“Winning for our members providing out of hours on-call in Scotland’
Last week saw the publication of “Guidance on Applying Compensatory Rest Related to On-Call for Staff Employed Under Agenda for Change Terms & Conditions”, published as part of the NHS Scotland Agenda for Change (AfC) Review, via the Scottish Terms and Conditions Committee (STAC). The RCM pushed for its development to ensure that midwives and other AfC staff were effectively supported in achieving adequate rest should they be called upon to support a contingency of service.
Midwives delivering care via ‘on-call’ models has become a long-accepted element of our working lives dating back well beyond the birth of the NHS to the days of all maternity care being provided at home in fondly recounted models such as ‘The Green Ladies’ of Glasgow (owing to their green distinctive bottle green uniforms). It is therefore still a surprise to many that modern maternity care continues to be reliant on midwives being called out to undertake additional work after completing a rostered day at work.
The RCM is clear that such approaches to delivering care must be used appropriately and safely, however we continue to face a recurring battle in resisting on-call being abused as enforced overtime to cover chronic staffing shortages in acute services to the detriment of care quality and safety and the wellbeing of midwives.
This practice also has a detrimental impact on midwives’ ability to provide planned care in the community and reduces continuity of care.
Our snap poll of members in the week from Monday 4 to Sunday 10 March 2024 also highlighted how 82% of midwives in Scotland reported working extra unpaid hours 34% of which saying this was between 5-10 hours. This is perhaps no surprise when we see the qualified nursing workforce in NHS Scotland has increased by 13.4% in the last decade, while qualified midwives lagged behind with a 7.9% increase, despite the exponential increase in demands and complexities of care. All of which indicates a chronic shortage of midwives that will undoubtedly be detrimentally impacting the workforce.
While there is much legislation in relation to ‘working time’ aimed at protecting staff from excessive detrimental working patterns with some additional provisions set out in the AFC handbook, the lack of consistent interpretation and provision of ‘compensatory rest’ has given rise to a continued feeling of conflict, burn out and abuse of midwives who are supposed to be on-call to meet specific care needs at home, not fill the gaps of poor workforce planning and lack of investment.
This new guidance now sets out clearly the legal duties of all managers and service leads to proactively identify, manage, and reduce risks associated with working hours, while ensuring that workers are fit to work and free from the effects of fatigue, which includes adequate provision of compensatory rest. Additionally, it emphasises how there should be “efficient systems of work and rota/shift management are in place which minimises the requirement for compensatory rest” as well as the requirement to monitor and record compensatory rest alongside the need to “review their on-call and compensatory rest provision to ensure that they prioritise immediate compensatory rest”. All of which should highlight where rosters need to factor in provision of compensatory rest and a consideration on whether on-call models are being used appropriately and safely.
The additional clarity that “where compensatory rest overlaps with rostered working hours, staff are not required to make up these hours later” means there should be appropriate staffing in place to support compensatory rest and therefore drive consideration around whether having midwives ‘on-call’ is in fact the safest and most efficient model of care provision for the future.
The guidance does not however stand alone in the battle to ensure that midwives are adequately compensated for the hours they work, lets not forget the 2019 “Agreed Policy on Accruing, Recording and Reclaiming of Time Off in Lieu (Toil) for Agenda for Change Staff in Scotland” that clearly sets out how the accrual of 15 or more minutes of additional time at work should be recorded and mangers must “take the necessary action to reduce the time owing by giving time back, or arrange payment for any TOIL not taken within 3 months as set out in Section 3 of the Agenda for Change Handbook.
The Scottish government and maternity services must ensure adequate funding and staffing to enable full implementation of both above circulars. Midwives must have a healthy work life balance, adequate rest, appropriate pay for work undertaken, alongside a maternity service that is appropriately staffed to ensure safe and quality maternity care for all.
