Addressing the impact of staffing shortages

By Sean O'Sullivan, Head of Health and Social Policy, RCM on 27 October 2022 Maternity Services Midwifery Workforce MSWs - Maternity Support Workers Safety Staffing Levels

Earlier this month, the Maternity All Party Parliamentary Group (APPG) and the Baby Loss APPG issued a joint calling for urgent action to address staffing shortages in maternity services.

There is now little dispute that maternity services are understaffed; even Government ministers have concurred with our assessment of a shortage of 2,000 midwives in England. What is less well understood is what impact these shortages are having on the quality and safety of maternity care, on the experience of women and families and on the morale and wellbeing of maternity staff.

This report has set out to explore these issues by tapping into the views of women and families, maternity staff and stakeholder organisations as to what has gone wrong and what can be done to tackle shortages. The overall evidence paints a bleak picture of maternity and neonatal services that are understaffed, overstretched and struggling to provide women and babies with safe and good quality care:

• Midwives, MSWs and other maternity staff are struggling to find the time to support women and families, to provide them with timely information and to compensate for the absence of senior and experienced colleagues. This is creating unacceptably high levels of risk and leaving women feeling uncertain and unsupported.
• Exhausted and demoralised staff are frustrated at a system and environment that makes it hard for them to give of their best; some are fearful about making mistakes that could have serious consequences for women and babies. Staff are caught in a vicious circle, as with more of their colleagues leaving, the pressure increases on those that remain.
• Staffing shortages are limiting opportunities for professional development and even access to mandatory safety training.
• While NHS employers are implementing some welcome initiatives to increase recruitment, they are struggling to stem the flow of staff who are leaving because they do not feel valued, cannot work the hours that they want or who are simply burnt-out.

These are extremely concerning findings, but what they also highlight is the commitment that midwives and MSWs have to provide women with the best possible care (and their clear frustration when it is not possible to do this) and the appreciation that women and families have for the efforts that staff make, particularly when they are working under such challenging circumstances.

In terms of tackling shortages, there is a broad consensus from respondents, on what needs to be done, now and in the medium-to-long-term, particularly:

• Increased investment, in line with previous recommendations made by the Health and Social Care Committee and the Ockenden Review, and more robust workforce planning measures.
• A greater focus on improving the health and wellbeing of maternity staff, more flexible working opportunities, a culture that values and respects staff and vigorous action to tackle unacceptable behaviours.
• Better support for students and newly qualified staff, including more investment in mentoring, preceptorship, CPD and career progression.
• Increasing entry routes into midwifery, such as expanding programmes for nurses wanting to convert to midwifery, apprenticeship programmes for MSWs and incentives for newly retired staff to return to support students and newly qualified staff.
• Better pay and conditions, both immediately and, longer-term, to redress the cumulative loss of earnings over the last decade.

Will the Government listen? Well, we are hopeful that Jeremy Hunt, the Chancellor of the Exchequer, will look favourably on this report, not least because it has been signed-off by the erstwhile joint chair of the Baby Loss APPG. His name? Jeremy Hunt.