Extra midwives announcement
The RCM has welcomed the announcement last week by Jeremy Hunt, the Secretary of State for Health and Social Care in England, for plans to train an additional 3,000 more midwives over the next four years, starting with an extra 650 student midwives in 2019 – an increase of 25%. This announcement, which coincided with an event to mark the second anniversary of Better Births, has been described by Mr Hunt as “the largest ever investment in midwifery training”. The Secretary of State also announced steps to develop a nationally defined role and competency framework for MSWs and to identify new training routes and clearer pathways into midwifery. He also pledged that more women will benefit from receiving continuity of carer throughout pregnancy, birth and the postnatal period.
The RCM regards this pledge on midwife numbers as a positive step towards safer services and supporting midwives to provide more innovative care for women. It is a long overdue acknowledgement on the part of Government that England’s maternity services need more midwives. It is testimony to the long campaign that the RCM has waged over many years to persuade successive Governments to take action to eradicate midwife shortages. It is also vindication for the RCM making support for maternity transformation in England conditional on the NHS investing in sufficient resources and staffing. I hope too that you will feel some relief, having endured years of working incredibly hard with increasing demands and inadequate resources, that there are more midwives in the pipeline.
We now need to know more about how these commitments will be turned from rhetoric into reality. The RCM is now seeking clarification about how the increase in training places, and the other measures announced by Jeremy Hunt, will be implemented in practice. How can the Government ensure that the 650 extra training places will materialise when it effectively removed the ability to control training numbers when it abolished the student bursary last year? What consideration has been given to the number of midwife teachers, student mentors, placement coordinators, preceptorship mentors and other staff that will be required in order to accommodate extra students and newly qualified midwives? How will it be possible to enable more MSWs to move quickly to become registered midwives when under legislation this cannot take less than three years? And what is the plan and timetable for introducing the competency framework for MSWs?
It is also important to recognise that maternity services won’t be transformed overnight. While we have welcomed the commitment to continuity of carer – the evidence is clear that this is the best way to provide safe and high quality care for women and their babies – the additional midwives who start training next year won’t be qualified and working in our maternity services until 2022. Until these midwives and MSWs are actually in the workforce, maternity services will continue to grapple with the same challenges around providing existing care where the focus is rightly safety first. So the priority for all maternity services must continue to be to ensure every woman has a named midwife during pregnancy and receives one-to-one care in labour. When services are confident of this then they can move on to greater continuity of care for women.
In any case, simply training more midwives is only half the problem. Action will also be needed to ensure that when these midwives qualify that they actually get jobs in the NHS. Of equal importance will be to support the current midwifery and MSW workforce so that the NHS gets better at retaining its current staff. We know that one of the main reasons that midwives leave the NHS is because they are not granted opportunities to work flexibly. Making maternity services more open to flexible working can be challenging for a service already short-staffed, but inflexibility only threatens to make the situation worse. This is also about recognising the diversity of the midwifery and MSW workforce and acknowledging that not everyone wants to work in the same way. A recent University of Birmingham survey on Better Births and continuity found that 35% of midwives were willing to work in a continuity-based model that included intrapartum care. At the same time 41% of midwives stated that they were unable to work in a different pattern to their current role and 37% reported that they would be unwilling to work any on-calls and/or nights.
These are all challenges that will need to be addressed if we are to make the most of the opportunity that the announcement on more midwives offers us. Nevertheless we should feel confident that the Government is serious about supporting maternity care; the agreement on pay, which the RCM is currently consulting you about, will also help to support the pledge on extra midwives and will aid the recruitment and retention of staff.
I am delighted that the RCM’s campaigning has paid off, and I am equally determined that we will hold the Government to account for these commitments. We are already talking to the Government, to NHS England and to the Maternity Transformation Board about what needs to happen to ensure these extra training places are commissioned and that these lead to more midwives in the workforce. I have also written to all Directors/Heads of Midwifery and to the 44 Local Maternity Systems in England to offer the RCM’s support in working together to improve recruitment and retention of midwives and MSWs. Over the weeks and months to come, we shall monitor what progress is being made and we shall keep you updated every step of the way.