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Huge drop in midwives’ morale amid Ockenden fallout

Published on: 13 Apr 2022

There has been a dramatic fall in morale among midwives across multiple measures within the NHS staff survey.

Although general morale deteriorated among most staffing groups in 2021, the results for midwives across numerous key measures have worsened to a far greater degree than average.

It comes amid the final Ockenden report into the maternity care scandal at Shrewsbury and Telford Hospitals Trust, which raised serious concerns about short staffing and people wanting to leave the profession.

The survey results, published on 31 March, suggest 52 per cent of midwives are thinking about leaving their organisation, up 16 percentage points on the previous year. In comparison, the number of general nurses thinking of leaving was 33 per cent, up just 5 percentage points.

Meanwhile, 27 per cent of midwives felt satisfied their work was valued by their employer, down 12 percentage points. This compared to 40 per cent for nurses, which was down 7.5 percentage points.

Just 6 per cent of midwives said their organisation had enough staff to do their jobs properly, down 12 percentage points. This was compared to 22 per cent of nurses, which was also down 12 percentage points.

Chris Graham, chief executive of healthcare charity the Picker Institute, which coordinates the staff survey, described the midwifery profession as an “outlier” in the 2021 results, in terms of how their experiences compare to other groups and how their responses have changed over time.

“Not only do midwives report worse experiences in many areas, but there is evidence of particularly sharp declines in some key measures,” Mr Graham said. “It appears likely that staffing shortages are a major factor here.”

Mr Graham said over the last year the number of full-time equivalent midwives had dropped by more than 300, with sickness absence rates risen by almost a quarter, with stress, anxiety, depression and other psychiatric illnesses accounting for a third of all absences.

“The risk is that this problem will become self-perpetuating as chronic staff shortages lead to more midwives experiencing burnout and requiring stress-related absences. Retaining and supporting midwives must be a top priority to prevent the situation from further worsening,” he said.

Ensuring the NHS has enough midwives to provide safe services for mothers and babies was a key recommendation of last month’s final Ockenden review.

At its board meeting last month, NHS England announced a £127m investment in maternity services, which was acknowledged in the Ockenden review. However, the review stressed this was “still significantly short” of the £200m to £350m maternity investment the health and social care committee recommended last year.

Suzanne Tyler, executive director at the Royal College of Midwives, said: “While we welcome attempts to train and recruit new midwives, this government is doing nothing to stop the experienced and qualified ones from leaving. At the same time, as demands on services and the pressures on maternity staff are rising, staff numbers are going down.

“[Midwives and maternity support workers] are exhausted, fragile and are starting to vote with their feet and simply head for the exit door.”

In response to the survey findings an NHS spokeswoman said: “Significant steps have been taken to support maternity teams, including a new £127 million investment to boost the workforce, with £8 million to support new midwives with extra coaching, pastoral care and development. This is on top of existing access to mental health services, 24/7 text support and flexible working.” 

In other measures, the proportion of midwives wanting to leave the NHS altogether also climbed almost 5 percentage points, to 9.5 per cent. The figure for nurses was a 1.5 percentage point increase (to 5.5 per cent).

The share of midwives recommending their organisation as a place to work fell 17 percentage points, to 43 per cent, compared to a fall of 8 percentage points for nurses (to 59 per cent).

The percentage of midwives saying they were confident their employer would address their concerns if they raised them fell 12 percentage points, to 48 per cent. For nurses, there was a fall of 4 percentage points, to 58.

This worsening experience at work was reflected in the wellbeing of midwives, with 71 per cent saying their work was emotionally exhausting, compared to 47 per cent of nurses. For the first time NHS staff were asked about burn-out. A large proportion of midwives agreed they felt burnt out (63 per cent), compared to 40 per cent of nurses.