Unit closures, fears for safety and major financial constraints impacting on quality of maternity care all highlighted in new RCM report

By RCM on 19 December 2017 Safe high quality care MSWs - Maternity Support Workers Maternity Unit Closures Staffing Levels NHS Pay Review Body Pay and Agenda For Change

Almost 50 percent (49%) of Heads of Midwifery (HOMs) from across the UK have told The Royal College of Midwives (RCM) that they have had to close their maternity units at some point in the past year because they could not cope with the demand and had serious concerns for safety.

One maternity unit had to close its doors due to understaffing and fears for safety 33 times during twelve months. In total units closed 209 times (between April 2016-April 2017). The average was six times and six units closed on ten or more occasions.

These latest figures have been released today as the RCM publishes its annual survey of senior midwives today as part of the trade unions evidence to the NHS Pay Review Body (PRB).

The Heads of Midwifery (HOMs) also reported the following;

  • 76% of HOMs said they had to redeploy staff to cover essential services either very or fairly often
  • HOMs were asked which areas staff were redeployed to and from, overwhelmingly HOMs reported that staff were redeployed from the antenatal service, the midwife led unit, community and the postnatal service to cover the labour and delivery suite
  • 67% of HOMs answered that on call community staff had to be called in to cover the labour and delivery suite. 45% of HOMs said this restricted the home birth service
  • 19% of HOMs said they had to reduce services in the last year. The most common were parenting classes and midwife led units
  • 71% of HOMs answered they had to call in bank and/or agency staff very or fairly often (very often - nearly every day, fairly often- a few times a week) compared to 62.1% in 2016
  • 51% of HOMs said that it was difficult/very difficult to ensure that staff take their breaks and leave on time

One Head of Midwifery in Wales said; “Quality and safety is a constant battle with finance - we present good outcomes for mums and babies, but this is to the detriment of certain areas like community and postnatal care due to our staffing challenges. I struggle with conflict between the requirement for staff and the financial constraints in demonstrating that despite good outcomes we need more midwifery and obstetric staff to cope with rising demand and acuity”.

“The staff regularly do not get their breaks and often leave late. They also undertake education and learning in their own time”.

Head of Midwifery, Scotland

“All midwives working within the hospital units (both consultant and midwife-led) have to take breaks primarily within the unit to ensure safety of mothers and babies. Staff frequently miss or have short breaks due to workload. Staff often are called in at short notice to cover unsuspected sick leave and due to the busyness of the unit”.

Head of Midwifery, Northern Ireland

“The role (HoM) is becoming increasingly more demanding and finances are a great challenge. Midwives are  working hard under very difficult and stretched services. There is very little money to invest in resources, education and training opportunities or the environment”.

Head of Midwifery, England 

Commenting, Gill Walton Chief Executive and General Secretary of The Royal College of Midwives (RCM) said; “Given the shortage of 3,500 midwives and an increasing complexity of cases the RCM asked Head’s of Midwifery in this survey questions about how they were managing service delivery under increasing pressures. Unfortunately, it is evident  that maternity unit closures have increased by ten percent since the RCM conducted this survey last year.

“HOMs also reported that they were asked to take on more services, but not given any additional budget. It also appears that existing staff are being relied upon to cover the gaps in the service through being redeployed to other areas (normally the labour and delivery suite), missing their breaks and working late. There is also a very obvious over reliance on using temporary staff such as bank and agency midwives which has been proven by the RCM in previous reports* to cost the NHS almost one-hundred million pounds per year.

“All of this again shows how UK 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. Midwives and maternity support workers are too often keeping services afloat by working long hours, often doing unpaid overtime and missing breaks, which is leading to stress and burn out. However, midwives will always endeavour to ensure that both mother and baby receive safe and high quality care.

"This new RCM report shows a system that is about to buckle at the seams and only able to deliver high quality care through the efforts and dedication of its staff. This is unsustainable, and our survey shows that midwives and maternity support workers are fed up with not having enough resources and staff to be able to give women the care they deserve and they are leaving in their droves making the shortage of midwives even worse. However, we know that 80% of midwives would stay in the NHS if they are awarded a fair pay rise.

“The RCM is calling on the NHS Pay Review Body and Jeremy Hunt to listen to the lived experience of those midwives and MSW’s on the front line, those who are trying to their best to deliver safe care to women and their families in a service that is struggling with a long standing and damaging shortage of midwives.What maternity services up and down the UK need now is a fair pay rise to make sure that new students view midwifery as an attractive career option and existing staff are retained in the service; without this we cannot hope to close the shortage of midwives. It is time for the Government to finally recognise that fair pay in the NHS is now well overdue.”



Notes to editors

In the RCM’s pay survey of midwives and maternity support workers includes thousands of comments from members about their feelings about pay restraint, their expectations of a pay rise and what this would mean for them and maternity services and how pay restraint is affecting their motivation, satisfaction and engagement.


The RCM has divided it’s evidence to the NHS PRB into 4 sections:

• Government Pay Policy.

• The Shortage of Midwives.

• The Impact of Pay Restraint.

• Midwives’ and Maternity Support Workers’ Motivation, Satisfaction and Engagement.


View the RCM Pay Review Body Evidence 2017 in our Publications section


*NHS organisations spent £97,164,386.40 on agency, bank and overtime in maternity services in the UK in 2016.

Read full RCM Agency, Bank and Overtime spend report published in October 2017


To contact the RCM Press Office call 020 7312 3456 or email [email protected]

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/.