A shortage of midwives is putting mothers and babies at risk, in spite of a Labour manifesto pledge to increase the numbers so that every pregnant woman would be cared for throughout by the same nominated midwife. Research shows that many baby units are failing to meet targets for the number of midwives and that Labour’s promise is far from being achieved.
The Royal College of Midwives has issued a warning of cuts to services, stress on staff, fewer home visits, less chance of a home birth for those who want it, and a shrinking workforce — at a time when the number of births is increasing.
The college’s assessment is supported by the healthcare analysis company Dr Foster. It examined the numbers of births and the numbers of midwives across England to see how close the NHS was to meeting the informal but generally accepted target of 32 births per full-time midwife per year. More than 62 per cent of trusts in England, and more than 56 per cent in the UK as a whole, were failing to meet this target.
The company also found that shortages of midwives often led to maternity unit closures. In the past year, units in England were closed for almost 4,000 hours, or 165 days. This meant that women expecting to give birth at a particular hospital were transferred elsewhere at the last minute.
The Healthcare Commission has investigated one unit, at Northwick Park Hospital in northwest London, where ten mothers died between 2002 and 2005. Although a midwife shortage was not to blame, the report said that the trust was too reliant on agency and part-time staff. The trust has since recruited 20 more midwives.
The commission is now conducting a review of maternity units throughout the country, and the King’s Fund has also announced a review of safety in maternity units, to start next month.
Training budgets for midwives are being cut, in some cases by 75 per cent or even 100 per cent. Fewer midwives are being employed than was the case a year ago, even though the number of births is rising at about 6,000 a year.
Three years ago the Government urged nursing students to become midwives, but now the college says that there is no money to employ them. Louise Silverton, the college’s deputy general secretary, said: “The midwifery shortage is getting worse at a time when we are experiencing a significant increase in the number of births. Graduates can’t get jobs and it has cost the taxpayer £45,000 to train each one.”
The college published a survey this month in which two thirds of midwifery heads said their units were understaffed.
Women who want to have babies at home are often denied the opportunity because of the shortage. As times2 reports today they can be let down at the last minute if there is no midwife available.
The Dr Foster figures show that staffing problems are greatest in the East Midlands, the East of England, and London, all areas where more than 80 per cent of units exceed the target of 32 births per midwife. In the East Midlands the average figure is more than 41.
The best area is Wales, with under 23 births per midwife and Scotland also does well, at just under 24. The Department of Health has admitted that improvements are needed. On the home births commitment, a spokesman said: “Nobody claims it will be easy, but the manifesto commitment is there. We would expect that home births would be a realistic option for women with an uncomplicated pregnancy.”
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Britain: £13bn hospital plans 'at risk from incompetent managers'
Dozens of privately financed hospital projects could face meltdown if the Government does not take a firmer grip, the Public Accounts Committee has said. Millions of pounds were wasted by “amateur and incompetent” NHS managers who tried to rebuild three hospitals on a single site in Paddington, West London, without a proper plan or sufficient land. The same could happen in other places if the Department of Health does not improve supervision and continues to depend on local NHS managers who are out of their depth in managing huge building projects.
The Paddington Health Campus collapsed after almost £15 million had been paid to consultants, lawyers and architects, the PAC says in a report. The Department of Health sat by while the project unravelled and the participants argued among themselves.
The parliamentary committee said that with PFI programmes worth £13 billion being planned, some could go the way of Paddington. The department admits that it blundered in not terminating the Paddington project sooner, but claims that the same will not happen again.
Edward Leigh, the chairman of the committee, said: “The collapse of the ambitious Paddington Health Campus project after five years was the direct result of appalling planning and forecasting of costs by the NHS trust partners, rows between them over the way forward and uncertainty over the Department of Health’s degree of support for the scheme.
“The department, in effect, left this £900 million construction project to local NHS staff who were rapidly out of their depth and floundering.”
The plan was to combine St Mary’s Paddington with the Royal Brompton and Harefield hospitals on a single site. But the Brompton and Harefield (itself the product of a merger) never agreed to merge with St Mary’s. Indeed, it made it a condition of its participation that it would not do so.
The department and local NHS managers nevertheless let the plan go ahead, incurring costs, for five years. What began in 2000 as a £300 million project had by May 2005 ballooned to £894 million. The completion date, set for last year, had slipped to 2013.
The failure of the plan can be traced to “ill-informed decisions taken by the NHS in northwest London”, the report says. When the scale of the problems became evident in 2002-03, there was a lost opportunity to pull the plug.
Mr Leigh said: “The department must look long and hard at whether its private finance unit is really up to the task of supporting local NHS trust procurement teams.”
The report sharply criticises the trusts for failing to put together a proper business case for the project, failing even to consult doctors and nurses over what facilities they needed. It then took “several years” for the partners, hampered by “insufficient manpower and capability”, to reach a clear position on the costs, planning issues, land required and afford-ability, it said.
The MPs criticised the North West London Strategic Health Authority for failing to halt it in 2003, but said that the Department of Health itself was also to blame. Eventually it was the Treasury, and not the DoH, that terminated the project.
The department is reviewing £13 billion of PFI hospital-build-ing plans, and aiming to reduce the total spend to between £7 billion and £9 billion. In evidence to the committee, Hugh Taylor, Permanent Secretary of the DoH, said it was “regrett-able” that the project had not been terminated sooner. But he was confident that it would not happen again, a confidence not universally shared by the committee, which concluded: “It remains to be seen whether this action will be sufficient to get a grip on a programme which continues to be managed by the NHS locally.”
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
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