Following acceptance at conference a letter was sent to the Minister of State for Illegal Immigration as follows:
Being a midwife is a demanding and unique role. They are responsible for creating and sustaining a positive relationship with the pregnant woman to help her to have the best possible birth experience. It takes years of study and on the job training to qualify, with a degree required, and all the associated university costs, and years of dedication to obtain the title and role of Midwife.
Yet despite this dedication, currently Midwives are being driven out of the NHS by understaffing, and fears they can’t deliver safe care to women in the current system according to a survey of its members by the Royal College of Midwives done in 2021. The College warned of a ‘midwife exodus’ as it published the results of its annual member ‘experiences of work’ survey. Over half of midwives surveyed said they were considering leaving their job as a midwife with 57% saying they would leave the NHS in 2021/22. A few years on we know the situation has not improved. With many news reports and articles being written over the state of maternity care in England and Wales.
Burnout among midwives and all maternity staff is higher than ever, particularly after COVID-19 which saw an increase in sickness absence adding to a pre-existing shortage of 2,000 midwives in England alone. Leaked results of an NHS national staff survey showed a sharp drop in those who believe their health and wellbeing was being supported by their employer.
In the RCM survey half of respondents said they did not feel valued by their employer and almost all (92%) of midwives and maternity support workers (MSW) said they did not feel their work was valued by the current Government.
Of those surveyed the highest dissatisfaction, some 96%, was amongst those who have spent five years of less working in the NHS. Half were considering leaving and most of these planned to so with a year.
In 2022 exhausted midwives were walking away from the profession with burnout as growing staff shortages created a ‘toxic cycle’ of resignations and further pressure on those who remained. One midwife, with nine years’ experience handed in her notice saying that working in the maternity sector was ‘soul-destroying’. “The feeling that you get when you leave the shift is a mixed emotion of exhaustion, sadness and stress. You feel that you have not done a good day’s work and you have not given the care that the families deserve”. She also said that midwives in hospitals were regularly required to do the work of three people often in areas they are not experienced in, and that she witnessed unsafe situations on a daily basis.
A quote from Dr Suzanne Tyler, director of Services to Members at the RCM stated that “Our staff are leaving because they cannot give the care they really want to give, they are leaving because the NHS is not a great employer…and they are leaving because over the last 10 years their pay has gone down so that the average midwife is now £7000 a year worse-off that she was 10 years ago”. Some midwives were reported to be relying on food banks and often have to take second jobs to make ends meet.
The government stated that it wanted the NHS to be “the safest place in the world to give birth” and that it aimed to hire more midwives and consultant obstetricians as part of a £95m recruitment drive. This was on top of the £127m NHS investment in maternity services which were to be put into place to increase the maternity NHS workforce and improve neonatal care, as well as a comprehensive emotional and psychological support package for staff .
This package including safe spaces for staff to rest and recuperate. Although Dr Tyler welcomed the investment she said the plan missed the point. “Pouring water into an already leaky bucket was no solution. It’s not the recruiting of midwives that is the problem it is retaining the ones we already have.
According to our research, many of the midwives we currently have are 50 years old or over, they will be coming up for retirement within the next 10 to 15 years.
With many younger midwives now leaving over conditions and lack of a decent starting salary, considering the responsibility and pressure they are under on a daily basis, where will that leave the state of our NHS maternity services. Unable to cope and putting patient and baby safety in jeopardy we fear.
It is ironic that many can earn more through agency working, so called ‘on that bank’, and the NHS will fund that to cover shortages and emergency shifts, so why not look at paying Midwives a decent and appealing salary in the first place to retain those qualified in permeant NHS roles. Ultimately it is the agencies profiting from this situation, aside from having to source midwives from overseas to fulfil vacancies, which we cannot meet through our own countries workforce. If the conditions and starting salaries were better, then more may be attracted into studying and taking on the role.
We await your response with interest, on this important issue.
Reply received from:
I Matthews
Ministerial Correspondence and Public Enquiries
Department of Health and Social Care
Thank you for your correspondence about retaining workforce levels in maternity care. I have been asked to reply. I appreciate the issues you have raised.
Since 2021, the Department has added £165million of recurring investment to the annual maternity budget, to grow and support the maternity workforce and improve neonatal care. On 30 March, NHS England published its three-year Single Delivery Plan for Maternity and Neonatal Services. The delivery plan will make maternity and neonatal care safer, more personalised and more equitable for women, babies and families.
To increase the number of student midwives, Health Education England (which has since merged with NHS England) worked with stakeholders towards a targeted increase of 3,650 midwifery student places in 2022/23, with training leading to professional regulation. The Department achieved increases of 626 student places in 2019/20, 1,140 in 2020/21 and 1,271 in 2021/22. Since September 2020, the Department has made available for eligible students a new, non-repayable training grant of at least £5,000 per academic year and further funding of up to £3,000 per academic year; for example, to cover childcare costs or for specialisms struggling to recruit.
NHS England has developed an extensive support package to enable trusts to establish and expand midwifery international recruitment as part of an ongoing programme to support improvements in maternity services and investment in the maternity workforce in 2021.
In 2021/22, £4.5million of funding was made available for trusts to spend on infrastructure costs to start their international maternity recruitment. This budget was allocated regionally. With current funding allocations, NHS England plans to support the arrival of 500 international midwives over the next 18 months.
A new core curriculum for professionals working in maternity and neonatal services is being developed by the Maternity Transformation Programme, in partnership with professional organisations, clinicians and service users, to address variations in safety training and competency assurance across England. A single core curriculum will enable the workforce to bring a consistent set of updated safety skills as they move between services and trusts.
The Government has provided almost £450,000 to the Royal College of Obstetricians and Gynaecologists to develop a new workforce planning tool to improve how maternity units calculate their medical staffing requirements. The tool will be freely available to NHS trusts across the country in the next year and will provide maternity staff with a new methodology that calculates the numbers, skill sets and grades of medical staff required within individual maternity units based on local needs.
The NHS People Plan has been developed to focus on improving the retention of NHS staff by prioritising staff health and wellbeing. This includes a wellbeing guardian role, healthy working environments, empowering line managers to hold meaningful conversations with staff to discuss their wellbeing, and a comprehensive emotional and psychological health and wellbeing support package.
The NHS People Plan is also focused on improving working conditions for staff through flexible working and supporting an inclusive and compassionate workplace culture. £45million was invested in 2022/23 to support the continuation of 40 mental health hubs across the country, the Professional Nurse Advocate programme and expanding the NHS Practitioner Health service.
Strong leadership has been established across the system with the appointment of named regional and local maternity safety champions led by two national champions. In every trust, frontline maternity safety champions work closely with a board maternity safety champion to promote ‘floor to board’ communication.
In 2021, a £500,000 training fund helped equip NHS maternity and neonatal leaders with a range of skills and knowledge to address poor workplace culture and facilitate collaborative working between nurses, doctors, midwives and obstetricians. I hope this reply is helpful.
