RCM warns of worsening maternity crisis as senior midwife survey shows services at boiling point

on 26 January 2023 RCM Maternity Services MSWs - Maternity Support Workers Midwifery Midwives Staffing Levels Government RCM Member Pay NHS Pay Review Body Pay and Agenda For Change Industrial Action NHS Staff

The maternity crisis we warned about is here. That’s the message from the Royal College of Midwives (RCM) as a survey of UK senior midwives says they are relying significantly on the goodwill of staff working extra hours to ensure safe services.

The finding comes from a survey of directors and heads of midwifery (DoM/HoM) forming part of the RCM’s evidence to the NHS Pay Review Body (PRB) for the 2023/2024 pay round. It paints a stark picture of chronic workforce shortages and challenges with maternity services often only functioning safely because of staff working long and additional hours, often unpaid.

It also shows a service haemorrhaging midwives at an alarming rate. The loss of experienced midwives is also impacting on the ability to support and train student midwives on their placements in the NHS. They are leaving because they cannot deliver the quality of care they so desperately want to want, because of their falling pay, and because they are exhausted, fragile and burnt-out says the RCM.

Responses to the survey of Homs and DoMs across the UK paint a stark picture of the maternity crisis as services struggle to staff units and recruit and retain midwives. Nearly three out of every four HoMs and DoMs (72%) said they were finding it either difficult or very difficult to recruit to vacancies in their units, with one in every three (33%) finding it very difficult. The survey results underline the seriousness of the situation with 78% of respondents saying it was difficult or very difficult to ensure staff take their breaks and leave work on time.

Shortened evidence has been submitted by the RCM to the PRB as it remains in dispute with the Westminster and Welsh Governments over the 2022/23 pay award. The RCM is balloting members in Northern Ireland from 31 January on the 2022/23 pay award. Participation in the process for 2023/24 does not mean that 2022/23 pay dispute is settled or that the outcome of the process will be accepted by RCM members, it says. Delays in the PRB timetable have exacerbated its members’ frustration with the process says the RCM.

The average midwife has lost around £56,000 in real earnings since 2008 according to the TUC due to pay stagnation and freezes, and inflation is currently in double digits. In a direct message to the Westminster Government the RCM says that it can act outside of the PRB process and called for urgent action to resolve the pay disputes that have erupted across the NHS, saying it remains ready to enter into negotiations. 

Dr Suzanne Tyler, RCM Executive Director, Trade Union, said “Our worst fears about where we saw maternity services heading are becoming a reality and the fault lies squarely at the door of successive Conservative Governments. Chronic understaffing is hitting the morale of midwives and maternity support workers (MSW) and the safety of care. They are leaving in droves and the Government must plug this worrying leak as a matter of real urgency. 

"Improving pay, more investment and increasing the workforce are crucial to building back our shattered maternity services. The Government must do that now and it can start with giving maternity staff the inflation busting pay award they deserve.”

The midwife shortage is also one that should never have happened says the RCM. If the midwifery workforce had grown at the same rate as the NHS workforce as a whole over the last decade, there would be 5000 more midwives and no midwife shortage.

Worsening staff shortages means senior midwives are heavily reliant on using bank and agency which is expensive and draining for the NHS. Over seven out of ten (72%) survey respondents reported calling in bank or agency staff nearly every day. Nearly a quarter (23%) said this happened a few times a week. Delivering safe services was also heavily reliant on the goodwill of staff. Almost all (94%) of senior midwives says they rely on moderate (40%) to significant (54%) levels of goodwill from midwives and MSWs to deliver safe care. These staff are often already working significant additional hours leading to burnout and exhaustion.

Across the UK pay, working conditions and the quality of care maternity staff are able to deliver remain pressing and urgent concerns. In Scotland the RCM has not accepted the pay offer there and has a mandate to take industrial action following a formal ballot. It is currently in talks with the Scottish Government to seek a solution to these issues. The RCM will begin balloting members over pay in Northern Ireland next week. RCM members in Wales are set to take strike action on 7 February followed by a week of action short of a strike.


To contact the RCM Media Office call 020 7312 3456, or email [email protected].  

Notes to Editor  

The RCM’s evidence to the NHS PRB can be read at https://www.rcm.org.uk/media/6551/royal-college-of-midwives-nhsprb-submission-2023-2024.pdf.

See also:

The Royal College of Midwives (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.