Staff shortages force most trusts to suspend NHSE maternity care model

HSJ research revealed a majority of trusts have been unable to implement the continuity of carer maternity model, after they were told to look again at whether it could be safely implemented.

The model intends to give women “dedicated support” from the same midwifery team throughout their pregnancy, with a 2016 review saying it would reduce infant and maternal mortality rates and improve care more generally.

It is particularly aimed at improving care for patients from minority ethnic groups and those with other risk factors, and has been championed by Jacqueline Dunkley-Bent, NHS England’s chief midwifery officer. Key targets around the model were included in the 2019 NHS long-term plan.

However, there is consensus nationally that it can only be rolled out safely where there are adequate numbers of staff to do so – otherwise the risks outweigh the benefits.

Earlier this year, the final Ockenden report into maternity care failings at Shrewsbury and Telford Hospital Trust was critical of the model, and said it should be suspended until trusts have enough staff to meet “safe minimum requirements on all shifts”.

HSJ reported there was subsequently tension among national leaders around this, with sources describing continuity of carer being “ideologically driven”. NHSE is still pressing to make it the default model of maternity care by March 2024, and HSJ has been told by some senior midwives that pressure to further roll it out places significant strain on services that are already over-stretched.

NHSE told trusts to submit their plans reviewing their continuity of carer model by mid-June, and research by HSJ reveals at least 82 trusts out of the 121 that provide maternity services in the NHS have either suspended provision or paused further roll out, as they did not have enough staff to run it safely.

Of the 103 trusts that responded to HSJ’s query, only 12 trusts – including Chelsea and Westminster Foundation Trust, Kingston Hospital FT and Yeovil District Hospitals FT – have been able to continue with fully implementing the continuity of carer model. Nine trusts had not even started to implement it due to staffing concerns, while 18 failed to respond, including Shrewsbury and Telford Hospital Trust.

According to NHS data, over the last year the number of midwives working in the English NHS dropped by more than 550, while the NHS Staff Survey revealed over half were thinking about leaving their job.

An NHSE spokesman said: “Immediately following the Ockenden Review, the NHS issued clear guidance supporting the findings that continuity of carer should only operate where safe staffing is in place.

“Providers have been given flexibility to agree timescales for the rollout alongside the planned recruitment of midwives.”

Last year, the Care Quality Commission raised major concerns about the variation in the quality and safety of England’s maternity services, and has recently said it will start to inspect maternity units on mass.

Meanwhile, Birte Harlev-Lam, executive director midwife at the Royal College of Midwives, warned the 15 immediate and essential actions set out in the Ockenden review were not “receiving the attention they need” because of the “focus centrally on continuity of carer”.

She added: “Heads and directors of midwifery are being pressured to write detailed prospective assurance plans for implementation of continuity, while struggling to achieve safe staffing on pretty much every shift. Many of them are already at breaking point and we are really concerned that this level of pressure will push them over the edge.”

She also warned continuity of carer had “unintended consequences”, as trusts have been forced to discontinue their own maternity care models, often involving a woman being under the care of an individual midwife.