Tag: Royal College of Midwives

Mounting Scottish maternity service staffing shortages spark safety fears, says RCM

Understaffing, staff burnout and fears they cannot provide safe care could see many midwives heading for the exit, according to a Royal College of Midwives (RCM) survey of its members in Scotland. A staggering half of respondents say they rarely have enough staff to provide safe care for women.

The RCM said it is deeply concerned by the survey results, which showed seven out of 10 midwives are also thinking of leaving due to low staffing levels and frustration with the quality of care they can provide. As one midwife responding to the survey said, “I love being a midwife, but I hate the care I am giving.”

The RCM lays out several recommendations to move forward positively and address the issues in the survey. These include a call for more support for midwives early in their career to ensure they feel well supported and positive about their chosen career rather than leaving.

There is also a need to ensure midwives have time to undertake essential education and development which is key to delivering safer and better care. An accurate tool to determine midwifery staffing levels is also overdue and a proportionate and substantial increase in the number of consultant midwives and clinical educators – who play a key role in ensuring safe care.

Jaki Lambert, RCM Director for Scotland said: ‘I know midwives and maternity support workers provide excellent care daily to families, but we cannot rely on goodwill alone.

“This shows deep seated and longstanding issues, certainly worsened by the pandemic which midwives fear are already impacting on the quality of care for women and their babies. There is a worrying catalogue of issues and discontent with an exhausted and a fragile maternity workforce with rock bottom morale.

“They have also been emotionally and physically battered by the pandemic and left feeling that their work and efforts are not valued. We need to move forward together with the Government from this point.

“There is a real disconnect between what maternity services need and what resources are available to them in terms of funding, professional development, resources, and staffing. It is only the incredible determination, skill and sheer willpower of midwives and their colleagues that are holding services up.

“Without action the staff, and the system they are propping up, will break. This is not safe, it’s not sustainable, and it’s not acceptable.”

Fears about understaffing run through the survey. Levels of staffing were consistently described as unsafe, with midwives raising concerns for the safety of women using seriously overstretched services.

Concerns with the quality of care being given was cited by six in 10 of those thinking of quitting.

Women with complex care needs benefit from additional midwifery support but the resources needed to support these women are often not factored into funding calculations, says the RCM.

The RCM says they are concerned that more experienced midwives and those near retirement who delayed leaving to help in the pandemic are starting to head for the exit. The loss of such rich experience impacts on the support available to early career midwives and the students following in their footsteps.

Mandatory training, designed to improve safety in maternity services, has also been a casualty of the workforce crisis, with more than four in 10 respondents unable to do this training during working hours, instead having to do it in their own time or not at all.  

The RCM calls for staff to be given the time to do this vital training. One midwife summed up the situation saying, “mandatory safety training cancelled due to short staffing making a dangerous situation even less safe.”

Growing pressures are also leading to worrying levels of strain and anxiety for maternity staff. Nearly all (88%) in the survey say they have significant levels of work-related stress. One midwife said, “I have nothing left to give my own children and family at the end of the day. I am at breaking point.”

Nearly every respondent said they are missing breaks with over half (52%) saying this happens two to three times a week and has become the norm. Many are not even getting the chance to have a drink or go to the toilet on shifts that can be as long as 12 hours. One midwife reported, “When I say no break, I mean flooding through sanitary products onto my clothing because I cannot take 10 minutes to change my tampon in a 12-hour shift.”

Jaki Lambert added, “The pain and anguish of midwives was very difficult to read about and I hope their words are captured in this survey.  It paints a deeply worrying picture of staff that are on their knees and are not currently seeing a way forward or access to the support they need to deliver the safest and best possible care.

“We can and must do better for midwives, women, babies, and families in Scotland. We know that the Scottish Government wants to fix this and we want to work with them to make sure that midwives are valued and their expertise recognised.

“It is essential that we recruit new midwives into the service, treat the midwives we have better to make sure they stay in post, and that they can continue to develop throughout their careers so that women in Scotland get the maternity care they deserve.”

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Invest in Scottish maternity to tackle deprivation, says RCM in message to next government

Tackling Scotland’s social deprivation and inequalities by investing in maternity services and staff must be at the heart of the next government’s policy. That’s the message from the Royal College of Midwives (RCM) in a Blueprint for maternity services published this week.

In five areas for action, it also calls for an end to Scotland’s midwife shortage, saying some areas of the country struggle to attract enough midwives. 

The pandemic has also exposed starkly existing inequalities hitting vulnerable women and those from Black, Asian and minority ethnic communities.  Maternity and other areas of healthcare have a key role to play in efforts to address these inequalities, says the RCM 

The RCM’s five areas for action for the next Scottish Government are: 

  • tackling social deprivation; 
  • delivering the best maternity care for all the people of Scotland; 
  • supporting NHS staff to recover from the pandemic; 
  • ensuring Scotland has birthplaces that are fit for the future; and 
  • ending Scotland’s midwife shortage for good. 

Pulling no punches, the Blueprint says the pandemic ‘has been brutal’ on maternity and other NHS staff, who have worked throughout to ensure safe and high-quality care for women. This has hit their mental and physical health and they must be given the time and support to recover from it. 

Jon Skewes, Executive Director for External Relations at the RCM, said: “There has been a monumental effort from midwives, maternity support workers, and maternity care assistants through the pandemic. It is time to step-up and really invest in them, in their pay and in their working conditions.

“Right now, we have a demoralised and exhausted workforce and women falling through the cracks and not getting the care they deserve. Staff are also often working in old, poorly designed buildings that are simply not fit for purpose. The pandemic has exposed the extent and the impact on care of this crumbling infrastructure.” 

Additional training places for student midwives are also needed in more of Scotland’s universities. When they qualify new midwives generally stay within the regions they trained in leaving the chances of recruiting staff stacked against other areas without midwifery courses.  

Jon Skewes added: “Tackling deprivation goes way beyond maternity and the wider NHS. Fixing it must be done through multiple channels including social care, education, and others.

“Maternity is a very good place to start improving the health of the nation, reduce inequalities and indeed, save lives that should not be lost. This has been a really tough year for the NHS and the people using it as it creaked under the weight of pandemic demands.

“It has also been a remarkable year because of how its staff and the service responded. Now is the time to invest to make it fit for the future.” 

Debt, dole, worry: Student midwives facing triple whammy threat

Many student midwives are struggling under the weight of financial concerns, poor mental health and an unpredictable job market, according to new findings by the Royal College of Midwives (RCM).    

Student midwives in England, who must pay tuition fees and take out maintenance loans to cover living costs, will have, on average, a debt of £41,000 when they qualify. Even for those who receive a training bursary, the financial future is bleak.

A staggering 91 per cent of student midwives in Scotland, Wales and Northern Ireland said their training bursaries were not enough to live on.   

Gill Walton, Chief Executive of the RCM, said: “Our student midwives should not be facing a triple threat of debt, worry and an unpredictable job market  Unlike other students, the demanding nature of their course mean they have little opportunity to seek part-time work to supplement their income.

“They have a longer academic year, they work nights, weekends and bank holidays, and are often on-call to go in a at a minute’s notice.  They show incredible dedication to their chosen career and there is an overwhelming case to give them better financial support, and to ensure they get jobs in our NHS when they qualify.”   

The pandemic’s impact on student midwives cannot be underestimated. The RCM found that 96 per cent of student midwives reported having mild or moderate mental health problems since the pandemic began.

Our survey shows that by the end of July just 36 per cent of students in their final year of midwifery training had been offered a job in the NHS. At the same time, midwifery educator numbers are not keeping pace with the rise in student midwife numbers, potentially leaving students less supported throughout their training.   

Gill Walton added: “Throughout the pandemic student midwives have made enormous efforts, working in our maternity services while also continuing their studies. At the same time the pandemic has disrupted midwifery education heavily.

“Some UK governments and institutions are doing better than others, but most are selling our student midwives short. They need to step up and ensure we continue to have the best educated, best prepared new midwives in the world. They are the future carers of mothers, babies, and families and we must invest in them.”   

Maternity services are open for business – help us keep them that way, says RCM

The Royal College of Midwives (RCM) has called on every pregnant woman to support them in keeping services open and available.

With maternity services across the country working to maintain as broad a range of services – including antenatal appointments and scans – as they can, the RCM has urged pregnant women and their families to do their bit to keep themselves healthy and protect midwives and maternity support workers (MSWs) too.

The RCM is calling on pregnant women to let their midwife know if they or anyone in their home starts to have symptoms of Covid-19 and they must also continue to attend routine appointments for antenatal care and scans.

Gill Walton, Chief Executive of the RCM, said: “It’s really important to remember that maternity services are open. Every day, up and down the country, babies are being born and new families are created. Coronavirus isn’t putting a stop to that.

“Yes, some things may be slightly different – you may see your midwife via a video screen for some appointments, for example – but you will still receive the care and support you need throughout your pregnancy.

“We want you to have a happy and healthy pregnancy and birth, and our members will support you every step of the way. What we’re asking in return is that you support them too, by reducing their exposure to coronavirus. If you or your partner has coronavirus symptoms, it’s vital that you let your midwife know before you attend an appointment.

“You’ll still get the care you need, but your midwife will be able to take the precautions they need to keep themselves as safe as possible. The same applies when you go into labour. Let the maternity unit know so they can be ready for you and help you welcome your new baby into the world.”

The RCM has applauded the maternity units that are embracing innovation to replace some face to face consultations with phone or by video calls. They have stressed the need for pregnant women to continue to attend all appointments for scans, blood pressure, urine checks and blood tests as planned.

It is also vital to contact their midwife if they have any concerns, particularly around the movement of their baby, without delay.

Gill added: “I am so proud of the work Heads and Directors of Midwifery are doing to keep services open and to make sure pregnant women still receive the care they need.

“Please support them this Easter weekend, by not taking a break from the important measures that are in place to keep you safe. Stay at home as much as you can, and if you can’t continue to observe social distancing; wash your hands regularly and avoid touching your face; and if you cough or sneeze, do it into the crook of your elbow or into a tissue.”

One in five midwife roles are currently unstaffed

The Royal College of Midwives has today made a plea to NHS leaders to protect the safety of pregnant women by ringfencing maternity services in the current crisis.

There is concern that vital staff, including midwives and maternity support workers, will be redeployed to other areas, at a time when a survey of senior midwives found that the shortage of midwives on NHS maternity units has doubled since the start of the coronavirus outbreak.

The survey of heads and directors of midwifery from across the UK, carried out by the Royal College of Midwives (RCM), found that, even before the outbreak, services were struggling to get by with almost one in 10 midwifery posts vacant.

Survey respondents now report that this shortage has doubled to 20 per cent. The coronavirus itself as well as self-isolation has combined with existing staff vacancies to mean one in five midwife roles are currently unstaffed today.

Commenting on the survey results Gill Walton, Chief Executive of the RCM, said: “While other areas of the health service can postpone and cancel procedures, there is still an ongoing need for maternity services.

“Women are still pregnant, still having babies, and they need the care and support of properly resourced maternity services. We have to ensure that midwives and maternity support workers are ringfenced from any redeployment to ensure that women continue to receive safe care.

“What this survey shows is that coronavirus is exposing the gaps that already exist in maternity services. The shortage of midwives has doubled since the start of the outbreak, a situation which is only likely to worsen as the pandemic spreads further.”

Over a fifth (22 per cent) of survey respondents also reported that local midwife-led maternity units had been closed, with more than a third (36 per cent) of areas also either stopping (32 per cent) or restricting (four per cent) homebirths.

In 11 cases the midwife-led unit has been closed to provide facilities to assess or care for coronavirus patients.

Nearly eight out of 10 midwifery leaders (78 per cent) reported ending routine face-to-face antenatal and postnatal visits, with a further nine per cent restricting just face-to-face postnatal visits.

Heads and directors of midwifery reported confusion about what should happen to midwives with long-term health conditions or who live with someone with conditions that put them at greater risk, and the impact their self-isolation would have on staff shortages. 

Gill Walton continued: “We have to protect the maternity front door and continue to provide the levels of care and support pregnant women need.

“We need to do all we can to make sure the maternity workforce is kept well and healthy as much as possible. The testing of NHS staff is an urgent priority.”

Health of the Nation: Personalising Realistic Medicine

Healthcare professionals are being encouraged to deliver a more personalised approach to care by Chief Medical Officer Dr Catherine Calderwood, who has published her fourth annual report: Personalising Realistic Medicine.  Continue reading Health of the Nation: Personalising Realistic Medicine