Budget Cuts, Service Cuts, Staffing Shortages = Maternity Services in 2016

By RCM on 19 October 2016 Maternity Services

Maternity unit closures, budget cuts and reduced services are among the issues highlighted by a survey of UK senior midwives published today by the Royal College of Midwives (RCM).

The survey comes as the RCM enters the second day of its Annual Conference in Harrogate, running on the 19th and 20th of October 2016.

According to the survey of heads of midwifery (HoMs) well over a third (38.6%) of maternity units had to close temporarily during the last year because they couldn’t cope with the demand.

Responses to the survey showed that units closed their doors on 281 separate occasions in 2016. The average was 8.3 times, with one unit closing its doors 50 times in a year. Eight units had to close their doors on ten or more occasions.

The number of closures is a reflection of the rising demands on services from increasingly complex births and staffing levels. Nearly all HOMs (93.2%) surveyed said their unit is dealing with more complex cases than last year (91.3% in 2015).

One HoM in England said: “The complexity has an impact upon the workload and the amount of interaction and care required. Often the women have social factors that require considerable midwifery input to keep both the woman and her baby safe”.

Maternity services are also seeing cuts to their budgets, despite the high birth rate and more complex births.  Almost a fifth (18.8%) of HOMs said their budget had decreased in the last year, compared to 14.6% in 2015.

On staffing levels well over a third of HoMs (38.6%) said that they did not have enough midwives to cope with the demands on the service. This is a significant increase on last year when 29.6% said they did not have enough staff.

The shortage of midwives in England remains critical with the country still short of 3500 full-time midwives. This is a shortage that has lasted for over a decade.

Services are also being cut as the lack of adequate funding and staffing shortages hit maternity services.13.6%, of HoMs reported that they had to reduce services in the last year, compared to 11.0% in 2015. This included reductions in parent classes and breast feeding and bereavement support.

These reductions are worrying. For example a great deal of importance is being placed on better public health where breastfeeding has a crucial contribution to make.

Well over three quarters of those surveyed (81.2%) said they had to redeploy staff to cover essential services either very or fairly often. This was compared to 75.9% of HOMs in 2015. As a result of this redeployment, services such as antenatal care and community care are being hit, as staff are redeployed to cover labour delivery suites.

Similar to last year’s survey, HoMs were also concerned about how maternity services were valued by their organisation’s board. Almost a quarter (23.3%) of HoMs disagreed or strongly disagreed with the statement ‘I have enough support from the Board in my organisation’. This is up from almost a fifth (19.2%) in 2015.

This statistic is particularly worrying. The national maternity review published earlier this year stressed the importance of maternity services being a high priority for trust boards. It is a real concern that so many senior midwives are not seeing this happening at their trust.

Another rise was seen when HoMs were asked were they able to meet all the conflicting demands on their time at work. Over two-thirds, 69.8% disagreed or strongly disagreed with the statement. Again, this is an increase from 62.3% in 2015.

The survey of Heads of Midwifery forms part of the RCM’s submission to the NHS Pay Review Body (NHSPRB) 2016. In its submission the RCM calculated that if a midwife’s salary had increased by Retail Price Index inflation since 2010 their salary would be over £6,000 higher than it is now.

If the projected pay restraint continues to 2020, as the Government intends, the difference will rise to over £9,000. This is a substantial drop in the real value of a midwife’s pay, and in the context of the increasing shortage of midwives the RCM is calling for the Pay Review Body to break the public sector pay restraint and recommend an appropriate pay award.

The RCM believes that the retail prices index (RPI) is the most appropriate measure for the cost of living. It is calling for an award of 1.9% based on the July rate of RPI which should be applied to the re-set pay structure to determine salaries for 2017/18.

Commenting on the survey, Cathy Warwick, chief executive of the Royal College of Midwives, said: “Yet again we are seeing senior midwives describing services that are being battered by increasing demands, inadequate resources and staffing shortages.

“It is very often only through the hard work, goodwill and sacrifice of maternity staff that services are able to deliver the safe and high quality care women need. These results show that midwives have never been so challenged in their ability to continue to provide high quality care for women and their families.

“Midwives and maternity support workers want to provide the best care for women and their babies. It is astonishing that units are temporarily closing because they can’t meet the demands of the service, staff are redeployed to the detriment of antenatal and community services and just after Baby Loss week we are finding that bereavement support services have been cut.

“Every week I speak to midwives who tell me they are exhausted by the pressures they are facing, and they lack the time to do their jobs as well as they would like. This situation isn’t sustainable and the Government must start to invest in NHS staff because we all know that an investment in staff is an investment in high quality, safe care.

“We are asking for the Pay Review Body to break with the Government’s disastrous policy of pay restraint in the NHS and say that after six years of cuts to the value of NHS pay - enough is enough. As the heads of midwifery have told us, midwives and maternity support workers are working harder than ever at the same time as they have had six years of real-terms cuts to their pay. We want to see a cost of living increase for midwives, maternity support workers and other NHS staff to show them they are valued and to reward their hard work.

“There is a growing shortage of midwives and midwives tell us because of the demands they face they are intending to leave midwifery, making the shortage worse. However, 80% of midwives who are intending to leave say they would stay if pay improved. With the shortage of midwives climbing the Government can’t afford not to invest in maternity services.”

“The Government say they are investing in services and that they are being given the resources they need. Well, I challenge this Government to come down to the front line and live the lives of midwives, maternity support workers, doctors and other maternity staff struggling day in and day out to do their best for mothers and babies. These dedicated staff will tell you a very different story from the one that Government wants us to hear.”

To contact the RCM Press Office and for a copy of the RCM’s full submission to the NHS Pay Review Body 2015 call 020 7312 3456 or email [email protected].


Notes to editors

*The HOMs survey asked questions around staffing levels, recruitment and retention, morale and motivation and budget cuts. HoMs were asked to answer for their Trust/Board about their service for April 2015 to April 2016. The 2016 HOMs survey had a response rate of 53%.

The RCM is the only trade union and professional association dedicated to serving midwifery and the whole midwifery team. We provide workplace advice and support, professional and clinical guidance and information, and learning opportunities with our broad range of events, conferences and online resources. For more information visit the RCM website at https://www.rcm.org.uk/.

Comments from Heads of Midwifery

On the Increasing Complexity of Births

“The complexity has an impact upon the workload and the amount of interaction and care required. Often the women have social factors that require considerable midwifery input to keep both the woman and her baby safe”.
Head of Midwifery, England

“No extra time built in to deal with these cases thus impacting on the workload”.
Head of Midwifery, England

“The level of complexity affects all parts of the maternity pathway which means there is pressure in every part of the service”.
Head of Midwifery, England

On Service Delivery

“We are currently experiencing shortages with midwives and this has a negative impact on staff taking breaks and leaving work on time. We are actively managing this with movement of staff to maintain a safe service”.
Head of Midwifery, Scotland

“Clinical staff frequently miss breaks and are late off duty. This has almost become an accepted situation...
Head of Midwifery, England