Sunday, June 3, 2012

How Many Midwives are there at Queen's Hospital?".

Neil Zammett Writes:-
 I have been reviewing the BHRUT papers, in May some 377 pages, trying to pick up on any key issues for Maternity and to my surprise I noted that in the executive summary of the workforce key performance indicators on page 2 the following statement:

Since June 2011, 37.80  Full Time Equivalent (FTE) midwives have commenced in post bringing the total number of midwives in the Trust to 287.35 FTE’s and, as already discussed, demonstrating an increase of 17.89 FTE’s over the 12 month period.

Unfortunately we are also seeing the number of midwifery leavers increasing – since June 2011 we have seen 39.90 FTE leavers.  Midwifery bank and agency FTE bookings increased in March by 6.67 FTE’s on the February position.

The report explains earlier staff in post growth differs from starters and leavers analysis because of timing issues to do with the payroll and changes in hours.
As it stands however the report shows that for the time period June 2011to March 2012 there was an apparent net loss of midwives and an increase on the previous month in bank and agency. My surprise is obviously due to general impression which has been created by the Trust that midwifery staffing and recruitment has improved. 

Going back to March 2011 after an initial report by the CQC, the Trust said:

“Funding is in place to bring 49 extra midwives to the Trust and we have recruited to 50% of these posts in the last week alone.  Further interviews are taking place at the end of this month.  We are redesigning services at Queen’s Hospital to make care safer, and improve the experience of women in labour.” 

 And in October 2011 just after the main CQC report was published the Trust said that:
 “Recruited an additional 72 midwives to ensure one-to-one care for women in labour”.
And yet again in January 2012, this time showing the full press release:

16th January 2012
Director of Nursing Deborah Wheeler said: “We have had great success in recruiting midwives to the Trust. Just this week we interviewed 40 trained midwives for positions at Queen’s and King George, and now have one of the best midwife to birth ratios in London.“
 Towards the end of 2010 the Trust travelled abroad to recruit experienced foreign midwives to the organisation.

“ At that time there was a shortage of midwives in this country and, like many other Trusts, we went to other countries such as Ireland and Belgium to find high calibre professionals.
“ Forty-six foreign midwives were taken on in addition to UK midwives. All passed extensive tests and interviews, and were given a thorough induction to the Trust.

“ Seventeen of these midwives have since left the organisation, while the majority continue to work for the Trust, and have proven to be real asset to the organisation.”
Obviously timing is an important factor there are delays between interviews and appointments and some job offers are not taken up.  The reality however appears to be that in a twelve month period, presumably April 2011 to March 2012 the net gain to the Trust was around 18 whole time equivalent midwives, not 49,72, 46+ or even 29 (46-17).

Presumably some of the Trust’s earlier statements refer to the use of Bank and Agency staff to improve the midwife to patient ratio and also exclude leavers.  I can understand the Trust wanting to put a positive slant on recruitment and I applaud the efforts which have been made but the question has to be asked, is this approach actually going to work in the long term?

Despite all the hype the increase over the last twelve months in midwives is only just over 6% and this will be eroding further over time.  In fairness to the present and past Boards at BHRUT this is not a new problem and I can remember spotting a comment from the university appointee, a doctor, from a few years ago to the effect that ‘we have been talking about recruiting permanent staff for months now but we still rely on bank and agency.  We urgently need to get on and do it’.  Not his exact words of course but the sentiment I remember.

What is important is that we focus on the real problems and not short term solutions which may mask these.  There is a crying need to look across East London at midwifery staffing and to match this to future demand.  Initiatives at BHRUT may simply create shortages elsewhere, or ‘drain’ the overseas recruitment market.  Extensive use of Agency staff pushes up costs and may again put pressure on the pool of midwives available in East London.

I would emphasise that this is not BHRUT’s responsibility but that of East London and the City cluster PCT.

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