NHS & MATERNITY SERVICES HEADING FOR CRISIS – says Royal College of Midwives

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Midwives marching on the 100,000-strong demonstration in London to defend the NHS
Midwives marching on the 100,000-strong demonstration in London to defend the NHS

‘WE have an NHS and maternity service that is heading for a crisis and the government’s policies are clearly failing,’ the leader of the Royal College of Midwives (RCM) said on Tuesday.

As the RCM annual conference got under way in Manchester the union launched a report showing that spending on midwifery agency, bank staff and overtime in the UK reached nearly £100m in 2016 – ‘enough to cover the national shortage of 3,500 staff’.

The report showed that in 2016, 26 NHS organisations spent over £1m on agency, bank or overtime to plug the midwife shortage, while nine spent over £2m. The findings come from a freedom of information (FOI) request investigating the costs of temporary staffing through agency, overtime and bank use.

A total of more than £97m was spent on midwifery agency, bank and overtime payments in 2016 throughout the UK, enough to pay for 2,731 full-time and experienced midwives or 4,391 newly qualified midwives. The FOI found that the average hourly spend for an agency midwife was £43.65.

This is compared to a permanently employed midwife with 10 years’ experience working full time in the NHS, for which the average hourly rate across the UK is around £18.30. The revelation comes as England struggles to maintain its maternity services with a shortage of 3,500 full-time midwives.

In Autumn 2015, the government placed a cap on agency spending in NHS trusts in England.

Maternity units in England spent £20,635,047 on agency midwives in 2016, which is down slightly from spending on agency midwives in 2015, which was £24,950,157. 

However, bank spending has leapt from £43,225,603 in 2015 to £58,646,085 in 2016, showing that the agency cap has not tackled the underlying problem and maternity units’ reliance on temporary staffing is still growing year-on-year.

The problems are also serious elsewhere in the UK. In Northern Ireland, NHS organisations spent £3.2m on agency, bank and overtime in maternity in 2016, in Scotland NHS organisations spent £5.3m and in Wales they spent £1,286,234.

The RCM believes that the current shortage of 3,500 midwives and seven years of pay restraint are the two main factors contributing to the rise in spending on temporary staffing. The RCM warned the shortage of midwives could grow even further because of the introduction of tuition fees and removal of the bursary for student midwives this year.

In 2016, the RCM conducted research of the reasons why midwives leave, or are considering leaving, midwifery and found that 80% of midwives said they would stay in midwifery if their pay increased. RCM director for policy, employment relations and communications Jon Skewes said: ‘This report shows quite clearly that our maternity services are understaffed and under-resourced.

‘The use of temporary midwives to staff permanent shortages is counter-productive and smacks of short-termism when there needs to be sensible and strategic long term planning in midwifery and across the NHS. It is costing more in the long run to pay agency, bank and overtime than it would if services employed the right numbers of midwives in the first place.

‘The first positive step the government could take is to end public sector pay restraint and fully fund a pay rise for midwives, MSWs and other NHS staff. This would retain hard-working, experienced midwives in the service so that when new midwives are trained, they are reducing the shortage rather than replacing the midwives who’ve had enough of seeing their pay packet dwindle while they’re working harder and harder.

‘The average midwife has seen their salary decrease in value by over £6,000 since 2010 so it is little wonder why midwives are looking for opportunities elsewhere. This report shows that the vast amounts of money spent on temporary staffing can and should be used to recruit and retain permanent staff and is proof that fair pay for midwives is overdue.’

• ‘A shortage of midwives means Maternity Support Workers are more vital than ever,’ said the RCM on Tuesday. The Royal College of Midwives officially launched Maternity Support Worker (MSW) Month on day two of its Annual Conference in Manchester Central.

To coincide with MSW Month, the RCM released the results from its latest survey of Maternity Support Workers (MSWs) which has revealed the following;

• MSWs as a whole feel undervalued by their pay and current banding. Almost 50 per cent (47.6%) of those surveyed are in band 3, earning less than £19,968 per year.

• Over seventy per cent (77%) of MSWs said they would like more training.

• Almost sixty (59.57%) per cent of MSWs surveyed said they would like to see their profession regulated.

• MSWs are a loyal workforce with over forty per cent (43%) working for their current organisation and employer for ten years or more.

• While over 60 per cent (60.9%) of respondents confirmed their title was MSW there remains a wide variety of titles used such as Maternity Care Assistant (almost 22%) and Health Care Assistant (over 10%).

Commenting, Denise Linay, Head of Organising and Engagement at the RCM, said: ‘Maternity Support Workers provide important support to women and their babies and are a vital part of the overall maternity team. Particularly with the current shortage of midwives in England, MSWs are increasingly playing a bigger role in supporting midwives in their work.

‘Their role can be quite varied including supporting the mother to implement advice given by the midwife on a variety of public health issues including breastfeeding. Supporting mothers to initiate and establish breastfeeding is a key element of maternity care.

‘Whilst midwives provide information and support for women immediately after birth, maternity support workers are a vital element in the ongoing support that women require. As with midwifery care, continuity of support from an MSW can also enhance a woman’s experience of her care.

‘These findings from RCM’s latest survey of MSW’s clearly reveal that MSWs are working at a much higher level than their pay would suggest and many respondents felt their pay and career progression as an MSW is currently quite stagnant.

‘It is also no secret that the role, banding and training received by MSWs varies widely, not only across the countries, but also at trust level where even there job titles can be different. The RCM wants support workers employed in maternity settings to be seen as an integral part of the wider maternity team as well as our union and professional organisation.

‘That’s why for the month of November, the RCM will be celebrating the role of MSWs and all the fantastic work they do to support not only their midwifery colleagues, but mothers, their babies and families too.’

• The leader of the Royal College of Nursing (RCN) has described as ‘deeply worrying’ a new Health Foundation report revealing that national policy and planning for the NHS workforce in England is ‘not fit for purpose’. The report, published on Monday, revealed high staff turnover and instability across the NHS and a drop in the number of student nurses.

While the NHS workforce increased by 2% in the year to April 2017, the number of nurses fell by 0.2%, the report said. Meanwhile, 1,220 fewer students applying from England had started undergraduate nursing degrees this year, based on data from the end of the university clearing round.

The report also shows the annual rate of people leaving the NHS is hitting 30% in some trusts, which is costly both financially and by reducing continuity of care for patients. RCN Chief Executive Janet Davies said: ‘The drop in the number of nurses this year is deeply worrying, and particularly damaging when nurses are having to cope with rising numbers of patients.

‘The reduction in students begs the question of how the promised expansion in nurse numbers in the future can be achieved. The drop in the number of students applying to nursing degree courses earlier this year, after ministers removed student funding, could only be dismissed if all the places were filled.

‘But now we learn that over a thousand fewer students began nursing degrees this autumn.

‘It is shocking to learn that some parts of the NHS are losing almost a third of their entire staff every year. We know that poor morale among nurses is being exacerbated by low levels of pay and inadequate staffing.

‘The huge sums being spent on perpetual recruitment at these trusts is money that should be spent on patient care.’