On 2nd January 2014, as the New Year got underway, an experienced midwife (who has chosen to remain anonymous) wrote an open letter of resignation to the Independent setting out why, in her view, the NHS maternity services have become so stretched and undermined. She lists budgetary constraints as a reason why they are increasingly less able to deliver high-quality care. In some cases this is leading to expectant mothers and their newborn babies being injured unnecessarily (in some cases catastrophically), leading to claims against the NHS for compensation.
What prompted this midwife, who described herself as a ‘loyal and dedicated frontline worker in the NHS for over 10 years’ to take such a radical step?
In her letter she describes how a range of pressures are making the role of midwife more difficult and less safe for patients. Some of these pressures reflect trends in society at large and largely beyond the control of government. For example there has been a 22% rise in the UK birth rate since 2001. Also, mothers are opting to have children later in life which creates additional risk of complication at birth, as does the increasing rate of obesity in pregnant women. Unfortunately however, the government has not chosen to respond to these challenges by investing in NHS maternity services commensurately.
An ideal ratio is 1 midwife for every 28 births per year. Instead, the ratio is currently 1 for every 32.2. According to the Care Quality Commission (CQC), 1 in 7 NHS Trusts providing maternity services do not have enough midwives and it is estimated that another 5,000 midwives need to be recruited. In 2010 the then new coalition government promised to plug the gap in numbers, but to date only 1,278 have joined the NHS due to budget deficits. At current funding levels, this chronic shortage of midwives won’t be alleviated until well into the 2020’s.
In her resignation letter, the midwife describes how this shortfall in staff numbers can mean that individual workloads are becoming unbearable with midwives working for nearly 13 hours without a break and still unable to complete basic but essential tasks to maintain the safety of women and their babies.
In some cases, acute shortages of midwives is even leading to the temporary closures of hospital maternity units such as the Trowbridge Birth Centre in Wiltshire and the Harwich Maternity Unit in Essex, both of which meant that expectant mothers had to travel to other centres at a distance of 13 and 17 miles away respectively.
To a lesser extent, there is also a parallel problem at doctor level, with more than half (53%) of all obstetric units in hospitals not providing the Royal College of Obstetrician and Gynecology’s recommended number of consultants on their wards.
As specialists in clinical negligence, we regularly see what can happen when inappropriate and sub-standard care is delivered to patients. We also recognize that this is often due to staff number shortages. The consequences are often devastating for all those involved.
It is a false economy to think that a failure to fund NHS maternity services appropriately will ultimately result in a saving to the public purse. Mistakes in maternity care account for one third of the £1billion per year that the NHS spends annually on settling personal injury claims for medical negligence. This figure has shot up by 80% in the 5 year period to 2012/13, in part due to staff shortage related negligence claims.
To put this total in perspective, one fifth of all spending on maternity services is now to cover the cost of medical negligence claims alone. As Margaret Hodge exclaimed at the Parliamentary Public Accounts Committee ‘…the system is not working’. However the cause of this problem should be properly attributed to a rising clinical negligence incidence rate caused in part by this lack of funding in NHS maternity services rather than the expense of litigation which injured patients would rather not have to bring but are often forced to through no fault of their own.
More investment is needed in maternity services to deal with the shortfall in staff numbers, prevent demoralization among NHS staff, improve the quality of patient care, and ultimately prevent more patients from becoming injured unnecessarily.