NHS midwives shortage remains despite increasing numbers

The Public Accounts Committee publishes its report into maternity services in England

The Rt Hon Margaret Hodge MP, Chair of the Committee of Public Accounts, today said:

“The vast majority of women who use NHS services to have their babies have good experiences, but outcomes and performance could still be much better. Despite an overall increase in the number of midwives there is still a shortage of 2,300 that are required to meet current birth rates – a truly worrying figure.

What’s more, the Department of Health and NHS England struggled to tell my committee who is accountable for ensuring something as fundamental as whether the NHS has enough midwives.

We know that many women do not want to give birth in hospital, with care led by consultants, and this is also more expensive. However, 87% of women still gave birth in this setting in 2012. Women who have a low risk pregnancy should be able to choose where to give birth, such as in a midwife-led unit. More could be delivered for less money with better results if there were more midwife-led birth centres available.

As things stand there is evidence that many maternity services are running at a loss, or at best breaking even, and that the available funding may be insufficient for trusts to employ enough midwives and consultants to provide high quality, safe care.

Pressure on staff leads to low morale, and nearly one third of midwives with less than 10 years’ work experience are intending to leave the profession within a year, an appalling waste of talent.

However, this current shortage is compounded by the fact that more than half the obstetric units cannot ensure appropriate consultant cover at all times. All those who use the NHS will be alarmed to hear that evidence suggests the quality of care is worse at weekends.

We know that when NHS maternity care goes wrong, the impact can be devastating for those concerned and costly for the taxpayer. Some £480 million is spent on clinical negligence cover – equivalent to £700 per birth. This is money that is sorely needed for frontline care. Maternity claims have risen by 80 per cent over the last five years. The Department of Health and NHS England should address the main causes of maternity clinical negligence claims so that fewer tragic mistakes occur.

The rate of babies who are stillborn or who die within seven days of birth compares poorly with the other UK nations and some European countries – and this is just not good enough.

Furthermore, black and minority ethnic mothers were less positive about the care they received during labour and birth, and the NHS has failed to address persistent inequalities in maternity care. NHS England must set out as a matter of urgency how it intends to reduce inequalities, and report annually on progress.”

Margaret Hodge was speaking as the Committee published its 40th Report of this Session which, on the basis of evidence from the Department of Health, NHS England, the National Childbirth Trust, the Royal College of Midwives and a consultant obstetrician, examined maternity services in England.

Having a baby is the most common reason for admission to hospital in England. In 2012, there were nearly 700,000 live births, a number that has risen by almost a quarter in the last decade. There has also been an increase in the proportion of ‘complex’ births, such as multiple births or those involving women over 40. Maternity care cost the NHS around £2.6 billion in 2012-13. The Department is ultimately responsible for securing value for money for this spending. Since April 2013, maternity services have been commissioned by clinical commissioning groups, which are overseen by NHS England. Maternity care is provided by NHS trusts and NHS foundation trusts.

There is confusion around the Department’s policy for maternity services, what it wants to achieve and who is accountable for delivery. Having clear objectives and accountabilities is crucial in a devolved delivery chain like the NHS. Stakeholders told us they were confused as to the current policy objectives and whether Maternity Matters removed the policy framework. In addition, some of the Department’s main objectives for maternity services, such as continuity of care for women by midwives, are described only as aspirations not objectives. The Department and NHS England struggled to articulate to us who is accountable for even the most fundamental areas of maternity care, such as ensuring the NHS has enough midwives. At local level, it is unclear how commissioners are ensuring maternity services meet the Department’s policy objectives, or how they are holding trusts to account. Over a quarter of trusts lacked a simple written service specification with their commissioner last year.

Recommendation: The Department should set out clearly its objectives for maternity care, explicitly stating who is accountable for their implementation and how success against its objectives will be measured.

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