The next few years will be tough ones for the NHS and maternity services.
Despite having a ringfenced budget, health spending will nonetheless come under intense pressure as it is asked to find £15bn-20bn in efficiency savings, which are to be reinvested in frontline services.
This is already creating strain on maternity services - many heads of midwifery are being instructed to tighten the purse strings, despite midwife numbers not being high enough to ensure adequate birth:midwife ratios.
Recent research by the Royal College of Midwives indicates that we are still over 3,500 midwives short in England alone and that this affects staff morale and motivation. It also compromises the care we wish to give women and babies.
This has been exacerbated by the seemingly continuous round of reconfigurations and threatened closures of maternity units that we have witnessed in recent years.
‘We will not stand by and watch our members’ hard won conditions be eroded while the service to women and babies suffers. The government should stop these attacks’
Over two thirds of heads of midwifery do not consider their staffing establishment to be adequate for the level of activity undertaken in their trust. This is not just because of the high birth rate - this has risen 19 per cent in the last 10 years, while midwife numbers have increased by only 12 per cent in the same period - but also because of the growing number of complex cases. For example, we have seen an increase in older mothers, an increase in younger mothers and a rise in obesity levels.
These concerns have been expressed at the highest levels in recent years and led to the Maternity Matters policy, which we publicly welcomed. However, there has been great regional variation in its implementation. In any case, it seems to have stalled and we remain 3,500 midwives short.
These shortages have far reaching consequences, not just in terms of stresses and demotivation placed on the remaining workforce but also on the impact on women and their babies. The RCM has often stated that the continuous care provided by a midwife is better for women and their babies and more economically efficient.
Professional support makes women feel calmer, reduces the need for pain relieving drugs, lessens the chance of a medical intervention and avoids costly litigation against the health service. (Claims for compensation by parents run at £1.38bn compared with the total spend in England on maternity services of £1.97bn in 2008-09.)
The three most common causes of children or mothers being injured at birth are: delay following a call for assistance; a busy or heavy workload; and senior staff not being available. All of these issues could be resolved by employing more midwives.
Moreover, attacking the pay and conditions of existing midwives will do nothing to attract more to the profession and the government’s imposition of a two year pay freeze, coupled with changes to their hard earned pension rights, has not gone down well among maternity staff.
We are also beginning to see some trusts attack the centralised pay and conditions of Agenda for Change that have served the NHS so well since 2004. Some trusts are seeking to reduce annual leave and sickness entitlements for new starters and limit progression through the pay scales. This is a retrograde step that will further deter new entrants and the RCM will strongly oppose all of these moves, not least because of their negative impact on patient care.
With regard to pay, we note that the retail price index currently stands at 4.7 per cent and most forecasters do not expect inflation to fall much below 4 per cent until well in to next year. It is simply not fair that dedicated public sector professionals should be asked to pay for an economic crisis that was caused by the greed of bankers - not by midwives.
It is for all of these reasons that the RCM’s Protect Maternity Services campaign will become more visible over the next few months. We will not stand by and watch our members’ hard won conditions be eroded while the service to women and babies suffers. It is time for the government to stop these attacks and address these issues.
All the above must be considered in light of the recent comprehensive spending review. Although we welcome the general commitment to increase health spending in real terms in each year of this parliament and ringfencing the NHS budget in real terms, the rise in the NHS budget is just 0.1 per cent, rising by £10bn from £104bn to £114bn over the next four years.
We expect this to limit the ability of the NHS to expand its maternity workforce, because there will be conflicting cost pressures such as, raising drug costs, an ageing population, an increase in the number of people with long term conditions - for example heart disease and diabetes - and the growth of lifestyle diseases like obesity.
The small rise will not be enough to meet the very real pressures on maternity services caused by the sustained increase in the birth rate and the increasing complexity of many births.
Cathy Warwick CBE is general secretary at the Royal College of Midwives