An influential committee of MPs has highlighted a “truly worrying” shortage of midwives and widespread confusion over plans for the future of maternity care.
In a critical report on maternity services in England, published today, the Public Accounts Committee flagged up funding shortfalls and accused the NHS of failing to address ongoing inequalities in maternity services.
While there has been an overall increase in the number of midwives, there was still a shortage of 2,300 midwives needed to meet current birth rates, the report said.
Latest workforce figures revealed last week show the number of registered midwives in the NHS increased by around 1,900 from September 2009 to October 2013.
Yet it was not clear who was actually driving policy around maternity care and in charge of key areas, the committee added, based on the evidence it had heard.
Committee chair Margaret Hodge stated: “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.”
In its report the committee urged the DH to clearly set out its plans for maternity care “explicitly stating who is accountable for their implementation”.
The report – based on evidence from the DH, NHS England, the National Childbirth Trust, the Royal College of Midwives and a consultant obstetrician – cast doubt on whether a new payment framework for maternity would cover the true cost of quality services.
“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 to employ enough midwives and consultants to provide high quality, safe care,” Ms Hodge said.
The creation of more midwife-led birth centres would mean “more could be delivered for less money”, she added.
Other issues highlighted in the report include the spiralling cost of compensation claims for maternity errors, with about £480m – a fifth of trusts’ spending on maternity services – set aside for clinical negligence cover.
The committee said the DH and NHS England needed to address the main causes of claims and investigate variations in performance between trusts to improve services, and ensure “fewer tragic mistakes occur”.
The committee also called for NHS England to take urgent action to address inequalities, including the fact black and ethnic minority mothers were generally less positive about care during labour and birth and were more likely to report lack of choice and continuity of care.
Other recommendations included taking steps to “actively manage” the development of maternity networks, which bring together commissioners, providers and service users to work together to improve services and results.
In its 2007 maternity strategy, the DH recommended the creation of such networks, but a quarter of trusts are still not part of one.
Cathy Warwick, chief executive of the Royal College of Midwives, described the report as “yet another wake-up call” for government.
Professor Cathy Warwick
She said maternity units were often forced to close their doors because of staff shortages, while the “huge” inequalities in care meant some of the most vulnerable women were not getting support.
“It is a concern that no one appears to have ultimate accountability for our nation’s maternity services,” she said.
“The buck has to stop somewhere but, more importantly, someone has got to ensure all areas of maternity care work efficiently and together. I fear at this moment this is simply not the case.”
Responding to the report, ealth minister Dr Dan Poulter said: “We have reversed the historic decline in midwife numbers.
“There are now 1,500 more working in our NHS and we have a record 5,000 in training. But of course there is always much more to do.”
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