Heads Of Midwifery Have Serious Safety Concerns

Midwives taking strike action over pay at the Chelsea and Westminster Hospital
Midwives taking strike action over pay at the Chelsea and Westminster Hospital

ALMOST 50 per cent (49%) of Heads of Midwifery (HOMs) from across the UK have had to close their maternity units at some point in the past year because they could not cope with the demand and had serious concerns for safety.

One maternity unit had to close its doors due to understaffing and fears for safety 33 times during twelve months. In total, units closed 209 times (between April 2016-April 2017). The average was six times and six units closed on ten or more occasions.

These latest figures were released yesterday as the RCM published its annual survey of senior midwives as part of the trade union’s evidence to the NHS Pay Review Body (PRB). The Heads of Midwifery (HOMs) also reported the following:

• 76% of HOMs said they had to redeploy staff to cover essential services either very or fairly often.

• HOMs were asked which areas staff were redeployed to and from. Overwhelmingly HOMs reported that staff were redeployed from the antenatal service, the midwife-led unit, community and the postnatal service to cover the labour and delivery suite.

• 67% of HOMs answered that on call community staff had to be called in to cover the labour and delivery suite. 45% of HOMs said this restricted the home birth service.

• 19% of HOMs said they had to reduce services in the last year. The most common were parenting classes and midwife led units.

• 71% of HOMs answered they had to call in bank and/or agency staff very or fairly often (very often – nearly every day, fairly often – a few times a week) compared to 62.1% in 2016.

• 51% of HOMs said that it was difficult/very difficult to ensure that staff take their breaks and leave on time.

One Head of Midwifery in Wales said: ‘Quality and safety is a constant battle with finance – we present good outcomes for mums and babies, but this is to the detriment of certain areas like community and postnatal care due to our staffing challenges.

‘I struggle with conflict between the requirement for staff and the financial constraints in demonstrating that despite good outcomes we need more midwifery and obstetric staff to cope with rising demand and acuity. The staff regularly do not get their breaks and often leave late. They also undertake education and learning in their own time.’

A Head of Midwifery, in Scotland said: ‘All midwives working within the hospital units (both consultant and midwife-led) have to take breaks primarily within the unit to ensure safety of mothers and babies. Staff frequently miss or have short breaks due to workload and, due to the business of the unit, staff often are called in at short notice to cover unexpected sick leave.’

A Head of Midwifery, Northern Ireland said: ‘The role (HoM) is becoming increasingly demanding and finances are a great challenge. Midwives are working hard under very difficult and stretched services. There is very little money to invest in resources, education and training opportunities or the environment.’

Gill Walton Chief Executive and General Secretary of The Royal College of Midwives (RCM) said: ‘Given the shortage of 3,500 midwives and an increasing complexity of cases, the RCM asked Heads of Midwifery in this survey questions about how they were managing service delivery under increasing pressures.

Unfortunately, it is evident  that maternity unit closures have increased by ten per cent since the RCM conducted this survey last year. HOMs also reported that they were asked to take on more services, but not given any additional budget.

‘It also appears that existing staff are being relied upon to cover the gaps in the service through being redeployed to other areas (normally the labour and delivery suite), missing their breaks and working late.

‘There is also a very obvious over-reliance on using temporary staff such as bank and agency midwives which has been proven by the RCM in previous reports to cost the NHS almost one-hundred million pounds per year.

‘All of this again shows how UK maternity services are overworked, understaffed, underfunded and struggling to meet the demands being placed on them. This is deeply worrying for the quality of care women are receiving, and the safety of services. Midwives and maternity support workers are too often keeping services afloat by working long hours, often doing unpaid overtime and missing breaks, which is leading to stress and burn out.

‘However, midwives will always endeavour to ensure that both mother and baby receive safe and high quality care. This new RCM report shows a system that is about to buckle at the seams and only able to deliver high quality care through the efforts and dedication of its staff.

‘This is unsustainable, and our survey shows that midwives and maternity support workers are fed up with not having enough resources and staff to be able to give women the care they deserve and they are leaving in their droves making the shortage of midwives even worse.

‘However, we know that 80% of midwives would stay in the NHS if they are awarded a fair pay rise. The RCM is calling on the NHS Pay Review Body and Jeremy Hunt to listen to the lived experience of those midwives and MSW’s on the front line, those who are trying to do their best to deliver safe care to women and their families in a service that is struggling with a long-standing and damaging shortage of midwives.

‘What maternity services up and down the UK need now is a fair pay rise to make sure that new students view midwifery as an attractive career option and existing staff are retained in the service; without this we cannot hope to close the shortage of midwives. It is time for the government to finally recognise that fair pay in the NHS is now well overdue.’

The message from the Royal College of Nursing in its written evidence to the independent NHS Pay Review Body (PRB) was that after seven years of pay restraint, nursing staff across the UK have been left angry and demoralised. 

This disaffection has resulted in severe nursing shortages, with 40,000 posts vacant in England alone. Unless nursing staff are given a pay award at least in line with inflation, the exodus of staff will continue, and nursing will become less and less attractive as a career.

The PRB will make recommendations to Health Ministers in the spring on next year’s pay award for NHS staff. The RCN, along with the other 13 NHS staff trade unions, is calling on the Review Body to recommend a pay rise at least in line with Retail Price Index (RPI) inflation, plus an £800 flat rate increase for all Agenda for Change staff to make up for lost earnings over the last seven years. 

Pay was first frozen for nursing and other NHS staff for two years from 2010, then salary increases limited to 1% from 2013 until this year. The RCN submission highlights that as a result of this pay restraint, wages for nursing staff have fallen far behind the cost of living since 2010.

While the RPI has grown by 20% and the Consumer Price Index (CPI) by 14% over this period, annual earnings (which include basic pay, overtime, shift pay and geographical allowances such as London Weighting) for Band 5 staff nurses have only increased by 6.1% over the seven years.

The average nurse in this category is now earning around £2,500 a year less than they would have been had their wages kept pace with inflation. The College’s evidence also argues that any increases in pay should not be linked to ‘productivity improvements’, as both the Chancellor and Health Secretary have suggested, and points out that it would be difficult for individual staff to be any more ‘productive’ when so many are already working extra hours without pay, working through their breaks and staying on after their shift has ended.

However, the submission outlines a number of barriers to productivity gains which nurses themselves have highlighted, such as:

• With the NHS short of 40,000 nurses in England alone, the pressure and pace of work are leading many older nursing staff to take early retirement – this is a huge loss of valuable skills and experience.

• Lack of clinical opportunities for experienced nurses (Band 7 and above) means that many feel they are forced into managerial roles when they would prefer to continue working with patients – again, this is prompting some staff to leave.

• Many staff also point to the scale and complexity of paperwork they have to contend with as a barrier to improving productivity and patient care.

These comments were typical of those received from nurses in connection with the pay claim:

‘We feel insulted by the 1% pay rise. If we weren’t so close-knit, morale would be much lower. No wonder we can’t recruit people into nursing. The government doesn’t respect the role or us.’ Band 6 Charge Nurse, Scotland. They are relying on our goodwill – but it’s about to break’. Band 5 Staff Nurse, London.

Janet Davies, RCN Chief Executive and General Secretary, said: ‘RCN members led the campaign to scrap the longstanding 1% cap on nursing pay increases, and were pleased when it was abandoned by the government in October.

‘However, after seven years in which their wages have lagged far behind the cost of living, nursing staff are now looking for a meaningful pay rise at least in line with inflation. Instead they have heard equivocal messages from the government about linking any future salary increases to productivity. This has generated anger and confusion among the nursing workforce.  

‘The NHS has been running on the goodwill of nursing and other staff for far too long. This goodwill cannot last indefinitely, and we look to the Pay Review Body to make a recommendation which both acknowledges the sacrifices made by NHS staff, and the economic necessity of a meaningful pay rise.

‘With at least 40,000 nursing posts currently vacant in England alone, the NHS cannot afford to haemorrhage any more nursing staff.’