A common factor in all the maternity-related scandals I’ve commented on over the past 10 years or so is staffing. Time after time, staff shortages created by difficulty in recruiting and retaining midwives and early retirement of others have been a regular feature of the reports into why the problems arose in the first place. Now, a report by the Royal College of Midwives underlines the chronic understaffing in some parts of the country by revealing the number of vacancies with some Trusts having to increase their reliance on bank or agency staff. A BBC report describes the individual experience of one midwife who made the difficult decision to leave the profession because of her very real concern that staff shortages will compromise her ability to deliver a safe level of care.
Safety concerns stem from staff shortages
The CQC national maternity inspection programme, which started in July 2022, has repeatedly highlighted safety concerns related directly to staff shortages. By the end of 2023, it had rated 10% of maternity units as inadequate overall (a 4% increase on 2022) and 39% as requiring improvement (6% more than in 2022). In many trusts, poor leadership was pinpointed as the reason for a poor workplace environment which had a direct impact on staffing levels. The RCM report also noted that midwife numbers have not increased at the same rate as the rest of the healthcare workforce and that several maternity units suffered from insufficient obstetric consultant cover as well. There are plenty of examples of the pressures faced by maternity units. In early 2023, a CQC inspection at Leicester Royal Infirmary cited ‘regular understaffing’ as the reason so many red flags were raised in the maternity unit and, more recently, staffing shortages were given as the reason for the temporary closure of the Eastbourne Midwifery Unit and the permanent closure of Pontefract Hospital’s maternity unit.
Inadequate staffing affects every aspect of maternity services: patients do not receive the level of care they need, and the extra shifts staff have to work to cover vacancies or absences takes a mental and physical toll leading to errors. Without supportive leadership, the challenges faced by overstretched staff can quickly become overwhelming leading to more of them leaving the profession.
Mothers have more complex needs
There is also the small matter of patient profile: women are presenting with more complex needs, are increasingly overweight and older, with a larger proportion than ever before needing caesarean sections which, in turn require more nursing. Thrombosis and thromboembolism are the main causes of maternal death as revealed by the latest data presented by MBRRACE-UK (part of an Oxford University multi-disciplinary research unit concerned with maternal and neonatal health). The figures show that maternal deaths (excluding covid-related deaths) increased by 3.64% between 2020–2022 and 2017–2019. The data also shows that the maternal deathrate among women from ethnic backgrounds and those from deprived areas, although slightly reduced, remain noticeably higher than their white contemporaries or those from less deprived areas. There are various factors at play here - and not just staff shortages - but high-risk pregnancies need one-to-one care which is difficult to manage when maternity units are permanently short-staffed.
Maternity errors account for highest payouts
Maternity-related errors continue to account for the majority of negligence-related payments against hospitals so any improvement in outcome will avoid the need for costly litigation. Nonetheless, the elephant in the room, that of staff shortages, shows no sign of departing and unless, and until, there are enough midwives to deliver the compassionate, personalised care envisaged by the NHS Maternity and Neonatal Programme, the tragedy of maternal and neonatal deaths and stillbirth will continue.
I have advised many families on the poor maternity care they have received at various hospitals, including Shrewsbury and Nottingham. If you have any concerns about the standard of maternity care you or a member of your family have received, please call me for a confidential chat to see if we can help.
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