Staff shortages adversely impacts quality of care and staff wellbeing

By Sean O'Sullivan, Head of Health and Social Policy, RCM on 08 March 2023 Maternity Services RCM Research Staffing Levels Trade Unions UK Women Maternity Safety

RCM delegates at this week’s TUC Women’s Conference have called on our sister unions to back a campaign to ensure that maternity workforce planning is based on the needs of women, babies and families and that this should be reinforced with a national strategy to support staff retention. This follows the publication, last year, of a parliamentary report that highlighted how staffing shortages were adversely impacting on both the quality of care for women and on staff wellbeing.

Given that the TUC Women’s Conference coincides with International Women’s Day, what does the current state of maternity services, and the experience of midwives and MSWs, tell us about how society values women?

Firstly, that it is hard to escape the conclusion that services predominantly run by and for women are all too often marginalised and underinvested in. Maternity care is no exception and the well documented instances of poor care reflect the fact that, for the last decade, maternity services have not had the funding and the attention that they require, and which women deserve.

In 2013, the NHS spent 2.8% of its budget on maternity services. That may not sound like a great deal, but in subsequent years funding has fallen to 2.6% in 2016/17, 2.5% in 2018/19 and just 2.3% in 2019/20. Reduced spending on maternity services is inevitably mirrored by the longstanding shortage of midwives. In 2015, midwives comprised 4.2% of professionally qualified staff in the NHS in England; now they make up just 3.6% of professional staff.

Secondly, midwifery is a graduate profession that mainly attracts women, that demands high levels of responsibility in return for low remuneration and family unfriendly working hours. In this respect it is representative of many services in which women predominate. The sad reality is that not enough is still being done to make adequate provision for women at work, especially for those with children and other caring responsibilities. Furthermore, the current cost of living crisis is likely to have a disproportionate impact on the women who use our services, and on our members who care for women and families.

The combination of a failure to invest in maternity services and to materially improve women’s employment conditions, is a driver of poor physical and mental wellbeing for many women. Women spend a significantly greater proportion of their lives in ill-health and disability than men. It is women between 45 and 64 years who are most likely to be providing informal care, to elderly relatives and children, and who are often dealing with their own physical and mental health challenges.

The RCM’s motion to the TUC Women’s Conference is part of our drive to place maternity services at the heart of policies to improve the life chances, health and prosperity of women and families. Alongside this, our Caring for You campaign is highlighting the need to invest in the health, safety and wellbeing of midwives and MSWs, the vast majority of whom are women, in developing healthier workplace cultures and in holding Trusts and Health Boards to account for their obligations to the staff they employ.

Investing in maternity services and recruiting and retaining more staff, is not just about improving maternal outcomes and experiences, important as these are. It is also about the contribution that good maternity care can make to women’s wider health and life experiences thereafter. That has got to be a cause worth fighting for on International Women’s Day.