Maternity services at Nottingham University Hospitals need to recruit dozens more midwives to return to desirable staffing levels, a new report has found.
Last month, the service was found to be ‘inadequate’ by the Care Quality Commission (CQC) which is responsible for inspecting healthcare settings.
It found: “The service did not have enough maternity staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.”
Now, the trust has revealed it is 73 midwives short of the levels which it feels are needed.
The CQC inspection – which was announced – was triggered in part due to requests by coroners, following the death of baby Wynter Andrews.
Staffing and safety on NHS maternity wards is not only a local problem – in November the Royal College of Midwives found the safety of maternity services nationwide were under ‘serious threat’, and the National Childbirth Trust said then there was a ‘crisis in maternity care’.
Now, a new report to update city council health bosses on the progress made to improve the NUH department so far has found that while work to recruit more midwives was ongoing, it ‘will take time’.
The report reads: “Last summer we were in a position where we had recruited to almost all of our midwifery vacancies, based on a tool that looks at the number of births.
“However we wanted to take advantage of a tool called Birthrate Plus, and so during the summer as part of the transformation work we took that opportunity.
“Birthrate Plus is a workforce planning tool.
“It helps identify how many midwives are needed to care for women based on a minimum standard of providing one-to-one midwifery care throughout established labour, taking into account total activity, not just the number of births per unit.
“This work identified that we need more midwives to provide that care for the increasingly complex pregnancies that we are seeing.
“The shortfall is now 73 midwives. We are committed to recruiting more midwives and that work is ongoing, but will take time.”
Other measures are also being taken to try to turn around the service. An interim Director of Midwifery has been appointed, and started this week (January 4).
In December, seven midwives were recruited, which the trust says means 18.19 full-time equivalent (FTE) posts have now been filled recently.
Additional consultants have also been brought in, adding 4.5 sessions per week per site (QMC and City hospitals).
On the issue of staffing, December’s CQC report found: “Staff had not completed training in key skills and did not always understand how to keep women and babies safe.
“The service did not always have enough midwifery staff to keep women and babies safe and provide the right care and treatment.
“Staff did not always risk assess women appropriately and in line with national and local guidance, and records were not always well maintained.
“Incidents were not always reported due to the demand on staff and the ineffective feedback and escalation, and lessons were not being learnt.”
It went on to say: “There was not enough suitable equipment available to help staff safely care for women and babies.
“The service did not have enough maternity staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.
“Although managers regularly reviewed staffing levels, they were not always able to adjust staffing levels to ensure safe numbers of staff in all areas due to staffing shortages.”
Elizabeth Duff, is the Senior Policy Advisor, at the National Childbirth Trust, and said: “It is absolutely essential to maintain adequate staffing levels in maternity services, even more so at a time when a woman cannot always have her partner with her in hospital.
“During pregnancy, labour and critically in the postnatal period with a newborn baby to care for, a woman’s condition can change rapidly and she may need urgent intervention to ensure her and her baby’s safety.
“Care offered by a known and trusted health professional has also been shown to improve outcomes and wellbeing.”
A spokesman for the Department for Health and Social Care said: “Midwives perform an indispensable role and work around the clock to safely care for mothers and babies.
“We are committed to ensuring the NHS has the resources it needs and have increased the number of midwives working in our NHS by 651 compared to last year.
“The NHS People Plan sets out a strategy to grow workforce resilience and improve staff retention.
“We are working to attract and retain more brilliant midwives by offering practical support for wellbeing, as well as a new training grant of £5,000 a year for all eligible new and continuing students.”
The NUH report concludes: “Finally, we recognise that the CQC findings will raise some concerns about our maternity service with local women and families and (we remain committed to making) improvements, ensuring it provides safe care every time, for every family.”