Publication of State of Maternity Services report Scotland 2018

By Mary Ross-Davie - RCM Director for Scotland on 12 September 2018 Maternity Services State of Maternity Services Report

Today the RCM are publishing our annual ‘State of Maternity Services’ reports. 

The difference this year is that we have published separate reports for Scotland and England, with the Wales and Northern Ireland reports to follow. In previous years, we have published a UK wide report.

I felt that it was important to have a separate report for Scotland as we have our own particular workforce challenges. This year’s report highlights the challenges for Scotland with our growing vacancy rate – which is particularly acute in the North of Scotland and in more remote and rural areas.  You will see in the report that the number of vacancies that have been unfilled for more than 3 months has quadrupled over the last 5 years. This leads to added pressure on the midwives in the service who have to cover these gaps.  The report also shows that we still have 40% of our midwifery workforce over the age of 50. This leads to uncertainty as we are likely to see a significant proportion of these midwives retiring over the next five years, losing their experience and skills from the service.

The RCM team in Scotland have raised the issue of growing vacancies, particular difficulties in the North of the country and higher rates of midwives retiring with the Scottish Government at every opportunity. We are delighted that the Scottish Government has responded to our concerns, by significantly increasing the number of student midwife places, piloting a new shortened midwifery programme in the Highlands and continuing the bursary for student midwives. The RCM Scotland team is involved in the development of legislation to enshrine safe staffing levels in law and contributing to the work being done to ensure that the midwifery workforce planning tool is fit for purpose. We are also aware that the new Best Start maternity policy also brings with it uncertainty; we don’t yet know how many midwives might choose to leave or retire rather than work in new ways or whether the new model of care will mean more midwives are needed. 

Behind any statistics there are the real stories – when I am out and about across Scotland meeting our members, I hear how much they are feeling the pressure. They are seeing many of their experienced colleagues retire from the service, being replaced with more junior midwives. While it is great to have new midwives joining us, this can increase feelings of pressure as we need to ensure that newly qualified midwives are well supported to develop their confidence and skills, they can’t just be ‘thrown in at the deep end’. While we welcome the rising number of students, this can also increase pressure. We need to be sure that the increase in students is matched by an increase in midwifery lecturers and mentors in practice areas. While many midwives welcome the idea of providing better continuity of carer as a result of the Best start strategy, such a big change brings with it pressure: some of our members are understandably anxious about what the changes to how they work will mean for them. 

While preparing this report, I spoke to the heads of midwifery in the three Health Boards in Scotland with the highest vacancy rates and they told me of the pressures they feel. All of the Heads of midwifery felt that their Board lead were being very supportive and doing what they could to address the issues. In the Western Isles there are only three midwives out of 22 who are under the age of 45 – 68% of the midwives are over the age of 50. Despite the beauty of the Western Isles, there has been difficulty in recruiting to midwifery vacancies – with some roles advertised three times. The resilience of the maternity service provided on those islands is clearly going to be under pressure unless we can ensure that more midwives can be recruited and choose to stay. In Grampian the vacancy rate among midwives has risen by 122% since 2017 – with currently 31 full time posts lying vacant. In September the Grampian service will welcome around 22 newly qualified midwives, but these still leaves unfilled vacancies. Unfilled vacancies lead to difficulties in providing all of the services that we want to provide to women and their families, such as ensuring women have the option to give birth in a midwife led unit.

I hope you find the report useful and interesting. I will use the findings from the report to continue to press for innovative and proactive solutions to the workforce pressures that midwives are experiencing every day across Scotland to ensure that we can continue to improve the excellent midwifery care that women, babies and families experience. 

Read the State of Maternity Services’ report 2018 - Scotland here.