'All the fat is off the bone, we cannot strip any more off'

Frequent maternity unit closures, restricted services such as home births and falling budgets are among the issues highlighted by a survey of senior midwives by the Royal College of Midwives (RCM). The findings come in a survey of heads of midwifery (HOMs) by the RCM published today which formed part of its submission to the NHS Pay Review Body.

Over a third (34.4%) of HOMs responding to the survey said the amount of money they have for staff is not enough to ensure they have the recommended, minimum level of staff to meet the demands on their maternity service.

Despite a rising birthrate, a serious shortage of almost 5000 midwives (in England) and more complex births, a fifth (19.6%) of HOMs reported that their budget had decreased in the last twelve months.

Nearly all HOMs (94.5%) reported they had to redeploy staff to cover essential services. Over a third (38.5%) said that they have to redeploy staff at least once a week. Much of this was moving staff from areas such as community and postnatal care to work in the labour and delivery suite.

To illustrate this over two-thirds (68.5%) of HOMs reported that on-call community staff had to be called in to cover the labour and delivery suite. Nearly a third (29.0%) of HOMs said that this restricted their home birth service.

This is a real concern for the RCM as this restricts choice for women. It also affects the care that women and their babies receive in the postnatal period, an area in which the Government have pledged to improve services. A lack of adequate care in the postnatal period can affect breastfeeding rates, and spotting issues such as infection and picking up women who may have maternal mental health problems.

Two-thirds (64.1%) of HOMs reported that they had to call in bank and agency staff ‘very often’ (nearly every day) or ‘fairly often’ (a few times a week). This is an issue because it affects continuity of care for women. Recent research showed that continuity of care leads to better outcomes for women. It also suggests that there are not enough staff to cover the demands on the services and ultimately could cost much more than employing adequate numbers of staff.

Almost half of HOMs (45.7%) said that in the last twelve months they had to take the decision to temporarily close their unit because they could not cope with the demand. Out of the trusts that had closed their doors in the last 12 months on average each trust closed on 10 separate occasions. One unit reported closing 61 times over the past year.

A number (8.7%) of HOMs reported reductions in services that their unit provides. Some of those (7.1%) who have a midwife led birthing unit in their trusts reported that it was in danger of closing thus restricting the choice available to women. 

A number of reports on the NHS over recent months such as that by Robert Francis have focused on the importance of staff training. It is a concern then that over a quarter (28.3%) of HOMs have had to reduce training in the last 12 months. Many HOMs said that there will be a focus on the minimum training possible and some reported that even mandatory training can be cancelled due to staffing shortages.

Commenting on the survey, Cathy Warwick, chief executive of the Royal College of Midwives, said: “Despite welcome increases in midwife numbers this survey describes a disappointing and worrying picture of our maternity services, and one that shows it is not improving.

“The midwifery shortages and cuts to services it describes will have a detrimental impact on the care women, babies and their families receive. This shows a service that sometimes severely restricts the choices available to women, is struggling to provide continuity of care and is bursting at the seams in its ability to cope.

"The temporary closures it highlights are just the tip of the iceberg. Before closures happen services have been already stretched to their limit and closing is the point at which safety could be compromised if that does not happen.

“I take heart that this survey shows things are not worsening. However, I have deep misgivings about the quality of the service midwives and maternity support workers are able to provide, working in such an unstable, pressure cooker atmosphere. There is a need to step-up the investment in maternity services and eradicate the midwifery shortage so that women, babies and their families everywhere can expect and receive a high quality service.”

The survey results can be viewed in the ‘RCM’s response to the NHS Pay Review Body 2013’ at http://www.rcm.org.uk/college/support-at-work/pay/.