Senior midwives without enough staff to meet demands on services says new survey

on 21 March 2019 Staffing Levels

Heads of midwifery (HoMs) across the UK responding to a Royal College of Midwives (RCM) Survey published today say they do not have enough staff to meet demands on their maternity services.

The survey also shows that pregnancies are becoming increasingly complex, that there is a lack of specialist midwives and that midwifery vacancy levels are increasing.

Staffing levels continue to be an issue. The accepted model for determining what minimum staffing levels a maternity service needs is called Birthrate Plus (BR+). So it is worrying that almost half (48%) of HOMs who responded said that their funded staffing levels do not match BR+ or other workforce assessment tools.

Almost half of HoMs (48%) said that they did not have the funding for the right numbers of staff to meet the demands on services. This is compared to just under a third (32%) saying the same thing the previous year; a worrying rise. 

At the same time nearly every HoM (96%) said that their units are dealing with more complex cases than last year.  One HoM said: “We are seeing an increase with diabetics, both gestational and pre existing, also ladies that previously would have not gotten pregnant due to complexities impacting on fertility.” 

Despite the birthrate levelling off the increase in complexity of pregnancies means the pressure on services remains. The RCM wants to see all maternity services having the right amount of staff to give all these women the safest and best possible care.

It is worrying that the number of HOMs reporting vacancies in their unit has risen this year. Over three quarters (79%) of HOMs said they have vacancies in their unit; in 2017 it was 76%.

Despite the increasingly complex care required by many women, HoMs reported not having important specialist midwives. Two thirds (69%) said they did not have a smoking cessation specialist midwife. Nearly half (44%) reported not having a consultant midwife. This is a critically important post on maternity units so this is a concern. Over two thirds (67%) of HoMs reported not having a female genital mutilation (FGM) specialist midwife and 41% reported not having a substance misuse specialist midwife.

Another concern centres on the Government’s commitment to have 3,000 additional midwives in training in England in the next few years. The RCM has welcomed this commitment but worryingly over half (56%) of HOMs said they would not be able to increase the number of student placements in their unit above their current level. This lack of capacity for services to absorb the promised additional trainee midwives should ring alarm bells within the Government.

Despite fall in spending on agency midwives - over two-thirds (65%) of HOMs still reported having to call in bank and agency very often or fairly often.

Temporary closures on maternity units remain an issue.  In the last year 40% of HoMs said their units have had to close for a temporary period. 13 units reported closing up to 8 times. Four units closed more than 10 times. One unit closed 28 times and another 34 times.

The impact on choice for women is also highlighted in the survey. A large number (89%) of HOMs reported having to redeploy staff very often or fairly often - up from 76% in 2017. The vast majority of staff from all areas such as community and home birth services were redeployed to labour wards. A third (33%) of HoMs said the redeployment of on-call community staff to cover labour and delivery suite restricted the home birth service.

Commenting on the survey, Gill Walton, Chief Executive and General Secretary of the Royal College of Midwives, said: “These are the people running our maternity services and what they say really matters. Our midwives and maternity support workers are incredibly passionate and committed. They are all doing a great job and despite the problems highlighted in this survey, our maternity services are among the best in the world.

“What is important now is that we get the resources the service needs as quickly as possible. We need to see the Government deliver and deliver quickly on their commitments and promises.

“We also need leadership at Government and local level to develop ways to deliver on the vision we all have for maternity services. These are the sort of issues that the National Workforce Steering Group will be coming together to tackle; we will be using our position on the Group to advocate for solutions to these workforce challenges. It is by working together that we will solve the problems, overcome the hurdles and then deliver a maternity service we can be even more proud of for women, babies and their families.

“We absolutely welcome and recognise the Government’s vision for maternity services in England. We also applaud the promise of more midwives. However solutions to the current situation need to be found, supporting delivery of the care I want to see happening in our maternity services.”          

Download the NHS Pay Review Body Evidence for 2019, containing the full results of the survey of heads of midwifery.


Note to editors

*The Heads of Midwifery Survey forms part of the RCM’s evidence to the NHS Pay Review Body. It was submitted to the NHSPRB in December 2018.  The survey was sent to 190 Heads of Midwifery (HOMs) in England, Northern Ireland, Scotland and Wales. The response rate was 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