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College publishes guidance to get midwife staffing ‘right’

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Midwives’ role should not be extended into obstetrics or nursing to compensate for staffing shortages, according to new workforce guidance issued by the Royal College of Midwives.

The document, which outlines how midwifery services should be organised and funded, also says there is no need for the creation of advanced practitioner roles in midwifery.

“Getting the right staffing levels and skill mix in can be a difficult and frustrating process”

Cathy Warwick

It was published alongside new RCM guidance on meeting safe staffing requirement, with both documents highlighting the challenges facing the profession, including an ongoing lack of midwives.

Financial constraints on trusts have led to disjointed antenatal care, poor quality post-natal support and insufficient specialist care and placed huge pressure on the maternity workforce, warned the RCM.

However, the college made it clear that these issues cannot be solved by getting midwives to take on even more.

Shortages of junior doctors have prompted discussion of new advanced midwifery roles, noted the workforce guidance.

But the RCM said it had looked into the concept and found it “wanting”. The role of consultant midwife already existed to provide clinical expertise and leadership, it argued.

“What most maternity services need is not another new advanced practitioner role but more consultant midwives,” said the guidance. “Further, we cannot see how midwives can generally take on medical roles without placing safety at risk.”

Moving midwives into more medical roles would further deplete the midwifery workforce, which is already 3,500 midwives short, according to the RCM.

“We are also concerned that posts and roles are being proposed without any plan for either their sustainability or the forward career progression of individuals,” says the guidance.

“It is not acceptable to permanently alter midwifery roles to compensate for staffing shortages”

RCM guidance

While midwives may develop additional skills that benefit women including perineal repair, cannulation and examination of newborn babies, the Getting the Midwifery Workforce Right publication urges against the extension of midwives’ role into obstetric, nursing or other spheres of practice simply to plug gaps.

“Whilst the RCM accepts that NHS organisations wish to maximise the flexibility of their workforce, it is not acceptable to permanently alter midwifery roles to compensate for staffing shortages or changes in doctors’ roles – for example, by routinely requiring midwives to assist in caesarean sections,” stated the document.

It also argued against expanding the proposed nurse associate role to midwifery, calling instead for more support for midwifery support workers (MSWs), noting that they currently lack clear training standards, job descriptions and career progression.

“Rather than create a new role, we would propose that NHS energy and commitment is given instead to properly developing and supporting the MSW workforce,” said the guidance.

“This would not only increase their productivity and contribution, but would also demonstrate a real commitment to developing this element of the NHS workforce,” it added

Meanwhile, the separate safe staffing guidance said developing the MSW role and ensuring support workers were trained and deployed appropriately was one way to maximise workforce capacity.

The document is designed to support senior midwives and NHS managers to implement midwifery staffing guidance issued by the National Institute for Health and Care Excellence, covering topics such as setting establishments, rostering, and dealing with sudden changes in demand.

The NICE guidance includes a process for calculating the midwifery establishment, but the RCM advised maternity chiefs to use the Birthrate Plus tool instead.

“The RCM view is that Birthrate Plus provides a more robust and proven methodology for determining midwifery staffing establishments,” said the college document.

When it comes to dealing with unexpected changes in staffing, the guidance recommends following in the footsteps of Kingston Hospital NHS Foundation Trust.

It allocates a senior midwife to each shift solely responsible for operational issues. This approach has led to a reduction in “red flag” events, highlighted the guidance.

Professor Cathy Warwick

Professor Cathy Warwick

Cathy Warwick

RCM chief executive Cathy Warwick said the two documents (see PDFs attached below) could help midwives make a case for more staffing and funding.

“Getting the right staffing levels and skill mix in can be a difficult and frustrating process,” she said. “This is particularly relevant, as many senior midwives face increasing demands and often diminishing resources and staffing.

“I am sure these publications will help senior midwives and other NHS managers to apply rigorous procedures for getting the best possible levels of care from available resources,” she said. “They may also help them to make a case for increases in staffing and funding.”

She added: “There are tools and guidelines for trusts to calculate the needs of maternity services, and we would expect trusts to use them and staff services accordingly.”

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