The only way is up

By Aviva Attias on 07 March 2018 Midwives Magazine Pay and Agenda For Change NHS Pay Review Body NHS

The RCM’s evidence to the NHS Pay Review Body paints a shocking picture of the toll of seven years’ pay restraint as it calls for a 3.9% increase to halt the spiralling staffing crisis.

UK maternity services are overworked, undervalued and reliant on staff goodwill – which is fast running out.

Midwives and MSWs are under more pressure than ever. They feel taken advantage of and worse off financially; many are in debt, with one in three now so worried about money that it is impacting their work, according to a recent survey (RCM, 2017).

Four out of five midwives feel they cannot give the care they want to, many are disengaged and demotivated, and a staggering 61% have said they are considering leaving the service in the next one to two years – although 80% of those would stay if their pay increased (RCM, 2017).

Breaking point

Almost half of those who responded to the RCM’s annual HoMs survey said they had to close their unit in the last year because they could not cope with the demand – up from 38.6% in 2016 (RCM, 2017). Staff shortages and unfilled vacancies saw NHS organisations spend close to £100m on agency and bank staff and overtime in UK maternity services in 2016.

On top of retention problems, which are especially visible among staff aged 35 to 44, there are fears the staffing crisis could deepen, with the withdrawal of bursaries and introduction of tuition fees for student midwives potentially impacting numbers coming into the profession, and the advent of Brexit interrupting the supply of midwives from mainland Europe.

The evidence describes the unsustainable catch-22 situation maternity services face, in which organisations are relying on goodwill to make up for poor staffing levels, leading to high levels of stress and burnout, causing yet more midwives to leave.

Ultimately, midwives and MSWs ‘have never been so challenged in their ability to provide high-quality and safe care’.

This is the stark message the RCM has laid before the NHS Pay Review Body (NHSPRB) as it considers salary rises for 2018-19.

Drawing on evidence from the HoMs survey and a survey of 2449 members’ views on pay, as well as freedom of information requests about agency, bank and overtime spending, this report packs an evidence-based punch, backed up with powerful personal testimonies, as it sets out the RCM’s case for fair pay (RCM, 2017).

Pay rise, please

The RCM, along with 13 other NHS unions, is calling for a pay rise of 3.9% – in line with RPI inflation – plus an additional £800 to go some way to making up some of what has been lost over the past seven years of pay restraint, during which time the value of pay for a midwife at the top of Band 6 has decreased by £6600.

Jon Skewes, RCM director for policy, employment relations and communications, says the evidence debunks the myth that, because of the vocational nature of the job, pay is not an important issue for midwives.

‘What it shows is that pay is actually causing people to leave the profession or leave the NHS,’ he says. ‘Reading the personal testimonies in particular was shocking – the effect that this is having on individuals and their families is heart-breaking.

‘This real-term loss in pay of between 16% and 20% over the last seven years, depending on where you are, is pushing midwives and MSWs to seek alternatives.

‘What has kept them going is their personal commitment to the profession and their regard for the value of the service they provide.’

Staff paying the price

Jon continues: ‘Helping women and their families bring new life into the world is one of the most fulfilling jobs you can do – but not at the expense of these individuals and their families,’ says Jon. ‘That is the position the government has forced them in to.’

The pay structure and annual uplift must be good enough to attract new staff into the NHS and students into midwifery, as well as helping to retain existing midwives, he adds.

‘The burden on staff is immense – that comes through in the evidence. People are barely coping with the pressure on individuals and on organisations. Without fair pay, it will not continue to hold together.

‘The question is whether we persuade the NHSPRB to recognise that, and break out of the government’s pay policy, which is still no more than 1% pay increases across the public sector.

‘A fair pay rise for all NHS staff is the key intervention that could be made now to break the downward spiral of the current staffing crisis.’

Unfetter pay review body

The RCM is also demanding an end to political interference, allowing the NHSPRB to make an ‘unfettered recommendation’, and it is seeking the NHSPRB’s views on reform of the Agenda for Change pay structure, which is under discussion by unions with NHS Employers and the Department of Health at the time of writing.

Money matters: the impact of pay restraint

  • 94% of HoMs said that seven years of pay restraint has had a negative impact on morale and motivation in their unit
  • 86% of the RCM members’ pay survey respondents feel worse off financially than five years ago
  • 50% have debts of £5000 or more, and 31% are at least £10,000 in debt

Maternity units under pressure

98% of RCM members said their organisation is reliant on their and their colleagues’ goodwill.
3500 is the current shortage of midwives in England.
£97m spent on agency, bank and overtime in maternity services in the UK in 2016 – enough to pay 2731 full-time, experienced midwives at the top of Band 6, or 4391 full-time NQMs.
(RCM, 2017)