After a week of more news headlines on the safety of Scotland’s maternity services RCM’s Director for Scotland Jaki Lambert discusses the reality behind the headlines.
No midwife or maternity care assistant (MCA) wants to see headlines about women and families not receiving the care they need. Yet this week that’s sadly what we’ve seen, despite all the amazing work the midwifery community does every day and the difference they you make to lives with your touch, your words and your care.
Unfortunately, it is a situation to which we’re becoming all too accustomed. Back in 2022, our survey of members in Scotland made clear the challenges that midwives and MCAs were facing every day: not enough staff, not the right skill mix, not the right equipment, substandard environments and no time to learn and develop.
The RCM’s recommendations to improve the situation were clear. Maternity services need the right staff, in the right place, with the right education and skills, including specialist and consultant midwives. They need strong midwifery leadership which is well-supported and is heard at the highest levels within Health Boards. Those coming into the profession need to be properly supported through preceptorships to ensure they stay. And staff need to be given the time to learn and develop, training together as part of multidisciplinary teams.
While we have made progress with some of this work, the most fundamental recommendation – ensuring there are enough midwives to provide care – has not been addressed. It is tantamount to gaslighting to be told consistently there are no vacancies when we know the establishment is not meeting care needs either in numbers or skill mix.
While there are Directors of Midwifery in the majority of Boards, the structures are inconsistent. We only have four consultant midwives, two of which are in one Board, a situation which comes not from a lack of will but from a lack of money. When these roles are so tied to safety, what this decision means is that there is no money for safe care or the retention of midwives.
Money is also the barrier for rollout of the new model for clinical supervision, that and time. There is now really good preceptorship happening in Scotland but again insufficient educators, supervisors and time are hampering these efforts.
The predicted absence allowance remains the smallest in the UK. Caseload sizes are unmanageable in many Boards if true person-centred care is to be realised. The career structure, while recently approved to move forward, has no funding currently allocated to ensure that the identified posts are funded.
The RCM was key to getting the new workload tool for midwifery being built but it is worthless if there is no money to implement it effectively. In reality they are measuring what midwifery is able to be provide rather than what is required.
So in 2023 we published the five year plan for the profession in Scotland. Recognising that overnight change was unattainable we described in detail the key steps to improve maternity care. The key themes throughout were safety, cultures, career structure and leadership.
Alongside this, our 2023 State of Maternity Services Scotland This clearly described the changed workload due to a combination of increasing interventions, complexity, policy and regulatory requirements. These require a greater skill mix and larger workforce if we are to meet the needs of families in Scotland.
Every time we meet with ministers, we share our findings and through each of these publications we have met with ministers to put forward make the case for change. Having members alongside us when speaking to politicians is so important, so they can see the genuine impact on the working lives of midwives and MCAs in Scotland.
We have actively participated in the Nursing and Midwifery Ministerial Taskforce, which aims at ensuring we have safe, supported, sustainable and valued nursing and midwifery careers in Scotland. The taskforce also resulted in midwives and nurses in Scotland making their voices heard during the pay campaign, so it needs to be meaningful. However, throughout we have been told there will be no money. The recommendations we have made built on the input of nurses and midwives from practice, academia, professional bodies and unions and with leadership with the Scottish Government, are now on the Cabinet Secretary’s desk.
Change needs to happen. Midwives and MCAs in Scotland want to be proud of the care they give and feel valued for it. Maternity care in Scotland is at a tipping point. Cabinet Secretary, it is in your hands.
