The government's refusal to publish a joint royal colleges' report that warns of the closure or merger of up to 80 maternity units is causing confusion among midwives and adding to recruitment and retention problems.
Last week, giving evidence to the nurses and midwives pay review body, Royal College of Midwives general secretary Karlene Davis said 'all the positive proposals for the future of maternity services outlined in the NHS plan are at risk' if immediate steps are not taken to address problems of staffing and skill-mix outlined in the shelved report, Reconfiguring Maternity Services.
The report, commissioned in 1998 by former health secretary Frank Dobson, was written by a joint committee of the RCM, the Royal College of Obstetricians and Gynaecologists and the Royal College of Paediatrics and Child Health, and was handed over to health secretary Alan Milburn in April.
One of its authors told HSJ that the report concludes that dozens of maternity units nationwide will be forced to close or merge because of a shortage of specialist doctors and midwives.
HSJ understands that public health minister Yvette Cooper has told maternity pressure groups that the government will not publish the report because it has been overtaken by the NHS plan. The plan promises to recruit 7,500 more consultants and 20,000 more nurses by 2004.
But it does not refer specifically to the need to improve the quality of maternity services, referring only to 'midwives developing their role in public health and family well-being'.
The RCM says that uncertainty over the future of the service in England and Wales is only adding to the problems of providing cover in the face of mounting levels of sick leave.
It told the review body that its own survey, examining why midwives leave midwifery, revealed that 80 per cent of maternity units are experiencing some level of staff shortage, with some units caught in a 'vicious cycle' of additional stress and higher sickness levels.
Ms Davis said that up to 10,000 qualified midwives have left the profession, with dissatisfaction a key factor.
Senior midwifery posts are also 'continuing to disappear' and 'career opportunities remain very limited' - both factors that would not encourage the return of qualified staff.
But the RCM survey indicates the scale of the task - it shows that only 16 per cent of the former midwives intend to return.
Head of employment relations for the RCM John Skewes told HSJ he wants 'a decent uplift in salaries well in advance of inflation'.
Midwives currently start their career on E grade with a basic salary of around£15,900. The NHS plan promises midwives speedier access to F grade. Mr Skewes said he wants the review body to build on that by implementing a minimum F grade.
The college believes this would have a knock-on effect of pushing up pay for more senior midwives and attracting more midwives back.
An all-party parliamentary group on maternity services chaired by Swindon MP Julia Drown will be launched on 29 November. One of its key aims is to achieve a national service framework for maternity.