Reconfigurations – nothing about us without us

By RCM Policy Advisor Tara Kaufmann on 23 May 2023 Maternity Services RCM UK Midwives Midwifery Workforce Midwifery

To coincide with the publication of the RCM position statement on reconfigurations, RCM Policy Advisor Tara Kaufmann shares what reconfiguration of services will mean for maternity staff and how to be consulted and have a stake in the changes.

The only certainties in life are death, taxes and NHS reconfigurations. To work in the health service means to be constantly told about (and sometimes consulted on) a rearrangement of the deckchairs, always with the promised benefits of service quality, efficiency, and staff satisfaction. 

More often than not, these reconfigurations are triggered by external demands, such as new national initiatives, workforce shortages, or a local cash crisis. Very often, maternity is shoehorned in without thoughtful consideration of the particular needs of that service. Consultation is often undergone at a gallop with a focus on short-term gains, often lacking strategic view of the long-term contribution to national policy aims. No wonder few of us enjoy them very much. But we don’t want to be out of the loop.

The RCM’s newly updated position statement on reconfigurations sets out our shopping list for every reconfiguration initiative. Obviously not all our members are involved in the same way in reconfigurations – the greater your leadership role, the earlier you will be informed. But all members should get an opportunity to contribute: if this isn’t happening, please talk to your RCM rep. And if it is happening, please talk to them too – they can help! If you yourself are a rep who has not been consulted, get advice from your regional or national officer.

Once you’ve got sight of the proposed reconfiguration, what should you be looking for? First and perhaps most important, there should be a clear evidence base for the proposals. Where is the evidence that change is needed, and where is the evidence that the aims will be achieved? There should be a particular focus on how the proposals will deliver the policy priorities of supporting midwives to practise safely, reducing health inequalities, and facilitating women’s choice.

With safety so high on the clinical agenda, proposals should clearly demonstrate how they will improve quality. This should not just cover the obvious, like distance from theatre, but should address that all those factors that we know are important for upholding safety, such as staffing and skill mix, multi-professional working, and support for professional development.

Home birth is an essential part of every maternity service, as is choice in birth settings. Proposed reconfigurations cannot shut down women’s choices in childbirth – please let your RCM rep know if there is any threat of this happening.

Just as importantly, be sure that reconfigurations will not negatively influence staff wellbeing. Midwives need and deserve a safe work environment, safe routes between service locations, access to refreshments and rest areas. These are also critical to stemming the exodus of skilled midwives from the profession.

All reconfiguration proposals should be transparent on the resource implications, both short and longer term. How can we reach meaningful judgements on how much value can be gained, or on the competing claims of different options, without this information? If you cannot get hold of this information, despite asking for it, then let’s start asking why.

Reconfiguration proposals can be very complex and hard to digest. They often feature grand claims, without providing evidence or proper examination of alternative options. The response mechanism often frustrates your ability to say what is really important to you. But you’re not alone: talk to your colleagues, your representatives, and your RCM reps and officers. Together we can become a stronger, more confident and influential voice. Nothing about us without us.