Royal College of Midwives Briefing

Royal College of Midwives briefing

“Maternity and Midwifery Services” debate

Westminster Hall Debate

House of Commons

Wednesday 2nd May 2007

2.30pm-4pm

Now is a good time to be debating maternity and midwifery services:

• 30 April-5 May is Midwifery Week ()
• The latest midwifery staffing figures were published last Thursday
• Maternity Matters, the Government’s strategy, has only just been published

RCM position in a sentence

Ambitious guarantees have been made that England will have a first-class NHS maternity service by the end of 2009, but action is needed now to reverse the trend towards a shrinking maternity service and midwifery workforce.

Headline facts

• The guarantees the Government has made about England’s NHS maternity services are ambitious, and that is commendable. It is also commendable that we have guarantees, rather than just targets or aspirations. “Guarantee” has an unambiguous meaning.

• England needs the equivalent of 22,000 full-time midwives to deliver these guarantees.

• The share of the NHS budget spent on maternity services is falling, not rising; the proportion of the NHS workforce made up of midwives is falling, not rising; the number of places for student midwives is falling, not rising; the headcount number of midwives is falling, not rising; the full-time-equivalent number of midwives is falling, not rising… the only thing that is rising is the number of births!

Maternity Matters and its guarantees

The Department of Health launched its new maternity services strategy, Maternity Matters, on 3rd April. The Royal College of Midwives happily congratulated the Government then, and we happily congratulate the Government now. It is an excellent document.

Maternity Matters guarantees that by the end of 2009, women will enjoy:

• choice of how to access maternity care, women will be able to go directly to a midwife or via a doctor
• choice of type of antenatal care – women will be able to choose between midwifery care or care led by both doctors and midwives
• choice of place of birth – depending on their medical history and circumstances, women and their partners will be able to choose between home births, or giving birth in a midwifery unit or with midwives and doctors in hospital
• choice of place of postnatal care – women will be able to chose how and where to access postnatal care

As stated above, the terminology used by the Government is important.

These are not aspirations – people may aspire to many things, but their aspirations can easily go unrealised.

These are not targets – people aim for targets, but they can miss them.

These are guarantees. That word has an unambiguous meaning. Guarantees are notnegotiable. They have to be honoured.

England’s NHS needs 22,000 full-time midwives to deliver Maternity Matters

To deliver Maternity Matters we need the equivalent of 22,000 full-time midwives in England’s NHS. At the last count (as at 30 September 2006)[1], the NHS in England employed the equivalent of 18,862full-time midwives – a shortfall of over 3,000 on where we need to deliver the plan. What is worse is that figure actually fell on the year before.

The Royal College of Midwives is realistic about how quickly more midwives can be brought into NHS practice and so we believe that we should aim for the equivalent of at least 20,000 full-time midwives in NHS practice in England by the time of the annual workforce snapshot in 2009, rising to at least 22,000 midwives by 2012.

This, the Royal College of Midwives believes, is a realistic midwifery staffing target and a realistic timeframe of several years within which to achieve that target. In addition to these 2009 and 2012 milestones however we will want to see steady progress throughout this period – however the latest midwifery workforce, published after the launch of Maternity Matters, showed a fall in midwife numbers.

We are of course aware that the Department of Health does not wish to sign up to a midwifery workforce target. Nevertheless we have calculated that the NHS in England will need the equivalent of at least this many full-time midwives to deliver Maternity Matters. If the annual workforce survey in any given year reveals that we have fewer in post then we will know that Maternity Matters is not being delivered – and if it shows a fall, as the latest figures for 2006 have done, then that certainly is not moving us in the right direction.

The statistics are moving in the wrong direction

i) Maternity services share of NHS resources is falling, not rising

The proportion of the NHS workforce represented by midwives has dropped from 2.1% in 1997 to 1.7% in 2005[2].

The share of the NHS budget spent on maternity services, which stood at 3.1% in 1997/98, has subsequently dropped to 2.2% in 2005/06[3].

ii) The number of places for student midwives is falling, not rising

There were 2,374 NHS midwifery training places commissioned in 2004/05, this dropped to 2,220 in 2005/06, and the forecast is that in 2006/07 there will be 2,071 (this figure is yet to be finalised)[4]. That is a drop of 303 places (or 13%) in just two years.

iii) Midwife numbers are falling, not rising

In 1997, there were the equivalent of 18,053 full-time midwives in the NHS in England, by 2006 this had risen to just 18,862: a rise of just 809 (or 4½%) in nine years. What is worse is that it actually fell at the last count – down the equivalent of 87 full-time midwives on the year before[5].

Put simply, we need the equivalent of 22,000 full-time midwives and we need to get there quickly. To get to that figure we need the number of midwives to go up, not down.

The full-time-equivalent figure is the Government’s preferred system of measurement. The Royal College of Midwives has now adopted this system too, which takes into account the large increase in part-time working.

The other system of measurement, headcount, does not differentiate between a midwife who works one day a week and a midwife who works full-time. In any event, the headcount figure has now dropped two years in a row – in 2005 and 2006 – leaving the headcount number of midwives working in the NHS in England down 375 between 2004 and 2006.

Whichever way we count the number of midwives working in the NHS in England, headcount or whole-time-equivalent, the number is falling, not rising. That does not help us get to where we need to be.

The table below shows how the figures compare, by region, between the snapshots taken on 30 September 2005 and 30 September 2006.

The figures for 2005 relate to Government Office Region and for 2006 to Strategic Health Authority, which explains why the South East’s figures are demerged in 2006 – there are two Strategic Health Authorities in England’s South East region.

REGION / 2006 headcount / 2005 headcount / +/- / 2006 full-time-equivalent / 2005 full-time-equivalent / +/-
North East / 1,276 / 1,274 / +2 / 1,003 / 1,011 / -8
North West / 3,959 / 3,887 / +72 / 3,138 / 3,094 / +44
Yorkshire & the Humber / 2,445 / 2,539 / -94 / 1,906 / 2,047 / -141
East Midlands / 1,704 / 1,757 / -53 / 1,294 / 1,310 / -16
West Midlands / 2,770 / 2,816 / -46 / 2,092 / 2,123 / -31
East of England / 2,328 / 2,352 / -24 / 1,742 / 1,725 / +17
London / 4,307 / 4,338 / -31 / 3,442 / 3,326 / +116
South East Coast / 1,760 / 3,423 / -113 / 1,325 / 2,506 / -36
South Central / 1,550 / 1,145
South West / 2,370 / 2,422 / -52 / 1,774 / 1,806 / -32

iv) The only thing that is rising is the number of births!

Despite the falling number of midwives, the number of live births taking place in England each year is on the up. The figure increased between 2001 and 2005 (the latest year for which figures are available) from 564,871 to 614,237. That is an increase of 49,366, or 9%, in just five years[6].

The Government Actuary’s Department (GAD) projects that the number of births in England each year will decline in the years ahead. Our estimate of the midwifery staffing requirements of Maternity Matters incorporates thisGAD-projected fall. Should the fall fail to materialise therefore there will be an obvious need for more than the equivalent of 22,000 full-time midwives in the NHS in England to deliver Maternity Matters.

Summary

The Government has made ambitious guarantees on NHS maternity services in England. The problem is that all the indicators are pointing in the wrong direction:

• the share of the NHS budget spent on maternity services is falling, not rising
• the proportion of the NHS workforce made up of midwives is falling, not rising
• the number of places for student midwives is falling, not rising
• the headcount number of midwives is falling, not rising
• the full-time-equivalent number of midwives is falling, not rising
• the only thing that is rising is the number of births!

We want the Government to succeed in its ambition for NHS maternity services in England. We know that the Government too wants to succeed.

Put simply, meeting the guarantees made in Maternity Matters will require the equivalent of 22,000 full-time midwives in England’s NHS. Sadly, the latest figures reveal that that milestone is not closer, but further away. Urgent action is needed now to turn this around.

Briefing prepared by Stuart Bonar, RCM Public Affairs Officer, 1 May 2007

[1]All 2006 workforce information taken from NHSHospital and Community Health Services Non Medical Workforce Census, England: 30 September 2006, Detailed Results, published on 26 April 2007 by The Information Centre (

[2]Information provided in answer to a written parliamentary question from John Baron MP, Hansard, 19 March 2007, c736W

[3]Information provided in answer to a written parliamentary question from John Baron MP, Hansard, 6 March 2007, c1968W

[4]Information taken from Appendix C of Maternity Matters

[5]All 2005 workforce information taken from NHSHospital and Community Health Services Non Medical Workforce Census, England: 30 September 2005, Detailed Results, published by The Information Centre (

[6]Information provided in answer to a written parliamentary question from Andrew Lansley MP, Hansard, 23 April 2007, c982W