All NHS trusts should have a director of midwifery to avoid maternity services getting “lost” within nursing, according to the chief executive and general secretary of the Royal College of Midwives.
In an exclusive interview with Nursing Times to mark her first year at the RCM’s helm, Gill Walton called for every trust board to have both a director of nursing and a director of midwifery.
“Midwifery is not a branch of nursing. Midwives have a completely different area of accountability and responsibility”
She also championed the midwife consultant role in helping to support the wider midwifery team to deliver safe care.
Her comments come as the college prepares to embark on a new campaign next year to promote and develop leadership in midwives.
The college will also use 2019 – which it is hailing the “year of the leader” – to launch a manifesto to raise the profile of midwifery leadership in all areas of policy and practice.
Ms Walton said: “One of the things that we are saying is that every organisation should have a professional lead for nursing, whether they are on a board or not, and a professional lead for midwifery.
“Midwives have so many opportunities now to do all sorts of things in their career”
She told Nursing Times that the two senior roles should they work “alongside each other professionally” and midwives should not be “completely embedded in nursing structures where they get lost”.
“We’ve seen where that happens that those services feel they don’t have a voice and they feel unsafe,” said the RCM leader.
She added: “Part of what we are trying to do in the year of the leader is get those structures right, and also promote the role of the consultant midwife as being the expert, evidence-based practitioner for all services.
“Midwives really need that person in order to help them to deliver the right care and not all services have a consultant midwife,” she said.
While recognising there were cross-overs, Ms Walton stressed that nursing and midwifery were two distinct professions and should be treated as such.
“Midwifery is not a branch of nursing,” she said. “Midwives have a completely different area of accountability and responsibility.
“The analogy that I use is that most nurses deliver prescribed care in a very skilled way along a pathway but the whole pathway is usually owned by somebody else i.e. a doctor, a GP, or consultant, but it’s the other way around in midwifery,” she said. “Every woman has a midwife [and] it is up the midwife the refer to another multi-professional team.
“A midwife may be sitting in that multi-professional team, but it is the midwife who carries that accountability – that is completely different,” she said. “We’ve got a much broader role around public health as well, so that is quite different to lots of nurses.
“I’m not saying there is a complete difference – there is a commonality in our roles of caring, communication,” she said. “There is definitely a thread of things we all do the same, but it would be the same thread as with doctors.
“Part of our year of the leader is to develop a manifesto, if you like, for midwifery which is about making sure midwifery leaders are in the right place right through the whole of the NHS, so they can carry out their roles safely and be recognised that midwifes are different from nurses,” she noted.
Ms Walton qualified as a midwife in 1987 at the Princess Anne Hospital in Southampton. At that time, there was no direct route into the profession, so Ms Walton was required to train in nursing first, which she did at University College Hospital in London.
Ms Walton went on to hold director of midwifery positions in various NHS trusts and has also been involved in education and policy.
She told Nursing Times that if she was reliving her clinical career today she would have liked to have become a midwife consultant – a role that did not exist when she was a practicing.
“Probably if I had my time again… I think I would have loved to have been a consultant midwife because I absolutely loved being a midwife,” Ms Walton said.
“If you wanted to progress or have a broader influence it was only really education and management you could go into,” she said. “Midwives have so many opportunities now to do all sorts of things in their career – it’s got much better since then.”
Ms Walton took over the reins of the RCM in September last year, following the retirement of Professor Cathy Warwick.
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Much of her first year in post has been spent travelling around the UK meeting midwives and maternity support workers, and observing how services differed between the four countries.
Ms Walton said she wanted the RCM to become a “conduit” for the sharing of good practice and ideas between England, Wales, Scotland and Northern Ireland.
“It’s the one thing that has stuck in my mind that we have to share the good practice more than we do,” she said. “If everyone shared all the good practice, maternity services would be perfect.”
“It’s the one thing that has stuck in my mind that we have to share the good practice more than we do”
In early 2018, then health secretary Jeremy Hunt promised to train an extra 3,000 midwives over the next four years.
Ms Walton said she felt the RCM’s warnings about midwife shortages were finally being heeded but added: “We can’t just stop there because all the time we are training more people are retiring.”
The RCM would keep pressure on the government to boost the workforce as promised, Ms Walton said. However, she noted that it was equally important to ensure there were enough of the other staff on the rota who supported midwives in the care of pregnant women and babies.
She said: “If we don’t have enough ultrasonographers for example, midwives start training to do ultrasounds, if you don’t have enough doctors, midwives start doing the things that doctors did.”
Midwives then “worry”, she said, because they are there to ensure women are given safe care and a good experience, but when there are insufficient other staff that responsibility “falls to the midwife”.
Ms Walton also recognised that there was a risk that the extra midwives promised could be offset by the loss of EU midwives over Brexit.
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Latest figures show the number of new midwives from the European Economic Area registering to work in the UK collapsed by 88% from 272 in 2015-16 – before the EU referendum – to just 33 in 2017-18.
At the same time, the number of EEA midwifes leaving the register each year has gone up from 160 in 2015-16 to 213 in 2016-17, peaking at 234 last financial year.
The RCM is supporting the People’s Vote campaign, which is calling for the public to have a say on the final Brexit deal due to concerns that promises made by Leave campaigners were not being kept.
While stating that the college was apolitical, Ms Walton made clear her scepticism about what Brexit would actually deliver for the NHS, following the promises made during the referendum campaign and subsequent political developments.
“There was lots and lots of talk about how the NHS would have lots more money if we left Europe”
For example, during the lead up to the referendum, Brexiteers famously travelled around the country in a bus emblazoned with the slogan: We send the EU £350m a week – let’s fund our NHS instead. But a recent YouGov poll of doctors and nurses revealed that 80% of respondents now believed that this statistic was not true and 83% of those thought it was a deliberate lie.
Ms Walton said: “There was lots and lots of talk about how the NHS would have lots more money if we left Europe. It’s a bit like saying ‘this can happen when you are in labour’, but when they are in labour you give someone different information. It feels similar.”
She said the RCM would be monitoring the official data to understand the impact of Brexit on midwifery services and workforce.
Likewise, Ms Walton said the college would be keeping a close eye on midwifery student numbers following the government’s withdrawal of bursaries in England.
Latest figures provided to Nursing Times by the Universities and Colleges Admissions Service show the number of people applying to student midwifery in the UK has dropped year-on-year since 2013.
In 2017, 9,695 people applied to a midwifery course, a fall from 11,965 in 2016, 12,720 in 2015, 14,095 in 2014, and 15,110 in 2013. In contrast, the data also shows that the number accepted onto courses has gone up, from 2,455 in 2013 to 2,890 in 2017.
However, Ms Walton said the RCM would compare the future application figures in England with Scotland and Wales, and would take action if it could prove the axing of the bursary was having a severe impact. Scotland has recently announced an increase in midwife student bursaries to £10,000 a year and Wales still offers the bursary.
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“If that piece of work shows that there is definitely an issue and we are not recruiting potential midwives into the university places, it would be right for the RCM to look at what we do about that and talk to and influence the right people,” she said.
A key focus of the RCM in the future would be around improving postnatal care and ensuring midwives were using their contacts with women to push public health messages, such as encouraging them to exercise and stop smoking, she added.
“I would like to look back and say, we have directors of midwifery and consultant midwives in every trust”
The RCM also wanted to work in closer partnership with other healthcare organisations that supported women and families, she said. It has recently joined a collaborative network called One Voice involving relevant royal medical colleges and a number of charities.
Asked what she wanted her legacy to look like at the end of her RCM tenure, Ms Walton said: “I would love to be able to say that we have helped midwives and maternity support workers give better care to women because we have done it in partnership with others – that we haven’t just does it on our own as the RCM but we have real synergy with all the other professions that are delivering maternity care.
“I would like to look back and say, we have directors of midwifery at every trust, we have consultant midwives in every trust, we’ve got really clear leadership development in universities for student midwives, and midwives are really well developed and supported all the way through their careers,” she said. “Is that a tall order? I don’t it is. I think it’s achievable.”