Small island maternity services may care for fewer women, but safe care still needs to be there round-the-clock – with the right people and skills to respond when an emergency happens, often many miles from additional clinical support.

A new RCM report sets out how Scotland’s island maternity workforce can be supported to do just that, with a broad mix of skills, access to advanced education and development, and career opportunities that help attract and retain midwives in island communities.

The report, Midwifery model and skill mix for sustainable island services, looks at maternity care across Orkney, Shetland and the Western Isles and how it can be sustained to ensure women and families can continue to receive high-quality maternity care close to home, even in an emergency. It was developed following workshops organised by RCM Scotland and NHS Education Scotland.

Five key takeaways from the report include:

1. Fewer births doesn’t mean less need for a safe 24/7 service: Island maternity services must be able to provide planned and emergency care around the clock, despite smaller caseloads and being further from additional clinical support. As such, the workforce planning needs to reflect that reality.
2. Island maternity teams needs the right mix of broad and advanced skills: Midwives on the islands need to work as generalists across a wide range of care, while the team also needs advanced capability to manage complex situations such as deterioration and stabilisation ahead of transfer.
3. Education and development are essential to keep those skills on the area: There are calls for advanced education programmes and strong links with universities, alongside opportunities for individual midwives to develop areas of practice needed by their local service.
4. New midwives need support that reflects realities of island practice: Preceptorship should be individualised, with supernumerary time and experienced support as midwives develop confidence working nights and on call, managing unscheduled care and supporting emergency transfers, including by air ambulance.
5. Sustainability means investing in the workforce for the future, not just staffing today’s service: The report calls for stronger leadership and career structures, succession planning and staffing levels that allow midwives to spent time off-island for training and clinical exposure without undermining the service back home.

Jaki Lambert, RCM Scotland Director, said: “Maternity care on the Scottish islands come with very different challenges given the remote locations and the need for midwives to be more generalist than elsewhere in the UK. Ultimately, safe care is the top line – but the question we wanted to ask was, how do we get there with maternity services which requires a different workforce approach to that seen elsewhere in the country? This work sits clearly within the recommendations form the Ministerial nursing and Midwifery Taskforce, providing tangible solutions.

“That’s why we brought midwives and midwifery leaders from across the three island boards together – to really look at what their services need, from the skills within their teams to education, development and leadership. What came through clearly is just how broad the role of an island midwife can be and how important it is that the workforce model recognises that.

“There is already so much innovation and expertise within these services. Island midwives are generalists in the truest sense – their role can span so many different areas of care. Across the islands, teams have adapted and developed their skills around what their communities need. What we need to do now is make sure the education, development and workforce structures are there to support it.”

The report was launched this week by RCM Chief Executive Gill Walton and Chief Membership Officer Robbie Turner during a visit at Balfour Hospital in Kirkwall, Orkney.

Read the full report here.