In the UK we have a new Secretary of State for Health. Neil Stewart, Editorial Director, reflects on the recent Maternity and Midwifery Forum’s annual midwifery education conference, “Educating Future Midwives, raising points for midwives to shout about in the political arena.
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There’s a hole in your bucket, dear Vicky, a hole (Victoria Atkins – is our new Secretary of State for Health in case you missed it!).
You know the popular nursery rhyme – Lisa and Henry end up going round in circles trying to plug the hole in the bucket.
This came to mind watching the Maternity and Midwifery Forum’s annual midwifery education conference, “Educating Future Midwives”.
The government and NHS are trying to plug the hole in the midwifery workforce bucket, which the RCM estimates at 3000 midwives.
NHS management are trying to plug the retirement hole with more advice on going or staying part time, or more flexible working with an added menopause plan.
Overarching all this they have the NHS workforce plan, recruiting midwives back into practice, recruiting overseas, encouraging a new apprenticeship model. All to plug that hole.
At the centre of the plan a large part of the planning involves increased targets for recruiting, educating new student midwives and graduating them into the workforce. But it turns out there are serious holes in the education bucket as well.
Enough of the nursery rhymes, in the real world the conference speakers took us through a mounting checklist of challenges and holes in midwifery education that urgently need addressing if the demands of the future, and the workforce plan are to be met.
‘O wad some Power the giftie gie us / To see oursels as ithers see us!’ – Robert Burns
Answering Burns call Professor Jenny Gamble, a leading Australian ally of UK midwifery currently working in the UK, took the conference through her observations on the state of midwifery in the UK, picking up key points in the recent RCM State of Midwifery education report but ending with some blunt warnings :
- “In the past, other countries have looked to the UK for leadership and learning about regulation, legislation, practice, education in relation to midwifery”
- “This is not the case now and the UK should look internationally for ‘how-to’ guidance and learning”
- “Midwives are actively disabled by the system”
She highlighted the hole in the theory of multi-disciplinary teams in maternity and the reality of the restrictions, rather than enabling, this places on the role of the midwife. She pointedly compared the lack of midwifery voices and leadership in key policy roles at top decision-making tables: a painful but important reminder that leadership in global standards and practice of midwifery has to be constantly worked on and asserted at every level.
Canterbury on our mind
The withdrawal of the midwifery course at Canterbury Christ Church was on delegates mind when Jacqui Williams from the NMC went through current issues of regulation. But the issue on most delegates minds was not just the lack of control the midwifery school had over placements but the price they could pay. The hole between what were the standards expected in teaching and the lack of understanding in some midwifery units where placements took place was of high concern and Jacqui mapped out the steps NMC was taking to push these front and centre with midwifery units and their managements. The need to assert powerfully to maternity units that these were standards, not just “nice to have” options for the supervision and support of student midwives came through as a call to action.
Teaching and education going digital native?
Robyn Cooke speaking on behalf of the Deans of Health set out an encouragingly proactive agenda in addressing and bridging the holes existing between NHS Trusts and Universities systems, especially on recruitment and retention of staff as well as students, building academic capacity and academic careers, not easy given the gaps in salary and systems raised later in the day.
It was good to hear the Deans of Health were turning this into their manifesto for health professionals.
Retention is a particular issue with the RCM State of Midwifery education report, highlighting the loss of 15% of students along the way. This represents a very serious loss of funds for universities and loss of recruiting for the NHS which seems not to be understood – in financial terms alone managers should be rushing to fix the loss or like water companies they will be condemned for ignoring the leaks at great personal and financial expense.
To add international perspective Dr Maeve O’Connell, Assistant Professor at Fatima College of Abu Dhabi took the conference through her completely different challenge building and getting certification in a country with 115,000 births but only 295 midwives, of whom only 10 were local Emirates. But it is an uplifting positive story of progress to set against the UK challenges in a country where the women still have between 6 and 9 children.
Dr Anna Byrom, National Teaching Fellow, Advance HE took us through the realities of students from Gen Z, “digital natives”, and what they expected and were likely to respond to in teaching resources and methods and how they learn; all ways in which midwifery schools can adapt to meet their expectations and access to resources.
Later in the conference, Gail Johnson, the Co-editor of the latest edition of Mayes Midwifery, and Anna Marsh, a pre-doctoral Clinical Academic Fellow, at Bournemouth University combined with her work at University College London Hospitals Foundation Trust, mapped how to get into research, writing it up, presenting and find funds. The happy news is that, despite all the growing obstacles, there is a growing demand for research opportunities and career choices since the landmark Lancet report of 2014 demonstrating the evidence for midwifery’s effectiveness.
The holes in the midwifery education bucket
The biggest holes and gaps, however, were set out by Nicky Clark, LME at Hull followed by Fiona Gibb and Heather Bower from the RCM sharing their report on the State of midwifery education.
Nicky Clark, the LME from Hull and chair of the NMCLME strategic reference group, stepped up the case for action, setting out more of the gaps and holes causing problems in midwifery education and holding back the developments essential to meeting the NHS workforce plan.
Addressing the salary gap and the increasing problems in recruitment and retention of academic staff, followed by the RCM report authors, they set out a compelling agenda for action.
One practical problem is that the RCM does not have a place at the negotiating table in universities to push the case.
On paper the starting salaries between university grades and NHS Agenda for Change look around £1000, but in practice, with shifts allowance, the reality is a gap of £10,000 to £15,000 has opened up, disrupting the essential staff flow between the NHS and Universities to keep education and practice in step. The system mitigates against recognising midwifery practice experience in the NHS leaving many educators having to start at the bottom and combine academic teaching duties with near full-time study for masters and doctorates essential to progress in the Universities system.
The retention rate of students is dropping. The latest figures the RCM could identify were a loss of 15% of students from courses, with anecdotal evidence that this is getting worse. In the larger midwifery schools this will represent losses of hundreds of thousands.
This in turn was highlighted in the RCM presentation on the decline in the numbers of teachers holding masters and PhD’s at a time when evidence-based research has never been more important in maternity and midwifery.
If you only listen to two of the presentations form the conference, you should listen to these, Nicky Clark, and Fiona Gibb & Heather Bower, and raise the voice of midwifery.
We have a new Secretary of State for Health. You need to tell her she has a hole in her midwifery bucket, and she needs to fix it.
Neil Stewart
Editorial Director
November 2023