Supplementary evidence submitted by the
Royal College of Midwives (WP 54A)
Since submitting our original evidence to the
inquiry into Workforce Planning, further and more up-to-date information
has been published that reinforces many of the points we made
in that original evidence. For that reason, we wanted to submit
supplementary evidence to inform the Committee's work further.
The Royal College of Midwives (RCM) represents
over 95% of the UK's practising midwives, and is the world's oldest
and largest midwifery organisation. It works to advance the interests
of midwives and the midwifery profession and, by doing so, enhances
the wellbeing of women, babies and their families.
NHS MIDWIFERY WORKFORCE
IN ENGLAND
The number of midwives is down, according to
the latest NHS workforce figures released on 24 April (subsequent
to the submission of our earlier evidence).
In the 12 months to 31 September 2005, the headcount
number of midwives working in the NHS in England fell 36 to stand
at 24,808. The headcount system is the Government's preferred
system for counting workforce numbers.
There was better news on whole-time-equivalent
(WTE) midwives, but they were up in number by only 95 to stand
at 18,949; this means that the number of WTE midwives working
in the NHS in England is up by just 5% in the eight years from
1997-2005 despite significant extra demands on midwifery time
through changes in practice.
At best the workforce situation is standing
still; at worst the earlier slight improvements in the NHS midwifery
workforce in England are being reversed. Moreover these latest
workforce statistics relate to a period prior to the financial
deficits in some trusts.
The RCM recommends that to reduce the excessive
amounts of stress and the workload of midwives, the Department
of Health (DH) must urgently seek to recruit significantly more
midwives whilst retaining those currently in post. To achieve
this, the DH must use the Birthrate Plus workforce planning tool
to assess workforce needs, set new and ambitious targets for increasing
the size of the midwifery workforce and ensure sufficient funding
to achieve that is in place, increase the number of places for
student midwives and give those student midwives better financial
assistance.
THE RECRUITMENT
OF NEW
STAFF IN
ENGLAND
As stated in the RCM's earlier evidence, to
reverse the worsening age profile of the midwifery workforce there
is a clear need to recruit into midwifery more and younger midwives
to ensure the ongoing sustainability of the profession. The chief
route to delivering that inflow of new and younger midwives is
through training more student midwives and ensuring that more
of them make it through their studies and into NHS practice—and
that they have a post to go to after qualification.
With a fifth of student midwives dropping out
of their studies and most citing financial difficulties as the
reason they finally dropped out, the RCM is calling for a step-change
in the level of support given to student midwives—we call
for an annual £10,000 non-means-tested bursary for all student
midwives.
Early Day Motion 197, which calls for just such
a bursary, has—as at the Summer Recess—attracted the
support of 224 MPs. It has now been signed by members of every
political party with MPs in the House of Commons, including over
half of the Health Committee.
In addition to extra support for student midwives
however there needs to be suitable employment available for the
student midwife upon qualification and increasingly we are finding
that this is not the case. We are receiving reports from soon-to-qualify
student midwives and recently-qualified midwives from right across
England who are unable to find employment as a midwife. This is
despite the fact that midwife numbers are dropping and—as
cited in the RCM's earlier evidence—Ministers readily admit
that it is this very lack of midwives that is the barrier to improvement.
The RCM recommends therefore that trusts do
not whittle away maternity services in an attempt to scrimp and
save money to make up their deficits. Midwifery was at the end
of the queue when extra investment was being poured into the NHS;
midwives must not now head the queue as the axe falls. New positions
must be created for newly-qualified and more experienced midwives—put
simply, to achieve the world-class maternity service in England
that the Government has repeatedly promised we need more midwives,
not fewer.
AN AGEING
POPULATION
Figures released by the Office of National Statistics
on 18 May show that in 2005 there were in England 22,246 women
aged 40 or above who gave birth - this was an increase of 1,453
women or 7% on the previous year. The number of older mothers
has doubled in the last decade.
As the figures submitted in our original evidence
showed, in England—and indeed throughout the UK—the
highest rate of babies born with congenital anomalies were those
born to women aged 40 or over. Midwifery care for older mothers
is therefore more demanding and this has a direct impact on what
is required of the midwifery workforce.
Also cited in our earlier evidence was the rise
in teenage pregnancies and these girls and young women also require
particular support from midwives. Both these developments do not
show up in the fluctuations of the birth rate, which new statistics
show has in any event increased in England in the past year, but
are very important in planning for future workforce requirements.
The RCM recommends that the national tariffs
relating to maternity services be developed that reflect all additional
costs associated with providing maternity care to women and babies
with diverse clinical and social needs. The RCM is working with
North East London SHA on developing an informed tariff along these
lines and would be happy to work with the DH on this.
INCREASING USE
OF PRIVATE
PROVIDERS OF
SERVICES
601,000 deliveries took place in England in
2004-05, of which 0.5% took place in a private hospital, according
to official statistics released in 26 May. This very low private-sector
contribution is unchanged on the previous year.
Additionally, only 390 deliveries in England
were attended by an independent midwife in 2004-05, which was
down by over 4% on the previous year, and again amounted to less
than 0.07% of all deliveries.
This is additional evidence therefore that the
ability of the private sector to assist in the provision of maternity
services to the NHS is very limited.
FINANCIAL CONSTRAINTS
The current financial deficits in some trusts
are clearly impacting on the provision of maternity services,
according to the findings of a survey of heads of midwifery released
on 8 May.
The survey, carried out by the RCM, found that:
— more than one in three managers reported
that their maternity services budget had been cut;
— more than one in four reported that
their training budget had been cut;
— more than one in four reported that
their midwifery staffing establishment had been reduced;
— half reported trusts operating a
recruitment freeze;
— one in four reported that vacant
senior midwife positions had been replaced with more junior posts
and a similar number reported that support staff had been substituting
for midwives; and
— one in four reported that trusts
had reduced the number of home visits by midwives.
These financial constraints clearly will not
help to improve midwife numbers, referred to above, a decline
in which was identified in the latest NHS workforce figures.
Royal College of Midwives
8 August 2006
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