Midwives on the picket line during strike action over pay

THE SAFETY of maternity services is under serious threat, according to a new survey released by the Royal College of Midwives (RCM) on Tuesday.

The survey found that eight out of 10 midwives (83%) do not believe their NHS Trust or Board has enough staff to operate a safe service.

Services are already stretched almost to breaking point, with 42% reporting that half of shifts are understaffed, and a third saying there are very significant gaps in most shifts.

These shortages are taking their toll on midwives and maternity support workers, with morale at rock-bottom. Seven out of 10 (71%) have considered leaving the profession, while over a third (38%) are seriously thinking about it.

Gill Walton, Chief Executive of the Royal College of Midwives, said: ‘These are dedicated professionals caring for women, babies and their families through the enormous pressures of the pandemic.

‘They are being pushed to the edge by the failure of successive governments to invest in maternity services.

‘Maternity staff are exhausted, they’re demoralised and some of them are looking for the door.

‘For the safety of every pregnant woman and every baby, this cannot be allowed to continue.’

Targets set in 2010 by Prime Minister David Cameron to increase the number of midwives by 3000 have failed to materialise 10 years on.

Instead many Trusts and Boards are having to operate a ‘make do and mend’ service that relies on staff working beyond their contracted hours.

That overtime is often unpaid, with the RCM’s survey finding that nearly two-thirds (63%) of midwives are working beyond their contracted hours for no additional pay.

In light of this, it is unsurprising that just two per cent said they felt valued by the UK Government.

Gill Walton added: ‘Midwives and maternity support workers are incredibly resilient, and it saddens and angers me to see the system crushing that indomitable spirit.

‘They come into the profession to support women and families through a life-changing time in their lives.

‘They come into the profession to provide safe, high quality care.

‘The legacy of under-funding and under-investment is robbing them of that – and worse still, it’s putting those women and families at risk.

‘It shouldn’t have taken a global pandemic to shine a light on these issues. We are saying to policy-makers, stop kicking the can down the road.

‘Fund maternity services now, fund them properly, and give staff the resources and support they need before we lose more of them, cutting even deeper into the ability of maternity and the NHS to ensure safe services and the best care.’

The survey was conducted online from 28 October to 8 November 2020. There were 1400 responses, predominantly from England (Wales: 58; Scotland: 144; Northern Ireland: 76).

The RCM has also called for a robust maternity support worker job evaluation programme.

Maternity support workers (MSW) should be paid fairly for the work they are doing, their trade union, the Royal College of Midwives (RCM), said ahead of national MSW Week, which started on Monday, 16 November.

MSWs support midwives and maternity teams in in hospitals, midwife-led units and in the community, caring for mothers and babies and performing tasks such as taking blood pressure and preparing equipment.

Increasingly MSWs also focus on specialist areas such as infant feeding support and public health promotion as well as taking on a bigger role in supporting new mothers in their own homes.

The RCM is calling for MSW posts to be properly evaluated, arguing that many are wrongly banded, and so MSWS are being underpaid.

Additional training is not being acknowledged and, despite carrying out more complex tasks, MSWs are being kept at low grades – and low pay.

That is why the RCM is campaigning for a robust and thorough job evaluation programme for MSWs, to ensure they get the additional pay they are entitled to for the work they are doing.

Gill Walton said: ‘MSWs are the unsung heroes of maternity, working tirelessly away from the spotlight to care for women, babies and their families.

‘They bear a massive weight for maternity services, with many doing additional training and taking on more skilled and advanced work for which they should be rewarded fairly.

‘Their roles supporting midwives is crucial to the continued and safe running of our maternity services, and to delivering the best possible care.

‘The dedication, commitment and sheer hard work of MSWs underpins our maternity services.

‘Governments and employers must recognise that contribution and ensure they are paid fairly and appropriately.

‘We must value them and reward their massive contribution and we must do that now.’

Meanwhile, Nurse staffing levels in neonatal services in Britain remain ‘significantly below’ national recommendations, according to a new audit released on Tuesday.

The state of neonatal services in England, Wales and Scotland is assessed each year through the National Neonatal Audit Programme (NNAP) led by the Royal College of Paediatrics and Child Health.

Workforce was considered for the first time in the audit of 2018 data, which found serious concerns about nurse staffing.

The latest analysis published earlier in the month for 2019 showed a continuing shortfall of nurses in the right numbers and expertise.

Nurse staffing ratios in neonatal services are set at one nurse per intensive care baby; one nurse to two high dependency babies; and one nurse for four special care babies with an additional shift coordinator.

In addition, it is recommended that at least 70% of registered nursing staff on duty should have a neonatal specialist qualification.

However, the latest NNAP report found that just 69% of neonatal nursing shifts were numerically staffed according to national guidelines in 2019, and only 44% had sufficient specialist nurses to meet demand.

Authors said this represented a ‘small improvement’ compared with 2018 when there were 64% of services numerically staffed appropriately and noted there had been no change overall on the number of shifts with specialist nurses.

However, the report warned that the specialist nurse staffing situation in neonatal intensive care units (NICUs) had, on average, worsened.

Findings showed that only 37% of NICUs across Britain had their shifts staffed sufficiently with nurses qualified with specialist neonatal skills.

The document said this was ‘particularly concerning as research shows that the most vulnerable babies have the best outcomes when they receive one-to-one nursing care’.

There were also wide regional variations in nurse staffing levels, noted the report, which found only 22% of shifts in the East Midlands were staffed with enough qualified specialist nurses, compared to 70% in North Central and North East London.

After the 2018 report, premature and sick baby charity Bliss warned of a looming nurse staffing crisis in neonatal services.

Responding to the new data, Caroline Lee-Davey, chief executive of Bliss, said the findings showed that ‘addressing the crisis in neonatal nursing must remain an urgent priority’.

She also raised concerns about nurse wellbeing, noting how understaffing, mixed with high-pressure environments and the impact of the coronavirus pandemic, were taking a ‘significant toll’ on their mental health.

‘We remain particularly concerned that there is a significant shortfall of specialist nurses to care for the smallest and sickest babies, for whom one-to-one nursing is so important to give them the best chance of survival and quality of life,’ she said.

‘Nurses are the backbone of neonatal services and provide excellent care to babies, and their families.

‘But working in such a high-pressure environment takes a significant toll on their mental health and wellbeing – exacerbated significantly by understaffing, and now also by the impact of Covid-19.’

Lee-Davey stressed it is ‘vital’ that progress around the development of the neonatal workforce is made ‘quickly’.

‘The unprecedented circumstances of Covid-19 mean it is more important than ever to work towards achieving and maintaining safe-staffing levels so that services are able to operate safely even when crisis hits,’ she added.

Recommendations within the NNAP report suggested that government bodies in England, Scotland and Wales must work to ensure that ‘sufficient resources are available for the education and employment of suitably trained professionals’ needed to meet and maintain appropriate nurse staffing ratios.

It also called on universities, Health Education England (HEE) and other relevant bodies in the devolved nations to ‘consider revising, renewing and standardising models of specialist neonatal education’.

It urged universities, HEE, neonatal units and neonatal networks to ‘monitor adherence to recommended nurse staffing standards’ and ‘develop action plans to address any deficits in nursing staffing and skill mix’.