The number of NHS midwives has increased in England over recent years but many trusts are still failing to meet safe staffing ratios, according to the National Audit Office.
In a report, published today, it said maternity services provided good outcomes and experiences for most women, but there are significant variations in performance across the country.
It noted that there had been an increase in midwifery-led units, consultant presence on labour wards and midwife numbers since the government’s 2007 Maternity Matters strategy.
The number of midwives has risen by 12% since the start of the strategy, the report stated. Nationally, there were 21,132 full-time equivalent midwives, on average, in 2012.
But it warned the NHS was not meeting a widely recognised benchmark of one midwife to 29.5 births and rates of complications and medical interventions varied widely between trusts.
Ministers have funded more midwife training places, but the NAO said it was “unclear” whether these would be sufficient to meet future demand. Meeting the benchmark would require around 2,300 additional midwives.
Meanwhile, it noted there were 152 midwifery-led units in June 2013, an increase from 87 in April 2007. Nearly 80% of women were now within a 30-minute drive of both an obstetric and midwifery-led unit.
But the NAO warned that choice was restricted by units closing due to a lack of space or midwives. Over a quarter closed for half a day or more between April and September last year, the NAO found.
Royal College of Midwives chief executive Cathy Warwick said the NAO report “vindicates” what the college had been saying for a “very long time”.
“We are many thousands of midwives short of the number needed to deliver safe, high quality care,” she said.
“There has been an increase in the number of midwives in training, but it is not enough,” she added. “When midwives do finish their training they are struggling to find jobs.”
She called on the government and trusts to take a “good, hard look” at the NAO report and “act upon it”.
The NAO report was particularly critical of the government, arguing that the Department of Health did not fully consider the implications of delivering the ambitions set out in its maternity strategy.
The report accused the DH of failing to demonstrate that it satisfactorily considered the “achievability and affordability” of implementing the strategy, and had not monitored national progress against it – regularly or comprehensively.
Amyas Morse, head of the National Audit Office, said: “The department’s implementation of its strategy has not matched its ambition.
“Our findings on how services are being managed, demonstrate there is substantial scope for further improvement.”
The report also highlighted the growing financial cost of maternity services and noted that trusts paid £482m for clinical negligence cover in 2012-13, equating to around a fifth of spending on maternity services.
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