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Midwife shortages driving 'reliance' on temporary staff

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Temporary staffing costs in UK maternity units rose to almost £100m last year, according to figures obtained by the Royal College of Midwives.

Trusts spent more than £97m on agency and bank staff and paying overtime in midwifery services, claims the report published today at the start of the RCM’s annual conference in Manchester.

“There needs to be sensible and strategic long-term planning in midwifery”

Jon Skewes

According to the RCM’s calculations, that sum is enough to pay for 2,731 whole-time equivalent, experienced midwives or 4,391 newly-qualified midwives.

The figures were obtained via Freedom of Information (FOI) requests to all NHS organisations with maternity units in the UK, with responses received from 159 trusts – 98.8% of the total.

They show 26 NHS organisations spent over £1m on agency or bank midwives or overtime in 2016 – 24 in England and one each in Scotland and Northern Ireland.

“At the moment too much money is going to employment agencies”

Justin Madders

The FOI request found average hourly spending on an agency midwife was £43.65. The RCM noted that this far exceeded the £18.30 hourly rate earned by a permanently employed midwife with 10 years’ experience working full-time in the NHS.

However, the figures suggest the government’s cap on agency spending in NHS trusts in England that was introduced in autumn 2015 has had some effect.


Map of Britain

Maternity units in England spent about £20.6m on agency midwives in 2016, which is down from about £24.9m in 2015. But the figures show spending on bank staff leapt from just over £43m in 2015 to more than £58m in 2016.

The RCM said the fact maternity units’ reliance on temporary staff was still growing showed the agency cap had not tackled the underlying problem of staff shortages.

Overall, England has seen a 20% increase in the total amount spend on agency, bank and overtime in midwifery from more than £72m in 2015 to more than £87m in 2016.

Other UK countries have also seen substantial spending. The NHS in Wales spent nearly £1.3m on agency, bank and overtime in maternity in 2016, according to the report.

In Scotland, NHS organisations spent about £5.3m on bank staff and overtime – but nothing on agency midwives. Meanwhile, the NHS in Northern Ireland spent £3.2m on bank and overtime – but nothing on agency.

The RCM cited the main reasons for the increase in spending on temporary staffing as ongoing staffing shortages – with an estimated 3,500 more midwives needed – and the cap on NHS pay rises.

It also feared staffing shortages could get worse with the end of the NHS bursary for student midwives, continued uncertainty about the rights of midwives from other European Union countries to remain after Brexit, and problems retaining existing midwives in an increasingly pressured service.

Last year, the RCM carried out research into reasons why midwives left, or were considering leaving, the profession and found 80% said they would stay in midwifery if their pay increased.

Health secretary Jeremy Hunt recently told the Commons that the 1% cap on pay rises for nurses, midwives and other staff on Agenda for Change contracts had now been “scrapped”.

More details on future public sector pay rises are expected in the budget on 22 November, though full clarity may not emerge until the completion of the current pay review body process.

Meanwhile, the RCM described the use of temporary staff to fill permanent vacancies as “counter-productive”.

“There needs to be sensible and strategic long-term planning in midwifery and across the NHS,” said Jon Skewes, the RCM’s director for policy, employment relations and communications.

“It is costing more in the long run to pay agency, bank and overtime than it would if services employed the right numbers of midwives in the first place,” said Mr Skewes.

He re-iterated calls to end pay restraint and “fully fund a pay rise for midwives, maternity workers and other NHS staff”.

Royal College of Midwives

Unions attack ‘ill-informed’ bursary reform plans

Jon Skewes

“This report shows that the vast amounts of money spent on temporary staffing can and should be used to recruit and retain permanent staff and is proof that fair pay for midwives is overdue,” he added.

Labour health spokesman Justin Madders was among those to express concern about the RCM report.

He highlighted Labour Party research, published earlier this year, that showed a rise in the temporary closures of maternity units due to short staffing.

“Ministers must step in with a long-term workforce plan for the NHS and they should put an end to the self-defeating pay cap,” said Mr Madders.

“At the moment too much money is going to employment agencies when it should be going to frontline patient care,” he said.

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