The Ward Round: Midwifery in crisis

“Maternity staff are central to the experience of maternity care, but also to its safety and effectiveness,” wrote Baroness Julia Cumberlege in her “Better Births” report of 2016.

The report, which was commissioned by NHS England as part of its maternity transformation programme, set out a vision for how the NHS should be delivering maternity care and how it “can and must do better”, highlighting that it is lagging behind its European neighbours.

Among its main messages was a warning that maternity staff were reporting higher levels of perceived stress and a less supportive work environment than other NHS workers.

This was seven years ago, and according to the latest NHS staff survey results, very little has changed for the midwifery profession. In fact, things have got worse.

The staff survey responses from midwives are shocking, even more so the sharp declines in many key areas, such as job satisfaction and confidence in their employer. The high percentage of midwives who report feeling emotionally exhausted and burnt out are also worrying.

It was striking that 16 per cent of nearly 12,000 midwives who responded said they were considering leaving healthcare altogether. If this high a percentage does decide to follow through, this would have a disastrous impact on the quality improvements the NHS is expected to rapidly make in maternity care.

Following the publication of the final Ockenden Report, the spotlight is firmly on this professional group. Inevitably midwife bashing has followed in the national media and this will only contribute to deep feelings of stress and hopelessness clearly shared by many in the profession and reflected in the staff survey.

In her report, Donna Ockenden acknowledged the ways in which investment was being made into the maternity workforce, including increasing the number of professional midwifery advocates to 800 in England, funding a pastoral care midwife in every maternity unit during 2021-22, and £4.5m for recruiting international midwives.

However, she is clear, midwifery and obstetric staffing numbers continue to cause “significant concern” and, as reported by HSJ in detail last month, she called for the suspension of the “continuity of carer” model, due to safe staffing concerns. Additional funding, akin to the £200-£300m recommend by the health and care committee, “must be forthcoming”, she said.

I asked NHSE, when reporting the midwifery results from the staff survey, what further actions it was planning to take. I was pointed towards the recent announcement that £127m would be invested in maternity services in England. But I was also told 2,734 midwives have joined the workforce in the last year, with Health Education England on course to deliver an additional 3,650 training places by 2023.

This distracts from the reality that more midwives are leaving than joining, resulting in a net reduction of 300 full-time midwives working in the NHS in December 2021, when compared to the previous year. The NHS can recruit and train as many midwives as money can buy, but if the existing workforce is voting with its feet, this really won’t do any good.

A reason to be (a bit more) cheerful

In more positive workforce news this week, plans have been announced for a new medical school in Carlisle.

A collaboration between the University of Cumbria and Imperial College London will see the first students enrolled in 2025 and it is hoped this will increase the number of doctors in the region; something that has remained a challenge in Cumbria for many years.

Professor Brian Webster-Henderson, deputy vice chancellor and the University of Cumbria’s lead on the initiative, said the new medical school would have a “dual benefit” of opening up more opportunities to study medicine and provide “a steady stream of trained doctors for the region”.

“This significant partnership will enable us to expand our diverse health care portfolio to include medicine for the first time, and develop joint research programmes to address many of the county’s unique challenges,” he said.

According to both universities, when medical students qualify, they will be “embedded” within the local ICS and encouraged to continue living and working in the region.

It’s unclear how this will happen exactly, as there are a range of different factors which decide where graduates are placed for further training. So the ICS may need to come to an arrangement with HEE that enables graduates to stay in the area.