By Tara Kaufman, Policy Advisor, Royal College of Midwives on 21 October 2022 Maternity Services Midwifery Workforce MSWs – Maternity Support Workers Safety Staffing Levels
The CQC’s annual report on the state of healthcare in England published today doesn’t pull its punches: “The… system is gridlocked” is its grim opening. It goes on to paint a familiar picture of long waiting times, difficulty accessing primary care, bedblocking caused by inadequate social care, anxious patients and demoralised staff. “At the heart of these problems,” it says, “are staff shortages and struggles to recruit and retain staff right across health and care.”
Maternity services are highlighted as an area of special concern. Despite the raft of policy initiatives and programmes in recent years, maternity care ratings are getting worse. Six percent of NHS maternity services in England are rated as inadequate, with a further 32 percent requiring improvement. That means that almost two in every five units are not good enough.
The report notes the same concerns time and again: quality of staff training, poor working relationships between midwives and doctors, inadequate risk assessment and failure to listen to the voices of women or frontline staff. Deeply embedded inequalities are also a concern. Black women suffer significantly higher readmission and mortality rates, and frequently report treatment that is disrespectful at best.
The report acknowledges the severe shortage of midwives, and notes that the high turnover of senior midwives often leads to inconsistent leadership and difficulties in embedding a supportive culture. Its discussions with frontline staff revealed a widespread sense of not being empowered to grow and learn. The midwives wanted more multidisciplinary training to ensure shared understanding and stronger relationships. They also called for better financial and buddying support for student midwives, and for maximising the contribution of maternity support workers.
The CQC has pledged to prioritise its work to keep an accurate view of the quality and safety of maternity services across the country. It says, “We are committed to doing all we can to accelerate safety improvements, facilitate wider learning across services, and influence action from national partner organisations where it is needed to alleviate the current challenges that staff face”.
The Care Quality Commission ‘The State of Health Care and Adult Social Care in England 2021/22’ report can be read at https://www.cqc.org.uk/publication/state-care-202122.
