Midwives in the NHS

Andrea Leadsom Excerpts

Monday 17th January 2022 Commons Chamber

[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.