Worth the wait

By Sean O'Sullivan, Head of Health and Social Policy on 30 June 2023 RCM UK Midwifery Equality and Diversity Research England Employment

Following the release of the long-awaited NHS Workforce Plan for England, RCM Head of Health and Social Policy Sean O’Sullivan shares what this will mean for practice, what we hope and what the RCM and other healthcare unions have been driving.

At last, at long last, the much-anticipated NHS long-term workforce plan for England has been published. The RCM, along with other health unions and professional bodies, has for many years been urging the Government to come up with a meaningful plan for assessing and meeting the workforce needs of the NHS, so it’s good to see it, finally, in black and white.

This has been a long time coming. Given the scale of the workforce issues facing maternity services in England – the shortage of 2,500 midwives, the failure to invest in the midwifery and MSW workforce or to improve working conditions and the demoralisation that many staff feel about working long hours in unsafe conditions – it is nevertheless a significant moment. It’s also a welcome milestone on the way to placing the maternity workforce on a sustainable footing.

There is a welcome shift away from an over-reliance on international recruitment, towards investing in homegrown talent and we think this is a more sustainable route to growing the midwifery workforce. The plan acknowledges the need for a long-term approach to eliminating staff shortages with overall training numbers required to increase by between 50% and 65% by 2031.

The plan recognises the link between safety and staffing and commits to increasing midwife numbers in line with the recommendations in the Ockenden Review. The midwifery workforce is projected to grow by 1.8% to 1.9% per year over the course of the plan, with staffing establishments expected to be filled by 2028. There will be an additional 500 student midwife places by 2028, an increase of 13% on current numbers.

We are pleased that this plan focuses on many of the areas that the RCM has long been lobbying for, including the expansion of midwifery apprenticeships. Midwifery apprenticeships are proving particularly attractive to those already rooted in the maternity workforce. They have evaluated very positively and demonstrated improved retention and virtually zero attrition rates and is something the RCM has been back for some time.

It is therefore welcome news that the plan proposes that midwifery apprenticeships should make up 5% of training places by 2028. The plan also commits to continuing to fund the shortened midwifery programme for this year and 2024/25.

We have long pushed for an emphasis on staff retention, and this plan reflects that. Improving workplace culture and behaviours, more opportunities to work flexibly, access health and wellbeing support and get funding for CPD are important as midwives and MSWs need to hear the message that valuing them and keeping them in post is at last recognised as a priority. And for our newly qualified midwives, they need to feel they are coming into a supportive environment.

The plan argues strongly that substantially increasing training and education must be accompanied by a focus on staff working in different ways, on growing skills and capacity and on more strategic use of skill-mix. This will include better utilisation of digital and technological innovations, and expanding new and extended roles, such as advanced practitioners (although maternity is not cited as a priority area for these roles).

Will the plan work? We all want it to succeed, and it is good to see that the Government is backing the plan’s ambitions with some firm funding pledges, at least for the next five years.

However, more details are needed before we can assess how workable the plan will be in practice. For example, will extra funding for midwifery apprenticeships include money for ensuring that MSW roles are backfilled? What will happen to funding midwifery shortened programmes when the current commitment ends in two years?

We need to know far more about how retention measures will be implemented, because we know just how difficult it is in practice to tackle these issues. Without meaningful action, staff will continue to feel burnt out and demoralised and maternity services will continue to struggle to support students and early career midwives.

There is no discussion of pay and conditions and the plan assumes a level of productivity improvement that could best be described as optimistic and, which in turn, will require significant increases in funding for estates, infrastructure and technology.

Nevertheless having the plan gives us the basis for further meaningful engagement about how these measures will be funded, implemented and monitored over the coming years. We have waited so long for this plan, but this is the start, not the end. We will be holding the Government and NHS England to account to make sure its delivered.