Half of maternity units in England understaffed, RCM survey indicates

Author: Caroline White

Half of maternity units in England are staffed below recommended levels, a Royal College of Midwives (RCM) survey* indicates.

The survey of directors and heads of midwifery forms part of the College’s submission of evidence to the NHS Pay Review Body (NHSPRB).

Midwifery continuity of care is the cornerstone of Better Births, the maternity transformation plan for England. But successful implementation relies on adequate investment and safe staffing levels, says the RCM. Almost three quarters (73%) of respondents stated this plan was difficult or very difficult to implement.

The findings show that over half (54%) of respondents said their funded staffing is below recommended levels.

Eight out of 10 (80%) units have midwife vacancies, and the number has almost doubled from 611 in 2018 to 1056 in 2019.

Almost a fifth (17%) of respondents said they had had to reduce services in the past year compared with 7% in 2018.

The three most reduced services were the midwife-led unit, parent education and home birth service. Though the number of heads of midwifery reporting having to close units for a temporary period fell to 27% in 2019 compared to 40% in 2018, the number of times staff regularly had to be redeployed has risen sharply over the past year.

Almost three quarters (74%) reported having to redeploy staff at least once a week to cover essential services. This compares to 62% in 2018. Labour ward/delivery suite was the most common area staff were redeployed to; the most common area labour ward staff were redeployed to was the postnatal ward.

One third of respondents said the redeployment of on-call community staff to cover labour and delivery suite restricted the home birth service or other continuity services.

Gill Walton, RCM chief executive, commented: “Despite positive government commitments to increase midwife numbers, our maternity services are facing increasing demand and insufficient staffing and resources.

“This impacts on the quality of care women are receiving and most importantly it is affecting the safety of our maternity services. We need to see the pace of midwife increases stepped-up and more investment put into our maternity services.”

The doubling in midwifery vacancies in the past year is adding to the pressures on maternity services, the submission points out

“There has also been a sharp rise in midwives being redeployed from their normal area of work, such as in the community, to cover essential services including labour wards and delivery suites. This means other key services such as home births and births on midwife-led units are cut back, reducing choice for women,” it points out.

“Pressures on our midwives, maternity support workers and wider maternity team are hitting morale,” warned Gill Walton.

“Services are too often relying on the goodwill of staff to keep them safe and of high quality. Poor morale leads to poorer services. This is not the way to treat staff and it is not the way to ensure women get the best possible care.”

*Royal College of Midwives NHS Pay Review Body Evidence 2020.