Numberjacks: New calculations reveal growing midwife shortage

By Stuart Bona, Public Affairs Advisor on 05 April 2023 Maternity Services RCM UK Education Midwives Midwifery Workforce MSWs - Maternity Support Workers England Pay and Agenda For Change Government NHS Pay Review Body NHS England Politics

The RCM’s Public Affairs Advisor, Stuart Bonar, explains how the midwife shortage in England is getting bigger, rather than smaller.

The NHS in England is short of 2,500 midwives. We can say that with confidence because it is not a figure plucked from thin air. This figure is the product of detailed analysis, looking at how many births are taking place, how many births are taking place in consultant-led units as opposed to midwife-led units or at home, how many midwives are in post, the need for specialist midwife roles, and other factors too.

It is a constantly changing situation, and for that reason the RCM regularly looks at how it calculates how many midwives the NHS needs and refreshes its calculation.

We have just done that again, with a new shortage calculation just released. There are several factors that impact it, so we thought it would be helpful to walk you through them.

First, obviously, is the number of births. We go to the Office for National Statistics and we get the number of live births and stillbirths that took place during a calendar year, and we add these two numbers together. The most recent year for which there are birth figures for England is 2021, and those show a rise of 11,000 births on the year before. A rising number of births obviously means more midwives are needed.

We then estimate the proportion of these births that took place in consultant-led maternity units (we estimate about 94%) and the proportion that took place either in a midwife-led unit or at home (we estimate about 6%). We have ratios of births per midwife per year in these two settings so we use those to get an initial rough estimate of the number of midwives needed for each of those two settings.

These ratios have been adjusted to take account of – to offer just one example – the ageing profile of women using maternity services. Changes such as this impact on the amount of care that the workforce needs to provide.

There are midwives such as heads and directors of midwifery who have roles that need to be factored in. Added to these are midwives with specialist roles such as those focused on smoking cessation or infant feeding support. We add a supplement to take account of these necessary roles.

Some of the activities traditionally carried out by a midwife are today carried out by maternity support workers, of course, so we allow for this too, which reduces our estimate of the number of midwives needed overall.

We crunch all these numbers and this gives us the number of full time equivalent (FTE) midwives the NHS in England needs to function well. When we input all the most recent numbers, the result was that, according to our estimates, the NHS in England needs the equivalent of 24,588 full-time midwives.

We then compare this with the number actually in post. If that is a smaller number then we have a shortage. The most recent numbers at the time we made the calculation were for December 2022, published by NHS England (formerly NHS Digital), when 22,108 FTE midwives were in post in the NHS in England.

The number of midwives is published monthly and does vary quite widely over the course of a year. In August 2022,  there were 21,231 FTE midwives, but by November there were almost 1,000 more, with the number standing at 22,230. We chose December because it was the end of the year and the most recent month.

Do the maths (24,588 minus 22,108) and it reveals a shortage of 2,480 full-time midwives. As these are estimates, we usually round this number up or down to avoid giving the impression it is more precise than it is. Our latest estimate is therefore that the NHS in England is short of the equivalent of 2,500 full-time midwives.

The Government committed in November last year to recruit an extra 2,000 into the NHS in England. That is less than our estimate of the shortage but, frankly, an extra 2,000 would go a fair way to addressing the shortage. We are – and will continue – to press them on the need not just to make promises but to deliver the extra midwives the NHS needs. Our solid, evidence-based calculations help us make that case.