Maternity staffing shortage hitting quality and safety RCM tells politicians

By Colin Beesley on 25 February 2022 Midwifery Midwives MSWs - Maternity Support Workers Maternity Safety Safety Midwifery Workforce Politics

Staffing shortages and underinvestment are hitting the quality and safety of maternity care said the Royal College of Midwives (RCM) Chief Executive Gill Walton, speaking to Westminster politicians this week.

She was highlighting the growing maternity workforce crisis at a joint meeting of the All-Party Parliamentary Groups (APPG) on Maternity and Baby Loss.  

Gill told the APPG panel that England is over 2000 midwives short of the numbers needed and the situation is getting worse. RCM analysis shows that midwife numbers fell by 331 in the year to November 2022, which Gill Walton described as “hugely worrying”.

“Having the right staff, at the right time, in the right place, is essential. We also need the workforce to make sure there is time to train and educate, not just midwives, but the whole maternity team together. They also need the time to listen to women. That is one of things that has been missing in the workforce over many years,” said Gill. “Staffing shortages will impact on the quality and safety of maternity care and that has been a repeated message.”

Maternity services have often been hidden within NHS trusts and the role of the midwife often misunderstood, said Gill, listing the mounting challenges midwives and their maternity colleagues face. These include significant underinvestment in maternity services, the absence of recruitment and retention strategies and patchy compliance with safe staffing guidelines. “There have also been huge challenges keeping services going through the pandemic, and politicians must be mindful of that. This has exposed the fragility on which maternity services are built,” she said.

Obstetricians also echoed the RCM’s concerns, pressing the case for more staff and investment jointly with the RCM. “It is important that we speak with one voice on maternity because that is how most obstetricians and midwives work around the country. The workforce is the lifeblood of the NHS and every day provide world-class services to women,” said Dr Edward Morris, President of the Royal College of Obstetricians and Gynaecologists. “There has been underfunding, growing waiting lists and with the increasing complexities of families having babies, the workforce has become stretched too thin. It is very clear that staffing numbers have not kept pace with demand. Understaffing will have a direct impact on safety,” he said, highlighting the worrying statistic that there were staffing gaps in middle grade doctor rotas in 90 per-cent of obstetric units.

Gill Walton also touched upon the importance of relationships and cultures within maternity to safety. “We must train and learn together. That’s the whole team including obstetricians and the wider maternity team. They must have time to train together,” said Gill.

Looking to the future, Gill outlined the RCM is supporting NHS organisations to turn around the chronic midwifery staffing shortages. She pointed to joint work with NHS England and Health Education England to look at ways of increasing entry routes into midwifery, such as return to practice, overseas recruitment, and shortened programmes for nurses moving into midwifery. “These will only make marginal improvements to the situation. What is really needed is to address retention issues and stem the growing numbers of midwives leaving the profession. We must focus on how we keep midwives in practice,” said Gill.  

She went on to lay out steps that could be taken to plug the growing exodus of midwives from the profession, saying this was her greatest concern. The list included more focus on staff wellbeing, better and more sustained support for newly qualified midwives and for maternity support workers, recruitment and retention premia and more flexible working.

The short-termism of current workforce planning was also an issue said Gill. She stressed the urgency of looking at long-term solutions and having proper workforce plans in place.  “With the final Ockenden report on the horizon, we cannot ignore the longstanding workforce crisis,” said Gill.