Midwives are “sick of admiring the problem” in maternity and, instead, want to see continued action to improve the system in which they are working, a top representative of the profession has said.
Gill Walton, chief midwife, chief executive and general secretary of the Royal College of Midwives (RCM), told Nursing Times about the biggest challenges facing the midwifery workforce, and where and how she would like things to change most.
“We’re good at admiring the problem but, actually, we really want solutions”
Gill Walton
Ms Walton, who has led the RCM since 2017, aired frustration and hope about the state of UK midwifery.
She pointed to broadly high satisfaction rates of women in maternity, but acknowledged that repeated reviews, inquiries and scandals were a sign that there was much work to do.
“Even though the landscape looks really negative, there have been some green shoots, which is really encouraging,” she said.
“The task is, of course, to share all of those good things and create an opportunity for development and hope, not keep focusing on the negative and spending loads of money on inquiries.”
Some of these “green shoots”, Ms Walton said, included advancements in care for bereaved families, maternity triage and other safety improvements.
She also noted schemes to improve the continuity of maternity care, preceptorship for newly qualified midwives and the growth of specialist midwives.
Maternity has been under the spotlight for the last decade.
In 2015, Dr Bill Kirkup’s report into mother and baby deaths at University Hospitals of Morecambe Bay NHS Foundation Trust was published.
Further high-profile investigations have since taken place, looking into other troubled maternity wards across the country, including in East Kent and Nottingham, alongside damming reports from the Care Quality Commission (CQC) and from coroners. These have flagged that many of the problems found by Dr Kirkup in 2015 still persist.
Ms Walton said maternity had been struggling long before 2015, but Dr Kirkup’s review brought the problem into the public eye.
She said systemic issues, such as a lack of resources, were a key part of the challenge.
“The system has been failing women and maternity care for a long time. Even when I worked in the NHS as a director, I can’t tell you how many times I used to fight for the resources that I needed to deliver safe care… it always felt like nobody was listening,” she said.
Issues that have been highlighted in reviews, such as midwives not spending enough time listening to women, have weighed heavily on the workforce, according to Ms Walton.
“[Midwives] absolutely are frustrated beyond belief that they can’t provide the care that they know is the right care for women,” she said.
Ms Walton added that the problems were known and felt by all midwives already, and more inquiries were unlikely to be the answer going forward.
“On the whole, people get up and go to work every day, trying their very best in the system that’s failed them,” she said.
She later added: “We don’t need another inquiry, because we know what the problem is.
“What’s the point of spending money on just admiring more of the problem?
“We’re good at that. We’re good at admiring the problem but, actually, we really want solutions.”
The RCM, in July, is due to host a health and safety summit to try to set these solutions in motion.
Among those invited to this event are system leaders and government officials, including health and social care secretary Wes Streeting.
“Midwives absolutely are frustrated beyond belief that they can’t provide the care that they know is the right care for women”
Gill Walton
“Each of the inquiries more or less said the same things… Wes Streeting keeps saying that maternity services keeps him awake at night. I would say he’s obviously not awake enough. We’ve invited him to the summit. Let’s see if he comes,” Ms Walton said.
Addressing disparities in maternity care for minority ethnic women also remains high on the RCM’s agenda, Ms Walton said. She suggested that improving interpretation and translation services could be a beneficial intervention.
Underpinning the maternity crisis is an under-resourced and overstretched workforce, claimed Ms Walton.
She said: “Until we can crack the workforce issues – and it’s not just one – how can time be invested into really thinking about improving the safety of services?”
Improvements to staffing, pay, training and working environments were, she said, “low-hanging fruit” that would drive some of the improvements that the national and local reviews had called for.
Ms Walton said the entire women’s health workforce had to be addressed, noting that shortages of other professionals had led to a dilution of the midwifery role in many settings.
“If I had a magic wand… I’d really want to sort out the whole of the workforce around women,” she said.
“If there are [fewer] sonographers… midwives start doing sonography.
“If there are fewer obstetricians, midwives start moving into some of the things that previously obstetricians did.
“When GPs stop engaging with antenatal care… midwives start doing more antenatal care.
“Where there is less psychological support for women who’ve had traumatic births and there isn’t anybody to refer them to, the midwives start learning how to do that.”
Ms Walton described this as “mad”, and said it meant that fewer midwives were able to perform their core, essential functions.
In addition, she spoke about the importance of properly deploying non-registered support staff.
Recently, the RCM, NHS England, the Royal College of Nursing and the Nursing and Midwifery Council published a position statement against the use of nursing associates in maternity.
Ms Walton said that nursing associates had been deployed in this manner due to a misunderstanding of “the holistic role of the midwife”, and called it “totally inappropriate” for this to be happening in maternity. She said, instead, the midwifery support workforce should be bolstered.
Meanwhile, midwife shortages in some organisations have led to role substitution.
Ms Walton said the practice of nurses being deployed in maternity wards in ways that are outside of their scope of practice was of significant concern to her.
Short of a magic wand, her hopes lie in the current UK Government taking a holistic approach to the NHS workforce crisis. For this to happen, she said midwifery must be both understood and valued at this level of decision making.
“If I had a magic wand, I’d really want to sort out the whole of the workforce around women”
Gill Walton
In 2018, Ms Walton told Nursing Times that one of her priorities was to ensure that midwifery had a stronger voice that was distinct from that of nursing.
Among her demands was a call for there to be directors of midwifery in every NHS trust.
Seven years on, the RCM boss said vast progress had been made in the leadership landscape, although the organisation still wanted consultant midwives in every setting – something that had not yet been achieved.
However, Ms Walton said the progress made was at risk of falling away because of the upcoming dissolution of NHS England, announced in March of this year.
“It actually has got better, but it might get worse with the cuts to NHS England,” she said.
“There are directors of midwifery now everywhere, with heads of midwifery supporting them, with chief midwife and deputy chief midwife posts across the system.
“So we’re relatively pleased with the progress that has been made since [2018].”
However, Ms Walton said the lack of assurance that midwives in policymaking positions, such as the national chief midwifery officer, would be retained worried her.
She aired concern that a disconnect between the profession and decision makers would widen: “My worry is it’s going to get worse… There is no concept of the complexity of birth and the additional things midwives are now doing.”
She said she hoped women’s health, particularly maternity, was high on the agenda in the upcoming NHS 10-year plan and refreshed long-term workforce plan. But, she worried that that might not be the case.
Ms Walton said her cup was “always half full” though, and that she remained optimistic that the government’s three key shifts for the NHS – prevention, community and digital – would be helpful to improving maternity services.
“We feel like we’re in a little bit of a shifting sand moment,” Ms Walton said. “[That] makes us want to speak louder and in a more focused way, to keep everything on the agenda.”
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