New report sees ‘gathering storm’ threatening safety of NHS maternity services

By RCM on 14 March 2017 Midwife Shortage England

A ‘gathering storm’ of forces is threatening the safety, quality and sustainability of maternity services in England. The claim comes in a new report from the Royal College of Midwives (RCM) that shows the forces driving up demand and increasing pressure on England’s maternity services.

The report ‘The gathering storm: England’s midwifery workforce challenges’  outlines how issues such as rising levels of complexity in pregnancy, midwife shortages and financial constraints in the NHS are ramping up the pressure on England’s maternity workforce and services.

England’s maternity services are facing sharply increasing demands. This is coming from an increasing and persistently high birthrate. Births in England rose in 2015 (the most recent year for which figures are available) and were up 100,000 on 2001.

Births are also more complex needing more of midwives’ and other staff’s time. For example there are more births to older women and increasing levels of obesity in pregnancy.

There is also a serious, longstanding and continuing midwife shortage in England; one that has lasted for over a generation. England is 3,500 full time midwives short of the numbers it needs.  Money that could be used to hire more midwives is instead used on more expensive agency staff.  At the same time the workforce is ageing, with over 1,000 NHS midwives in England in their sixties and heading towards retirement.

The total number of student midwives also fell at the last count, meaning fewer coming through to replace those that may leave. The Government also continues to refuse to remove the question mark hanging over the long-term legal status of England’s 1,300 EU midwives. This could potentially leave England with an even more serious midwife shortage.

The Government rightly claim there are more midwives, but this is not enough. In the 12 months to October 2016 the number of midwives rose by 171 –  less than one extra midwife per maternity unit. At this rate it will take decades to remove the midwifery shortage that has already lasted more than a generation.

England also has an increasingly dissatisfied midwifery workforce as stagnating pay and other employment issues bite into staff morale. A recent RCM survey of 1,500 RCM members from across the UK suggests that 40% of midwives are seriously thinking of leaving the midwifery profession in the next two to three years. This is especially worrying given that only around a quarter of those are midwives nearing retirement.

The report also puts forward solutions to the problems in maternity services. It sets out ways in which decision makers across government and England’s NHS can tackle the situation. These include a more adaptable approach to requests for flexible working, and allowing the NHS Pay Review Body free reign to recommend staff pay wards. This will help retain midwives and not push them into costlier agency work. Implementing other changes will also help too, such as ensuring more low-risk women give birth outside of obstetric units.

Jon Skewes, Director for Policy, Employment Relations and Communications at the Royal College of Midwives, said: “England’s maternity services are buckling under the demands being made on them; this cannot continue. The Government has got to ensure England’s maternity services have the staff and resources to provide safe, high quality care. We are pointing out the problems and offering solutions and the Government has to listen to them.

“They have also got to do much more to show they value and support staff. Without the dedication and commitment of its staff and their determination to go above and beyond, NHS maternity services would be severely compromised, the safety of services would be in question and quality would fall. It is in the hands of the Government to do something about this gathering storm, but it needs doing now.”

Read the full report ‘The gathering storm: England’s midwifery workforce challenges

The RCM has produced a range of publications on the current situation. Among those are Getting the midwifery workforce right and RCM guidance on implementing the NICE safe staffing guideline on midwifery staffing in maternity settings published in December 2016. The State of Maternity Services Report was published last month, and a report on the use of agency staff in midwifery Agency, Bank and Overtime spending in maternity units in England in 2015 was published in October 2016. 

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


Notes to editors

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