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'Radical' changes to maternity staffing models called for by review

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A national review of maternity services has called for a “more radical” approach to staffing models, in which small groups of midwives take responsibility for a caseload between them to ensure women are looked after by professionals they know.

Teams of four to six midwives based in the community would support the mother, with one midwife taking the lead – who is “ideally” present during labour.

An identified obstetrician would also work with the group and a caseload of around 30 to 40 births per midwife should be expected.

“We want to start with 20% of the workforce first of all providing the ’continuity of carer’ [staffing] model, the next year 40%, then 60% and then 80%”

Julia Cumberlege

NHS England has confirmed that the new model suggested by the review will now be piloted, ahead of its possible adoption across the country. The review panel itself called for national rollout to start in 2018-19, with an annual increase of 20% of births under the new system expected from then onwards.

In addition to this “continuity of carer” model, antenatal and postnatal appointments should both increase on average by around 10 minutes so more time can be spent explaining to women what choices they have in where they give birth and to deliver more personalised care, said the review.

It suggested the move should also help to address the current situation in which around 40% of women do not know any of the midwives who come to visit them at home after birth.

“We’ve been told by midwives they spend 50% of their time filling in data sheets rather than caring for mums so we’ve got to have a transformation in that area”

Cyril Chantler

These changes should be supported by the creation of community “hubs” through which women access different maternity care at one site – such as midwife-led units and smoking cessation services – but can then be transferred from into obstetric units for more specialised care.

Feedback provided as part of the review showed staff had concerns about ensuring continuity of a carer under the current maternity system and without additional resources. They said a large proportion of midwives worked part time which made these types of models more difficult to manage.

But to deliver the new staffing structure across England, a “significant increase in the midwifery workforce is not required”, said the review panel’s report, which was published today.

In modelling the proposed changes to staffing, the panel found increasing the numbers of midwives had only a small impact on the proportion of women who would receive care from a midwife they knew in labour.

“The challenge is likely therefore to be related to moving staff to different models and ensuring their teams have their full complement of staff,” said the report.

When asked by Nursing Times how these changes could be delivered without significantly increasing the size of the midwifery workforce, members of the review panel stressed it was possible to achieve and that reducing paperwork by switching to technology would help free up midwives’ time.

The review’s chair Baroness Julia Cumberlege said: “We need more investment in the time midwives spend with women and we’ve put that in the report.

“We’ve done a lot of work on the modelling and we’ve got the support of the Royal College of Midwives to do this, so we know it’s possible. We’ve set some targets to do it. We want to start with 20% of the workforce first of all providing the continuity of carer model, the next year 40%, then 60% and then 80%.”

Sir Cyril Chantler, vice chair of the review, added: “We mustn’t underestimate the importance of technology. It affects the rest of our lives but has so far had minimal impact on clinical practice.

National maternity review

Review warns of ‘lack of respect’ between maternity staff

Cyril Chantler

“You cannot provide continuity – whether it’s end-of-life care, chronic disease management or maternity care - without an electronic plan and record. We’ve been told by midwives they spend 50% of their time filling in data sheets rather than caring for mums so we’ve got to have a transformation in that area.”

However, at an earlier point during the report launch, Baroness Cumberlege suggested the new staffing model might have the effect of attracting more midwives back into the profession.

She noted that around 2,500 midwives currently registered with the Nursing and Midwifery Council were not in practice – about 10% of the current workforce – which she suggested was for some due to the current lack of autonomy they have in their work.

“We think a lot of those are going to come back into the service - and we need more - and that is another way of attracting them back in,” she said.

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