NHS maternity staffing crisis putting babies’ lives at risk
on 13 October 2022 RCM Maternity Services MSWs - Maternity Support Workers Midwifery Midwives Staffing Levels RCOG - Royal College of Obstetricians and Gynaecologists RCOG Sands Safety Maternity Safety NHS Staff Bereavement Care
The Royal College of Midwives (RCM) and leading UK pregnancy and baby loss charity Sands are warning that a severe shortage of staff in maternity services is putting mothers and babies’ lives at risk.
The message comes as a report - on maternity and neonatal staffing - is published today by the All-Party Parliamentary Groups on Baby Loss and Maternity as part of their joint Safe Staffing campaign.1
Responses to the APPGs’ call for evidence – from women, families, staff, and organisations - reveal that staffing shortages are severe, pervasive, and having a profound impact on maternity and neonatal services.2
The report paints a bleak picture of services that are understaffed, overstretched, and too often letting down women, families, and staff alike.
Cherilyn Mackrory MP, Co-Chair of the APPG on Baby Loss, said: “This is a crucial report that highlights the impact staffing shortages on maternity and neonatal care services. Following on from the Ockenden report, this report affirms yet again that investment is needed to ensure maternity and neonatal services are well staffed and supported so that we deliver the care women and families need.
“I give thanks to all the individuals and organisations who have contributed to the call for evidence and look forward to working with the Baby Loss and Maternity Parliamentary Groups to feed these views into Government.”
Understaffing increasing risk of harm
Alarmingly, some NHS staff spoke of a widespread and growing sense of fear of mistakes, incidents or other failures due to the chronic levels of understaffing. Time pressures are affecting the standard of care staff can offer, such as little time to carry out even basic checks such as during antenatal appointments.
Intense pressure on staff is leading to many leaving their professions, because they cannot continue to work under poor conditions. A survey of RCM members last year showed that over half of midwives surveyed said they were considering leaving their job with 57% saying they would leave in the next year. This is being borne out in official statistics showing that England is down over 500 midwives in the past year on top of a longstanding shortage of over 2000 midwives.
One area highlighted repeatedly in staff submissions was how frequently staff are forced to work beyond their scope of practice, and the danger this presents to the people in their care. Tragically, there were reports of instances where staffing shortages had caused harm. Several respondents described failures in care that would not have occurred with safe staffing levels.
Gill Walton, Chief Executive of the Royal College of Midwives, said: “A serious, persistent and worsening shortage of midwives and other staff is having an impact on the safety and quality of care for women, babies and families. Staff are working flat out and doing their best but they are burnt out, fragile and exhausted. The demands on them mean they cannot deliver the level of care they so desperately want to, and choice for women is being eroded. For many, crisis mode is now the norm.
This is why many are choosing to simply walk away from the NHS because they know they cannot deliver the right care, and for the sake of the own mental and physical health. We must see urgent action and investment because services are simply on their knees.”
Poorer care for parents and babies
The APPG report also cited impacts such as reduced time to speak to parents and advise them when something has gone wrong, or simply to prepare them for parenthood, and, in general, just less time for compassion to be shown.
Staffing shortages mean that often specialist services are also hit such as bereavement specialists. Some families were left in the hands of staff inexperienced in bereavement care and are often not referred on for support such as psychological support, as midwives do not have the time.
A recent Bereavement Care Audit by Sands found that 12% of trusts and boards across the UK had no bereavement specialist working in the maternity service. The charity estimates that each bereavement specialist has just two hours working time to dedicate to each death, including all aspects of the role, including supporting families directly.3
Clea Harmer, Chief Executive of Sands said: “Today’s report paints a worrying picture of NHS staff having to make the choice between supporting a bereaved mother or caring for a mother giving birth to a living baby, often rushing between the two leaving no time for personalised, compassionate bereavement care.
“Too often inexperienced midwives are being left on their own to care for bereaved families and this is simply not good enough.
“Every parent whose baby has died deserves equal and excellent bereavement care. It’s the very least we can do for them. Good quality bereavement care is vital for parents who have experienced the loss of a pregnancy, or whose baby has been stillborn or died in hospital during the first weeks of life.”
Sands and the RCM are now calling on the Government to fix the staffing crisis in maternity services, including in bereavement care.
Sands offers support and training to midwives, and other healthcare workers, to ensure they have the skills they need to both care for bereaved families, and to look after their own wellbeing.
Solving the staffing crisis
The report makes a number of recommendations in line with the Commons Health and Social Care Select Committee report last year and the Ockenden Review findings. These include:
- A multi-year, fully funded settlement for maternity and neonatal services.
- The ringfencing of a proportion of the funding settlement for the training and development of maternity and neonatal staff. This should be sufficient to cover the back-filling of posts.
- The establishment of and adherence to nationally agreed minimum staffing levels for maternity and neonatal staff.
- Improving the health and wellbeing of staff, through more flexible working opportunities, a culture that values and respects staff and action to tackle unacceptable behaviors.
Dr Edward Morris, President of the Royal College of Obstetricians and Gynaecologists, said: “The NHS is one of the safest places in the world to give birth, but there is more that can be done to ensure that we continue to improve maternity safety and offer a high standard of care to those who access maternity services across the UK.
“The RCOG continues to deliver a number of programmes that are contributing to improving maternity safety. These include the development of a workforce tool to inform the correct level of staff and our ABC programme which aims to avoid brain injury in labour and our guidance for the hiring of long term locum doctors.
“We hope this report adds to the growing body of evidence that maternity services are under incredible strain, and staffing levels are below where they need to be. As a College we continue to call for the Government to commit to the much needed funding for maternity staffing and training as a priority.”
For information about Sands or to arrange an interview with Clea Harmer please contact Adrian Brown, Communications & Engagement Lead at Sands on 07748 047 337 or email [email protected]
For the RCM Media Office call 020 7312 3456, or email [email protected].
Maternity APPG contact: Jill Mortimer [email protected]
Baby Loss APPG contacts:
Notes to editors:
- The joint maternity and baby Loss APPGs report on maternity and neonatal staffing can be read at www.sands.org.uk/appg. The link will be live from 00.01 on 13 October.
- The call for evidence was open for six weeks, from Wednesday 22 June to Wednesday 3 August. Responses were submitted via an online survey using the website Survey Monkey. 14 questions were asked in total. No questions were mandatory, and respondents were free to answer as many or as few as they chose. A copy of the questions can be found at the end of the report. The call for evidence received 102 responses.
- Bereavement Care Audit (Sands 2022).
Every day in the UK, 13 babies are stillborn or die shortly after birth. Sands works to save babies’ lives and support anyone affected by pregnancy loss or the death of a baby. Sands’ vision is a world where fewer babies die and when a baby does die, anyone affected receives the best possible care and support for as long as it is needed.
Sands provides bereavement support services both nationally through its Freephone helpline, mobile app, online community, and resources, and locally through a network of around 100 regional support groups based across the UK and run by trained befrienders.
Sands works in partnership with health care professionals, trusts and health boards and offers a range of training programmes and bereavement care resources to ensure that every bereaved parent and family receives the best possible care wherever they are in the UK.
Sands supports and promotes research to better understand the causes of baby deaths and save babies’ lives. The charity also raises awareness of baby loss and works with governments, key influencers, and other stakeholders to make reducing the number of babies dying a priority nationally and locally. www.sands.org.uk
About The Royal College of Midwives (RCM)
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 | A professional organisation and trade union dedicated to serving the whole midwifery team.
Selection of comments from Survey respondents
"Maternity services are already broken and dangerous due to staff shortages. Many people try to compare health services to the airline industry yet a plane doesn’t take off when there is not enough crew, the plane hasn’t had its safety checks or been fuelled." (Obstetrician)
"Staff are burnt out, rude and missing red flags leading to dangerous practice. Staff are directly traumatising women." (Parent)
“Forget mental health support, smoking cessation or addiction issues – no time to ask or offer support beyond the basic check-up. Women are experiencing terribly unsafe and unsupportive care and babies will die because of it.” (Midwife)
“The delays in inviting women in for induction of labour have been unprecedented this past year. One lady was delayed and her newborn unfortunately died soon after birth. This may not have happened had we had the capacity to induce her labour sooner.” (Midwife)
“Staff are burnt out, and undervalued. Staff are retiring and not returning as they would once have done, and others who are nowhere near retirement age are looking for ways out of midwifery too. We don't get paid enough to carry the level of responsibility and pressure which we shoulder on a daily basis, and quite frankly we feel utterly undervalued.” (Midwife)
“Staff do not have the time to learn from incidents, literally, every day they come to work it is a matter of survival, managers are unable to allocate time for personal development. Study days cancelled regularly... every day it is a fight.” (Midwife)