth (17.8%) report that their budget has been cut, and almost a third (30%) report that they have been asked to reduce their budgets. Just 42% report an increase in their budget, a fall from 47% last year. 

The results – from a survey of HOMs across the UK by the Royal College of Midwives (RCM) are released on the final day (Friday, 27^th November 2009) of the RCM’s annual conference in Manchester.

When asked about their staffing levels over two thirds (67%) of HOMs also reported that they do not have enough midwives to cope with the workload in their unit.  Well over two-thirds (72%) said they needed more midwives to bring their midwifery staffing levels up to an acceptable level. Over 90% of HOMs cite rising birthrates and the increasing complexity of births as the key reasons why their units are struggling to cope with the workload.

Despite recent and welcome increases in the numbers of midwives**, and plans to recruit more, the figures show that the increase is not keeping pace with the birthrate. There still remains a significant midwife shortage. The RCM still believes that the Government’s target of 3,400 more midwives will not be enough - if the birthrate continues to rise - to delver a high quality service. For this to become a reality the RCM estimates that over 5000 more midwives is the target that the Government should be aiming for.***

Thepicture however is not all bleak. Following a freedom of information request the RCM found that spending on maternity services is up on average by 7% across the UK. This is above the average NHS spending increase of 4%. But, this is a service playing catch-up, and that has seen historically low investment compared to other parts of the NHS.

Regionally there are significant variations in general vacancy rates. London (12.6%), the East of England (12%) and the South east (10.9%) all have exceptionally high levels. This is compared to the average vacancy rate for the UK of 6.5%, up from 5.4% last year, and this compares badly with an acceptable level of vacancies of around 3%.

A number of other regions have lower but still worrying levels of vacancies with South Central England (7%), the West Midlands (5.7%) and East Midlands (5%) all running well above acceptable levels. The RCM would want to see concerted action to chip away at these morale sapping levels of vacancies, and are hopeful that Maternity Matters, the Government’s blueprint for maternity services, will achieve this.

HOMs also report that they are struggling to recruit midwives, so even when they have the funding they are struggling to improve their staffing levels. Almost half (48%) say that recruitment and retention of midwives is quite a problem or a major problem. The number of HOMs who see recruitment and retention of midwives as no problem has fallen from almost 60% 2 years ago to just 25% this year.

Stress and heavy workloads top the table of reasons why HOMs say they are struggling to recruit and retain midwives.  A third of HOMs (33%) report that stress is a major issue, and nearly a third (30%) say heavy workloads are having an effect on recruitment and retention.

Cathy Warwick, general secretary of the Royal College of Midwives, said: “There is no doubting the Government’s commitment in word and deed to maternity services. The direction of their policy is good, more money going into maternity services and midwife numbers are increasing.

“However, on the ground midwives are having to work ever harder and longer to maintain a high quality service for women and babies.  I have to ask myself how long they can keep doing this, and it is obvious that there is still an awful lot of ground to cover.

“The RCM remains sceptical as to whether the planned increase in the number of midwives will match or even catch up with, the ever increasing birthrate. It is also an issue as to whether all the resources allocated to maternity services will reach the front line, given the financial pressure that the NHS is facing to save money.”

The RCM conference runs on Thursday 26^th and Friday 27^th November 2009 at Manchester Central Convention Complex.

For more information contact the RCM Press Office on 020 7312 3456

Notes to editors

The Royal College of Midwives (RCM) aims to promote and advance the profession of the midwife. The RCM represents the vast majority of the UK's midwives and is one of the world's oldest and largest midwifery organisations, and celebrated its 125^th anniversary in 2006. It is also a trade union. For more information visit the RCM website at www.rcm.org.uk.

The survey of Heads of Midwifery received 76 responses from a questionnaire sent to 203 HOMs across the UK, a 37.4% response rate. It was conducted by the RCM in July 2009. It was conducted to gather information to support the RCM’s contribution along with other unions, to the NHS Pay Review Body.

The full report can be found on the RCM’s website at http://www.rcm.org.uk/college/employment-relations/pay/ - ‘RCM Evidence to the NHS Pay Review Body 2009’

*The birthrate has risen by 18.6% since 2001. See table below.

**The Government have pledged to increase the number of midwives by a total of 3,400 (whole time equivalent, equating to 4000 more as a headcount figure0) by 21012. They have recruited an additional 1000 (headcount) so far.  For midwife numbers since 2001, see table below.

***The number of midwives needed is calculated using a tool called Birthrate Plus. This takes into account the level of activity on a unit, including the number, type and complexity of births.  Birthrate Plus would suggest that the current birthrate requires 24,937 whole time equivalent midwives whereas there are currently just 19,639. This leaves a shortage of 5,298 whole time equivalent midwives.

The number of Headcount and WTE Midwives

The Rising Birthrate in the UK