Midwives in the NHS
(2 years, 11 months ago)
Commons ChamberRead Hansard Text Read Debate Ministerial Extracts
Siobhan Baillie (Stroud) (Con)
In late November, midwives, doulas, families and healthcare professionals across the country marched in their thousands. They powerfully set out their concerns about the issues they face, and 100,000 people signed a petition to ensure their voices are heard. It is both a privilege and a daunting prospect to be standing here to try to represent their views.
Before I continue, I declare an interest. I am pregnant and, although I was hoping people would think I had eaten too much Christmas trifle, I realise I am now struggling to hide the bump. God willing, there will be a summer bundle of joy to give me additional sleepless nights over and above the ones that are normal for an MP. This makes me a current case study for maternity services, with literal skin, blood and placenta in the game.
So far, I am one of the lucky ones. The service I received from the Stroud and Gloucestershire midwifery teams during my first pregnancy was world class. It is testament to Gloucestershire’s commitment to local expectant mothers that I not only received consistent care during my first pregnancy but I have the same midwife again. I thank them all, and Jan Partridge in particular. Her name should be enshrined in Hansard, as she is a legend not only in my household but in many others around my community. I know parents across the country feel the same about their own midwifery teams for their help during one of the most frightening, painful but special moments of life.
I stood on a manifesto promising to make the UK the best place in the world to give birth, with personal, high-quality support. I sincerely hope that we can make that a reality. The March with Midwives manifesto sets out demands, which include: listen—they seek an urgent consultation to understand the steps required to address the immediate crisis; fund—an immediate appropriate restorative pay rise for midwives and financial support for student midwives; enable—to make it possible for self-employed midwives to work, thus putting 250 experienced midwives immediately back into the workforce and providing flexibility; and reduce—provide a £5 million crisis fund to charitable organisations for the provision of breastfeeding support and antenatal education, to reduce the pressure on midwifery staff.
The manifesto is wide-ranging, but it does highlight a number of important concerns. All the briefings that I have been sent and everything I have read indicate that many things lead back to staffing levels.
Jim Shannon (Strangford) (DUP)
I commend the hon. Lady for securing this debate; the number of MPs here is an indication of its importance.
In the Royal College of Midwives annual survey, over half the midwives surveyed said they were considering leaving their jobs. Fifty per cent. said they would leave the NHS next year. Of those who were leaving, eight out of 10 said that they were concerned about staffing levels—the very thing that the hon. Lady has referred to—and that they were not satisfied with the quality of care that they were delivering.
Does the hon. Lady agree that urgent action must be taken today to support those midwives considering leaving the NHS, so that they feel able to do their jobs to the best of their ability?
Siobhan Baillie
I thank the hon. Gentleman for his intervention. Staffing issues are absolutely crucial and I want to pose a number of questions about them.
Jeremy Hunt (South West Surrey) (Con)
I congratulate my hon. Friend on securing this debate and on the forthcoming addition to her family.
On the point made by the hon. Member for Strangford (Jim Shannon) about staffing levels, does she agree that one of the most important reasons why we need to fill the staffing shortfalls—the 2,000 extra midwives needed immediately—is that we need to be better at identifying higher-risk pregnancies? Continuity of care, so that people are looked after by the same midwife throughout the pre-natal, birthing and post-natal periods, is an incredibly effective way to do that.
Siobhan Baillie
I could not agree more with both interventions. I think we are going to hear more from other Members about continuity of care, which is the way to manage pregnancy and how most midwives want to work. But that can be achieved in many hospitals and many midwife teams only if we have the staffing. Given the numbers at the moment, this is a key issue.
Rachael Maskell (York Central) (Lab/Co-op)
I am grateful to the hon. Member for securing today’s debate and also wish her well with her pregnancy.
I have spoken to midwives in York and visited maternity services. Many women find that they are diverted from York to other maternity services at the time of delivery—clearly, very stressful for them—because we just do not have adequate staffing. Does the hon. Member not agree that we need a proper workforce plan to ensure that women have the safety that they require through their pregnancy and particularly at the time of birth?
Siobhan Baillie
I think what we will hear from the Government is that there is a plan for recruitment, but we need more details. The Royal College of Midwives is certainly asking questions. My right hon. Friend the Member for South West Surrey (Jeremy Hunt) knows from the work of the Health and Social Care Committee that when the current Culture Secretary was maternity services Minister last year, she was incredibly passionate about this issue. She accepted that the NHS was short of the equivalent of 1,932 full-time midwives—but since then, sadly, the number has fallen by a further 222, leaving the shortage at over 2,000. Since records began in 2009, the number of NHS midwives has fallen in England year on year. We are in a really difficult situation at the moment.
To put this into perspective, there were more than 613,000 births in England and Wales in 2020. At the last count of midwives in 2021, there were 26,901 in England, but that drops to 22,301 if we look at part-time figures. By looking at the birth rate and the number of midwives, we can see just how stretched midwives are.
The Association for Improvements in Maternity Services says that
“urgent action is certainly needed to shore up what seems to be a maternity service that is losing staff at a catastrophic rate.”
Over half of midwives surveyed by the Royal College of Midwives say they are considering leaving their job. I know personally a wonderful midwife, Stevie, who has chosen to retire this year, and I wonder how many midwives are making the same choice. My mother, who is a nurse, not a midwife, is choosing to retire as well. They have had a pretty tough two years in the NHS, as we know, but the most worrying feature of the RCM survey, which the hon. Member for Strangford (Jim Shannon) mentioned, is that the highest levels of dissatisfaction are among newer midwives—those who have spent five years or less working in the NHS. So we have a pipeline problem, a new intake problem and a problem with retention of experienced staff.
Dame Andrea Leadsom (South Northamptonshire) (Con)
I congratulate my hon. Friend on getting this important debate, and on the part she has played in looking at the best start in life for every baby, which we worked on together over many months. Does she agree that the problems not only for midwives but for the whole early years workforce have been exacerbated by the covid lockdown, with far too many families unable to see their health workers face to face and partners often excluded from important events such as scans and the birth itself?
Siobhan Baillie
I could not agree more, and I thank my right hon. Friend for everything she has done for early years provision. When we think about the early years and the importance of giving children the best start in life, we remember that midwives have children in their hands at year zero; it could not be any earlier than that. I will give more details of the reality of the pandemic world and what midwives and NHS staff have faced, but the effect on the beginning of the relationships and the fear when you do not have your partner with you in the ward has been absolutely awful. I appeal to all Ministers to think extremely carefully about further covid restrictions, if they ever again become necessary.
We know that the staffing shortage does not affect only midwives and hospital staff, but it has a real impact on families trying to bring new life into the world. As the hon. Member for Strangford alluded to, 87% of RCM members say that they delay using the toilet due to lack of time, more than 75% skip meals, and over half say they feel dehydrated most or all of the time at work—no doubt telling women to hydrate while unable to do so themselves. These professionals have the lives of our most precious loved ones in their hands. I ask the House: are those really the conditions we want them to be experiencing?
I have had messages from midwives all over the country. Last year, I received a letter from a former midwife saying that she was
“extremely concerned about the deepening crisis within maternity care.”
She handed in her notice. That is a loss of more than 10 years’ experience in clinical midwifery—experience that we cannot magic up overnight to replace her. She felt that she could not always provide the good, kind midwifery care that she was trained to give. She cited increasing paperwork, long hours and the inability to work hours that fitted around her family as key concerns. She had begun dreading each shift. Being required to work faster and do more than was humanly possible meant fearing making a mistake that could lead to a tragic outcome.
Another midwife wrote a blog entitled, “How do we keep going when there is nothing left to give?” in which she talks about midwifery being a celebration of new life and how midwives get to share the joy of families starting out, but also how they are struggling in a system that does not allow them to do what they dreamed of, trained for and worked so hard for. With no staff available or even in the pipeline, the midwife describes having to close facilities, reduce antenatal education, and minimise post-natal visits. Another midwife talks about trusts having to introduce incentive payments, selling back annual leave and employing agency staff, but even then staff are declining the extra work because they are so cream-crackered and feel constantly stressed that the money just does not get them over the line.
Maternity staff are all incredibly caring human beings and they want to do a good job. They tell me they can recover from the physical strain of their job each day, but the mental anguish is weighing heavier and heavier. That mental strain is very real, as problems and errors in maternity services can have devastating consequences.
Although outcomes for mothers and babies have improved in so many areas in the last 10 years, any loss is too great. Understandably, the families affected cannot rest until they have knowledge of what happened and believe that it will not happen again. My heart breaks for them and, if I am honest, I will struggle to tell their stories without crying.
Birthrights is a UK charity that provides advice and information on legal rights, and trains doctors and midwives. The Ockenden review, which looked at maternity services, took serious evidence following the devastating loss at the Shrewsbury and Telford Hospital, and I know that the Health and Social Care Committee has also investigated maternity. Approximately 59%—about £4.2 billion—of the value of new clinical negligence claims is attributable to poor maternity care. In 2021, maternal mortality rates were found to be more than four times higher for black women, two times higher for mixed-ethnicity women and almost twice as high for Asian women. There is clearly so much more that we need to learn and change.
I know that this is issue is close to the hearts of many across this House. Between them, the Prime Minister and the Leader of the House boast a lot of experience of births, and the Minister is an excellent person to be responding given her own professional experience. The Government have made two important commitments: the first is to train 3,650 student midwives over four years, starting in 2019-20, and the second is to employ an additional 1,200 midwives. Obviously, that is hugely welcome, but given the seriousness of the situation and the fact that midwives are taking to the streets, I ask the Minister to update us on any progress and explain the recent decline in the number of midwives.
Peter Gibson (Darlington) (Con)
I congratulate my hon. Friend not only on her pregnancy, but on securing the debate. As the son of a community midwife, I know how hard our midwives work. The issues that she is outlining are not just about recruitment, but about retention. Does she have any ideas on how we can tackle that retention issue, too?
Siobhan Baillie
It would be interesting to hear from the Minister on that. Midwives and some of the marchers have suggested talking about financial payments, but there also needs to be a culture shift. If we are asking midwives to do things that they desperately want to do, such as the continuity of care, but they do not have the staff teams to do them, they will feel as though they are failing. No money in the world will make that any better. Working together constantly and joined-up thinking are important to help that retention. I pay tribute to my hon. Friend’s mother.
I have some questions for the Minister. How many midwives are currently in training and recruitment? Why are babies not counted in the patient headcount to determine staff ratios? What measures, such as flexible working, are being considered to make the profession more attractive to those who have caring responsibilities or who are choosing a second career? Are we looking at salaries and financial support for students?
The issues that midwives face are incredibly complex, and as my hon. Friend the Member for Darlington (Peter Gibson) said, it is not just about staff. Midwives tell me that, without proper administrative support to reduce their huge non-clinical workload, they feel they are drowning in their jobs. The Association for Improvements in Maternity Services says that midwifery is a service that seems unable to support its own staff, including precious newly qualified members, with frequent reports of bullying. That is incredibly worrying. In England, that cultural problem was a key focus of the “Better Births” report in 2016, and it is an issue that the ongoing maternity transformation programme has been working to address.
The pandemic restrictions, which my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom) mentioned, caused huge problems for mothers and partners. Mothers are now so scared that the restrictions will come back.
Shaun Bailey (West Bromwich West) (Con)
Further to the intervention from our right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), I am sure my hon. Friend will be aware that, contrary to NHS guidance, my own NHS trust, Sandwell and West Birmingham, stopped allowing birthing partners to be with expectant mothers. We managed to get that decision overturned, but just to re-emphasise the point, does my hon. Friend agree that birthing partners form an important partnership with midwives in ensuring that the safety of expectant mothers is paramount in the delivery process? I am sure she will expand on that later in her speech.
Siobhan Baillie
I thank my hon. Friend for all the campaigning that he has done—as has my hon. Friend the Member for Rutland and Melton (Alicia Kearns), who is not in the Chamber this evening—and he is absolutely right. Birthing partners not only provide that immediate bond and that precious time with the baby; they provide support for the mother and support for the team, and have the important ability to spot what is going on. A mother who is taking quite a lot of gas and air might need someone else to have a couple of conversations when she cannot do so herself.
We are making changes in schools so that we do not see restrictions and closures again, and I think that if we are ever faced with the need to introduce further covid restrictions, we cannot do that in maternity services. The restrictions have had a knock-on impact on midwives as well: seven out of 10 RCM members have experienced abuse about visiting restrictions. That abuse may well have come from very worried and well-meaning people, but there is no doubt that it has contributed to their wish to leave their jobs.
The campaign group Pregnant Then Screwed did a great deal of work on this, and 98% of respondents to its survey said that the possibility of further covid restrictions on maternity services was causing them anxiety. There is enough for pregnant women to be worried about without their having to worry about that. Mothers reported rushing their hospital care during the pandemic, and seeking early discharge so that they could get home to be with their partners. As was mentioned earlier by my right hon. Friend the Member for South West Surrey, women-centred care is the ethos of midwifery. and continuity of carer is the national recommendation. It is the right approach, but at no stage have the current staffing levels and the impact of covid been taken into account to assess the viability of a new system. The vaccine mandate continues to cause concern, and the potential loss of more staff is adding to the pressure-cooker effect.
We in Stroud are hugely proud of the facilities that we have. In the past, Stroud constituents have come together and fought to save the maternity unit, and that fight was so strong that I do not think anyone would dare to try to close it down again. We have also recently instigated an important campaign to deal with mental health and birth trauma. Between 25% and 40% of women view their experience of giving birth as traumatic—I am probably in there somewhere—and one in four have experienced sexual abuse. Such issues often have a huge impact on fears for pregnancies and future births. The campaign and the dedicated mental health team that Gloucestershire is setting up will change perceptions and conversations surrounding birth from the off. Our minor injuries unit across the road from the maternity unit has received a welcome £2 million for refurbishment purposes. I was at the hospital recently for my scan, and it is really buzzing. Although I have raised some serious matters, I do not want expectant mums to be worried about the care that they will receive at Stroud or anywhere else, as professional maternity teams will look after all of them.
One midwife told me that midwives do not speak out because they are always trying to put the women in their charge at ease, but unfortunately it has reached the point at which they feel that they must do so, which is why they have sent me here today. That said, although a Minister will respond tonight, the issues raised are clearly not just for the Government to address. NHS trusts, their human resources teams, managers, and all of us as patients in society need to think about how we behave, how we use the NHS, and how we can improve it. Making the NHS a political football, claiming that more and more money is the only way to fix issues, or putting the NHS on a pedestal so that there can be no criticism or open scrutiny, will not help a single midwife in this great country. I believe that the men and women of our maternity services deserve better. They literally hold new life in their hands, along with all the hopes, dreams and responsibilities that come with that job.
I leave the final words to a midwife who told me:
“I love my job. I love supporting women and the team. But I too feel that maybe this is as far as I can go. I have never suffered with mental health concerns prior to this last year. Anxiety has crept into my normally happy life due to work issues.”
I think that that is quite a stark way in which to end the debate, and I genuinely think that we can do better. I look forward to hearing from the Minister, who I know cares deeply about this issue, and I am grateful for the time that I have been allowed tonight.
Mr Deputy Speaker (Mr Nigel Evans)
The hon. Member for Stroud (Siobhan Baillie) and the Minister have agreed that Taiwo Owatemi may make a short contribution. I ask her please to allow the Minister some time to sum up.
Taiwo Owatemi (Coventry North West) (Lab)
Thank you, Mr Deputy Speaker; I will be very brief. I thank the hon. Member for Stroud (Siobhan Baillie) for securing this important debate and wish her well with her pregnancy.
We in Parliament have been talking about the issues that midwives face and their working conditions for quite a while now, and they were discussed just last year in a Health and Social Care Committee report on maternity health. As a member of that Committee, I have two simple points to make.
The first is about NHS staff shortages, which have affected many midwives in this country and which our Committee has been looking at for a while. Our report last year clearly shows the severe staff and resource shortages that have affected the NHS and midwives specifically. According to the Royal College of Midwives, just 4,773 midwives have joined the register since 2019. The number of midwives working for the NHS in England has actually reduced: the full-time equivalent numbers have gone down by 125. The demand for midwives has not decreased, and nor has the supply of registered midwives, but the number of midwives in the NHS has done so. As many hon. Members have said, it is important that the Government do more to ensure that fully certified midwives get the much-needed jobs and fill up the spaces in the NHS.
I will move on to my second point, because I am aware of time. As a result of the lack of resources and staff, midwives are suffering under terrible working conditions. Midwives across the country have stated that they are not getting loo breaks, that they do not have time to eat lunch and that they are working on minimal sleep. That is really concerning, particularly because it can affect patient care. It is common sense that mothers and their babies in my constituency of Coventry North West will suffer if midwives are being overworked and under-resourced. It is vital that the Government do as much as possible to ensure that midwives are not placed in that situation or in impossible working conditions. It is time that we fixed these burdensome circumstances and that the Government provided resources for midwives.
Finally, I thank all the wonderful, hard-working midwives at Coventry and Warwickshire Partnership NHS Trust for all the work that they do despite the current working conditions.
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
I thank my hon. Friend the Member for Stroud (Siobhan Baillie) for securing this debate and wish her well with her “vested interest” and her pregnancy. I am sure that her experience with her midwife, Jan Partridge, will be positive.
I want to thank all midwives and maternity teams up and down the country. For the past 18 months to two years, they have gone above and beyond their duty. I have visited maternity units, spoken to midwives and heard how difficult it has been, particularly with covid. Being on a maternity ward, particularly a labour ward, is a busy enough experience anyway, but if there are women there with covid, the added infection control measures bring extra pressures. With staff isolating and being off sick, it has been an incredibly busy time, and I have heard at first hand many of the experiences that my hon. Friend raises.
I say to midwives that I fully recognise the pressure that they are under. Sometimes there are not enough staff on the wards, and they are dealing with more complex cases. I hate to use the term “geriatric women”, but we are seeing women becoming pregnant much later in life, with the risks and complications that that brings. We are also seeing babies being born much earlier. The expertise and skills that a midwife brings to those situations mean that we all see the incredible work that they do.
There are three areas that I think we need to address. The first is staff numbers, an issue that the hon. Members for York Central (Rachael Maskell) and for Coventry North West (Taiwo Owatemi) and my hon. Friend the Member for Stroud all raised. I reassure hon. Members that we are trying to get on top of staffing levels. Health Education England undertook a survey based on the Birthrate Plus midwifery workforce planning tool to assess the numbers of current midwives in post, current funded posts and recommended funded posts to try to bridge the gaps between the three. Following that, NHS England invested £95 million to support the recruitment of 1,200 more midwives and 100 more obstetricians and to support multidisciplinary teamwork. There is also £450,000 for a new workforce planning tool at a local level, so that maternity units can calculate their own staffing level requirements.
We are trying to increase the number of midwives in practice. Returners are being encouraged to join Health Education England’s Return to Practice programme, where a payment of £5,000 is given to employers to support returners. Funding is given to the students to pay for their fees and their Nursing and Midwifery Council tests of competence, and they get a stipend while they are learning.
My hon. Friend is right about new students. We have increased student training places to 3,650. We are also recruiting from overseas. Early this year, we are advertising and interviewing for between 300 and 500 overseas midwives to join the NHS in the next 12 months. We are also recruiting extra maternity support workers to support the work of midwives.
We are also trying to improve the environment and to bring in a positive working culture. Some £52 million has been brought in to accelerate the digital maternity programme, so that the burdensome paperwork and paper records that midwives are having to work with will hopefully come to an end. Improving that documentation will improve the outcomes for mums and babies, too.
There is so little time to express how much we are doing. We are trying to bring in a positive working culture; it is not right that midwives are having to go without toilet breaks or are unable to drink during shifts. That is completely unacceptable, and it creates a vicious circle: because working conditions are so tough at the moment, we are losing experienced midwives, which makes trying to recruit and retain more staff even more difficult.
The debate we have had this evening is just the start, and I want to work with Members across the House to ensure that we support midwives as much as we can. We are serious about increasing staffing numbers and improving the working environment for midwives, because that is how we improve the safety of maternity care.
Mr Deputy Speaker (Mr Nigel Evans)
The Speaker and his team send their congratulations to the hon. Member for Stroud (Siobhan Baillie).
Question put and agreed to.