Midwives Respond To The East Of England's Darzi Review NHS Consultation

Main Category: Nursing / Midwifery
Article Date: 20 Aug 2008 - 4:00 PDT

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The RCM Responds to the East of England's NHS consultation "Towards the best, together": Midwives say the best is yet to come - 610 more midwives needed rather than 160 proposed.

Responding the NHS's East of England consultation, "Towards the best, together", a "vision" document answering the Darzi Review, Pat Gould, the Royal College of Midwives' team manager for Eastern, London and South Eastern regions, said: "We welcome many of the report's recommendations believe and truly believe that this consultation document is a timely contribution to the debate about the future of maternity services in the East of England. The College agrees with the premise that healthcare in the region needs to change and nowhere is this more relevant than in relation to maternity and newborn care."

However, the region's maternity services are facing a number of key challenges in the coming years, including dealing with a rising birth rate, more complex pregnancies, and midwifery staff shortages. By 2009, the Government has pledged to provide one-to-one care for all women, but most maternity units in the East of England do not have enough midwives to provide one-to-one care and the report is only proposing recruiting another 160 midwives.

Mrs. Gould said, "Faced with a rising birth rate and an increase in more complex births, it is a gross understatement to say that 160 midwives are needed. With an emerging baby boom, we need, at a conservative estimate at least, 610 more midwives in the region."

She added: "We welcomed many of the reports other recommendations and proposals, such as for postnatal services; but some of the proposals are vague and further consideration is needed in respect of the level of support given to women and their families. We are particularly disappointed that the vision document had little to say about where postnatal care is provided. The RCM believes that that care after birth - where appropriate - should be available in local one-stop settings, offering women a range of support, such as drop-in clinics or children's centres. "

Mrs. Gould said: "How can we expect midwives to cope when we are in the midst of a baby boom and their workload is racing ahead of staff numbers? Midwives are struggling to provide the one-to-one care promised by the government, and the birthrate is set to carry on rising. Across the country we are really beginning to see the quality of maternity care being compromised by poor staffing levels.

"The Government in February has made a commitment to providing 4,000 new midwives, the equivalent of 3,400 full-time midwives, across the country by 2012. We also need Trusts in the region to make maternity services a priority, so that mothers and babies get the service they need and deserve. Morale among midwives is low. We want to see midwives valued and cherished and rewarded in their pay-packet for their skill and dedication. The challenge for the Trusts in this region is to make maternity services a priority and show that maternity services really do matter."

Notes

1. The Royal College of Midwives (RCM) is the professional and trade union membership organisation that represents 95% of practicing midwives. It is the only such organisation run by midwives and for midwives. The RCM is the voice of midwifery, providing excellence in professional leadership, education, influence and representation for and on behalf of midwives. The College actively supports and campaigns for improvements to care services and provides professional leadership for one of the most established of all clinical disciplines. It is one of the world's oldest and one of the largest midwifery organisations, and celebrated its 125th anniversary in 2006. It is also a trade union. For more information visit the RCM website at http://www.rcm.org.uk.

2. The region's maternity services face a number of key challenges in the coming years, including:

A rising birthrate. In 2007 there were just over 64,000 births in NHS units in the East of England and in the last five years - during which there have been year on year increases in births - the birthrate in the region has increased by approximately 10%[1]. Furthermore, fertility rates in the East of England have increased from 56 conceptions/1000 women aged 15 - 44 in 2001 to 60/1000 women in 2006[2].

More complex pregnancies. A combination of changes in the demographic profile of pregnant women and technological advances means that the region's maternity services are caring for a higher proportion of women with complex medical and social needs:

In 2006, more than one-in-five of all babies (21%) were born to mothers who were born outside of the UK. This has significant implications for maternity services because women from minority ethnic groups, particularly those from a socially deprived background, have higher rates of complication in pregnancy.

One of the key demographic changes impacting on the complexity of maternity care is the combination of significant numbers of young women (aged 20 and under) giving birth as well as an increasing number of women aged 40 years or older who are currently pregnant and giving birth.

Teenage pregnancy rates in the East of England fell by 14% between 1998 and 2007 and are lower than any other region in England. However, the picture within the region is variable, with significant reductions in Hertfordshire and Bedfordshire, a modest fall in Luton and Peterborough while teenage pregnancy rates in Norfolk have actually increased[3]. Teenage pregnancy rates pose a major challenge for maternity services because of the association between teenage parents and poorer antenatal health, lower birth-weight babies and higher infant mortality rates.

Nationally conception rates for women aged 40 and over have increased significantly in recent years, reaching a record 12.2/1000 women aged 40 years or more.

The rate in the East of England at 11.8/1000 women is not far short of the national average[4]. Midwifery care for such women is more demanding, due to the increased health risks to mothers and babies associated with pregnancies for women over 40 years, and this has a direct impact on what is required from the midwifery workforce.

3. Midwifery staff shortages: Most maternity units in the East of England do not have enough midwives to provide the level of one-to-one care that the Government is pledged to provide for all women by 2009.

4. Birthrate Plus: This is the respected and widely used midwifery workforce planning tool, recommends a ratio of one midwife for every 28 deliveries for hospital births. This equates to approximately 36 midwives for every 1000 births (although units with a high caseload of women with complex medical and social needs will need more midwives than this). Unfortunately, the recent Healthcare Commission review of maternity services found that only one unit in the region exceeded this recommendation (James Paget 38 midwives/1000 births), while ten units had a ratio of less than 30 midwives per 1000 deliveries[5].

5. The number of midwives notifying their intention to practise in the East of England fell from 2,692 in 2006 to 2,541 in 2007[6].

6. Many trusts are facing a persistent 'retirement bulge' with 26% of the region's midwives aged 50 years or over[7]. Training commissions in the East of England need to take account of this retirement bulge.

7. The region's midwifery vacancy rate is running at 7.83%, up from 1.8% in 2006. This makes it the highest rate in the UK outside of London and compares poorly with the national midwife vacancy rate of 5.08%, up from 3.25% last year.* A vacancy is only classed as a vacancy when a Trust is actively seeking to fill the post.

The Royal College of Midwives