Maternity workforce review published
Using midwives and other maternity staff more effectively is the key to improving maternity care in hospitals, according to findings of a review led by King’s, commissioned by The King’s Fund.
Despite the fierce debate over midwife numbers, increasing staffing levels will not be easy in the current financial climate. Evidence shows that the maternity workforce could be utilised more effectively to improve outcomes for mothers and babies.
The review considered current evidence around maternity workforce staffing and deployment as well as safety in labour and birth for women and babies. UK stakeholders were also interviewed about innovations in practice through workforce changes.
The report recommends deploying midwife-led care much more widely for women at a low and medium risk of problems, with the potential to improve outcomes for women and babies and to save costs to the NHS. In 2009/10, only 10 percent of hospital births in England took place in midwife-led wards.
The report identifies other ways in which care could be organised more effectively within maternity teams. Shifting tasks from doctors and midwives to nurses and support workers where appropriate could free up the time of midwives to provide one to one care for women and doctors to focus on supporting women at higher risk of problems and would help to ensure that there is adequate consultant cover available 24 hours a day.
The report also calls for further development of the Birthrate Plus tool, which has been used for a number of years to plan midwifery requirements and to determine midwife-to-woman ratios. Although the tool is popular and is widely used, it does not take into account the contribution that other staff can make.
In common with the rest of the NHS, maternity services face significant challenges over the next few years. Demographic changes mean that a rising birth rate coupled with the increasing complexity of many births has increased the pressure on services. With the NHS needing to find up to £20 billion in efficiency savings by 2014/15, the report argues that improving productivity through better deployment of the maternity workforce may be a more realistic goal than significantly increasing staffing levels.
Professor Jane Sandall from the Division of Women’s Health at King’s College London said: ‘Current evidence shows that the maternity workforce could be utilised more effectively to improve outcomes for mothers and babies. Having sufficient staffing levels is important, but there is also evidence that care could be organised more effectively. Midwife-led care in a collaborative maternity team for women at a low and medium risk of problems has the potential to improve outcomes for women and babies, and to save costs to the NHS.
‘There is real potential to improve quality and safety of care in childbirth by realising the potential of the existing workforce.’
Anna Dixon, Director of Policy at The King’s Fund said: ‘Midwife-led care should be the norm rather than the exception. Midwives’ time must be used more effectively with an increased use of maternity support workers, doulas providing lay support and specialist nurses. This would free up doctors to spend more time caring for higher-risk women. Having sufficient staffing levels is important, but there is a need to rethink how staff are deployed.
'I hope this report will facilitate a wider debate about maternity care that recognises the need to organise the workforce more effectively.’
To read the report, please visit www.kingsfund.org.uk