Midwives 'calling in sick because they can't afford travel'

It comes as figures this week show that one in 20 midwifery posts in Scotland is empty – rising to more than one in 10 in the Greater Glasgow and Clyde region.

Members of RCM Scotland had backed strike action over pay in a ballot, but the trade union is now consulting midwives on the Scottish Government's improved offer which would provide average uplifts of 7.5 per cent. 

The consultation closes on December 19. 

In an interview with the Herald, Ms Lambert, who was appointed in February this year, said: "No midwife wants to go on strike.

"You wouldn't have thought even six months ago that we'd be having these conversations but there does come a point where we need to be able to say how frustrated we are. 

"I've had a head of midwifery in Scotland tell me that she'd been phoning round staff who'd been phoning in sick to find out why.

"It was the end of the month and it turned out they'd been phoning in sick because they didn't have the money to get into work. That is unheard of. 

"I wouldn't have believed it if I hadn't heard it directly from a head of midwifery - you just think 'what on earth?'. It's unthinkable."

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Midwives in the first two years of their career earn between £26,000 and £28,000, and would see their salaries increase by around 10% if they current pay offer is accepted. 

However, Ms Lambert stressed that the majority of RCM Scotland members are Band 6 midwives earning between £33,000 and £40,700 a year.

For those at the top of that pay scale, the current pay offer would equate to an uplift of around 6%, with less for those in senior leadership roles. 

She said: "While it's great for maternity support workers and our early career midwives - and we absolutely want them to be paid appropriately - it really does concern me that we're not rewarding those people who take on extra responsibility. 

"In years gone by these percentages might have looked great, but at the moment they just aren't cutting it. It's a pay cut."

The latest workforce statistics, published on Tuesday, show that 5.5% of midwife posts were vacant by the end of September this year, compared to 2.8% in September 2015, despite a record 700 student midwives joining the health service in September. 

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The vacancy rate ranges from zero in NHS Ayrshire and Arran to 11.4% in NHS Greater Glasgow and Clyde, but Ms Lambert said the official figures are not necessarily an accurate reflection of the real pressures on frontline staff. 

She said: "I'm slightly concerned because what some of the heads of midwifery tell me in terms of vacancies isn't reflected in those numbers that are reported. 

"For example, if I have a vacancy that I can't fill and I put in two support workers - just to make sure there are bodies on the ground - that will then not show up as a midwifery vacancy.

"It's also not telling you what your vacancies are based on your workforce tool that takes into account acuity, population need, and all those different variables; it's telling you against the staff establishment [the total number of funded posts].

"Those are two different things."

Midwife vacancy rates by region and over time in NHS Scotland (Image: TURAS)

Understaffing, burnout and fears that services were too overstretched to always provide safe care were highlighted in a survey of RCM Scotland members last December, to which nearly 900 midwives responded. 

Concerns over quality of care were cited by six in 10 of those who said they were thinking of quitting.

It comes as figures obtained by the Herald under freedom of information today reveal that more than 1000 investigations have been launched by health boards in Scotland over the past decade into significant adverse events in maternity, obstetrics, gynaecology and neonatal services. 

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In November, the MBRRACE monitoring report found that - excluding Covid - there had been 220 deaths between 2018 and 2020 in UK mothers during or up to 42 days after pregnancy, equivalent to a 19% increase in the maternal mortality rate compared to 2017-2019. 

Blood clots and psychiatric disorders - leading to suicide or fatal alcohol and drug abuse - were the most common causes of death. 

The vast majority (86%) occurred in the post-natal period, and mothers were three times more likely to die by suicide in 2020 compared to 2017-19. 

No regional breakdown was available, but maternal mortality in Scotland is also understood to have increased. 

A recent study in the BMJ also found that - pre-pandemic - the UK had one of the highest maternal mortality ratios in Europe, at 9.6 deaths per 100,000 live births, compared to 2.7 and 3.4 in Norway and Denmark respectively.  

Ms Lambert said the MBRRACE report was alarming, particularly in light of the cost of living crisis. 

She said: "What does it tell you when you've got increased levels? In a way, what it tells you is the state of a country.

"It tells you about the difference between rich and poor. 

"If you look at the causes of death, you're looking at mental health, you're looking at suicide.

"The causes are moving away from what you'd think of as the traditional causes - bleeding, eclampsia, obstetric emergencies - and instead what we're seeing is a shift to it being mainly in the postnatal period, to that impact of mental health and inequality. 

"This is something we should be hugely worried about because it shouldn't be happening.

"I was in Denmark not that long ago - same latitude, very similar population, similar birth rates - but completely different outcome data.

"Again, there's a country that has done a lot to mitigate against the impact of inequality.

"Our maternity care is good, but what we cannot do is fix the challenges that people are facing as a result of inequality and cost of living. 

"Housing, heating - these are the things that are making the huge changes to people's outcomes. That's more than a midwife can do."