More than half of Britain's maternity units are putting mothers and babies at risk because of a national shortage of midwives, MPs warn.
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In a damning report on the state of maternity care, the Commons public accounts committee criticised both the Department of Health and NHS England for being unable to tell it who is accountable for "ensuring something as fundamental" as whether the NHS has enough midwives.
It said it had gathered evidence that "many maternity services are running at a loss, or at best breaking even, and that the available funding may be insufficient for trusts to employ enough midwives and consultants to provide high quality, safe care".
The report added: "Although there has been a welcome increase in midwives, there is still a national shortage of some 2,300 midwives required to meet current birth rates.
"Pressure on staff leads to low morale and nearly one-third of midwives with less than 10 years' work experience are intending to leave the profession within a year.
"Over half of obstetric units do not employ enough consultants to ensure appropriate cover at all times.
"Evidence suggests quality of care is less good at weekends."
The committee reported that rates of infection among new mothers, infection to the baby and injury to the baby "are all higher at the weekend".
It added: "Although there have been substantial improvements in levels of consultant presence on labour wards in recent years, over half of obstetric units were still not meeting the levels recommended by the Royal College of Obstetricians and Gynaecologists at September 2012."
The MPs said the Department of Health acknowledged that a seven-day-a-week service was required and that it needed "to work out how to achieve this in terms of employment contracts and affordability".
But despite a new overall payment framework being introduced for maternity care, the Department of Health has only "limited assurance" the funding is enough to deliver key objectives, such as continuity of care for women.
The cross-party group of MPs also said more than a quarter of maternity units had to close to new patients for half a day or more between April and September 2012, with one of the reasons being a lack of midwives.
While many women have good experiences, "performance and outcomes could be much better", the report said.
Rates of stillbirth and babies dying within seven days of birth were still higher in England than other UK nations and there was too much variation in the quality of care offered by different trusts.
MPs also pointed to the "too high" NHS compensation bill for when maternity care went wrong, adding: "The most common reasons for maternity claims have been mistakes in the management of labour and relating to Caesarean sections, and errors resulting in cerebral palsy.
"The clinical negligence bill for maternity services is too high.
"Maternity cases account for a third of total clinical negligence payments and the number of maternity claims has risen by 80 per cent over the last five years.
"Some £480m, nearly a fifth of trusts' spending on maternity services, is for clinical negligence cover, equivalent to £700 per birth."
The MPs also called for women to be given more choice over where to give birth, with research on more than 5,000 women showing that only a quarter wanted to give birth in a hospital obstetric unit.
Nevertheless, 87 per cent of women gave birth in this setting in 2012.
Almost half of women surveyed said they wanted to give birth in a midwife-led unit inside a hospital.
Labour MP, Margaret Hodge, who chairs the committee, said: "The vast majority of women who use NHS services to have their babies have good experiences, but outcomes and performance could still be much better.
"Despite an overall increase in the number of midwives there is still a shortage of 2,300 that are required to meet current birth rates - a truly worrying figure.
"What's more, the Department of Health and NHS England struggled to tell my committee who is accountable for ensuring something as fundamental as whether the NHS has enough midwives.
"As things stand, there is evidence that many maternity services are running at a loss, or at best breaking even, and that the available funding may be insufficient for trusts to employ enough midwives and consultants to provide high quality, safe care."
Cathy Warwick, chief executive of the Royal College of Midwives (RCM), said: "Maternity services are many thousands of midwives short of the number needed to deliver safe, high quality care.
"The birthrate remains exceptionally high and as this and the National Audit Office report states, births are also becoming increasingly complex.
"This puts even more demands on midwives and maternity services.
"We are seeing areas such as antenatal and postnatal care in particular suffering because trusts often do not have enough midwives to provide consistent and high quality care before and after pregnancy."
She added: "At the moment there seems to be a gap between the actual cost of maternity care and the amount of money hospitals get to provide it.
"This cannot continue and maternity services need to see the money they receive meet the cost of care.
"If this does not happen I fear services will be cut, choice will be reduced and care will suffer."
19 November 2012
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