Maternity unit closures, budget and training cuts and reduced services are among the issues highlighted by an RCM survey of UK senior midwives.
According to the results, over two-fifths of maternity units had to close during the last year because they couldn’t cope with the demand – 32.8% in 2014 and 41.5% in 2015.
Units closed their doors on average on 6.6 separate occasions in 2014 and 4.8 in 2015. The most times a single unit closed in a year was 33 times (2014) and 23 times (2015).
The number of closures is a reflection of the rising demands on services from increasingly complex births and staffing levels. Most senior midwives surveyed – 96.9% in 2014 and 91.3% in 2015 – said their unit is dealing with more complex cases than the previous year.
More than a quarter of HoMs – 29.5% in 2014 and 29.6% in 2015 – said that they simply did not have enough midwives. The shortage of midwives in England remains critical with the country still short of 2600 full-time midwives.
Services are also being reduced, as inadequate funding and staffing shortages bite. In 2014, 10.9% of HoMS reported that they had to reduce services in the last year, and in 2015 it was 11%. This included reductions in specialist midwives, fewer parent classes and less bereavement and breastfeeding support.
Services, such as home birth and postnatal care are also suffering, with 65.6% and 64.6% of HoMs in 2014 and 2015 respectively saying that on-call community staff have to be called in to cover the labour and delivery suites.
In 2015, a third of HoMs (35.8%) said that this restricted the home birth service, up from just over a quarter (26.2%) in 2014.
In both years, HoMs reported that the most common type of redeployment was staff from the community and postnatal service to the labour and delivery suite.
In both years, three-quarters of those surveyed said they had to redeploy staff to cover essential services either very or fairly often.
HoMs were also concerned about how maternity services were valued by their organisation’s board. In the 2015 survey, almost a fifth (19.2%) of HoMs disagreed or strongly disagreed with the statement 'maternity is a priority in my organisation'.
Many HoMs responding to the 2015 survey also had concerns about how well they were able to do their job given the pressures and demands of the role.
Nearly a third (31.2%) ‘disagreed’ or ‘strongly disagreed’ with the statement: 'I am able to do my job to a standard I am personally happy with'.
In 2015, two-thirds (62.3%) ‘disagreed’ or ‘strongly disagreed’ with the statement: 'I am able to meet all the conflicting demands on my time at work'.
Some HoMs also reported having to provide additional midwifery services, but without any extra budget.
Major reports, including the Francis and Kirkup reports, have focused on the importance of staff training, but the survey reveals that two-fifths – 21.9% in 2014 and 20.3% in 2015 – of HoMs had to reduce training for their staff.
RCM chief executive Cathy Warwick said: ‘Our 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 MSWs are too often keeping services afloat by working long hours, doing unpaid overtime and missing breaks. This is not a situation that leads to safe and high quality care for women and babies.
‘All of this shows a system that is creaking at the seams and only able to deliver high quality care through the efforts and dedication of its staff. When services are operating at or beyond their capacity, safety is compromised and mistakes can, and almost certainly will be made, through no fault of the dedicated staff delivering the service.
‘The government is responsible for this and it is they who are letting down women, babies and their families, as well as the staff they purport to value. This is simply not acceptable.’
The surveys of HoMs form part of the RCM’s submission to the NHS Pay Review Body 2015. To read the RCM’s submission, including the results of the HoMs surveys, visit the RCM’s website pay page.