Introduction:

In July 2022 the Royal College of Midwives (RCM) called on the Government to urgently act to stop England’s maternity services from “spiraling into an ever-worsening crisis”. A Health and Social Care Select Committee Expert Panel’s report showed a serious shortage of midwives and immense pressures on England’s maternity services. The report also came shortly after the government announced a 4 per cent pay increase for midwives and maternity support workers.

According to the RCM, England has a shortage of 2,000 midwives, with figures showing there were 600 less midwives in April 2022 in comparison to the previous year. England has seen a decade and more of serious midwife shortages with the situation worsening on a monthly basis.

Consequently, staff morale is at an all-time low as midwives face a raft of demands to evidence the quality and safety of the care they deliver. Quite literally, midwives are leaving the profession despite their passion and commitment for their chosen vocation, and many of those considering midwifery as a future career are being put off due to damaging media statements like “ Midwives feeling burnt out and undervalued.”. Without a stable and sufficiently staffed workforce, safety and quality of care is compromised and mistakes are made – as evidenced in the Ockenden report.

A recent HSJ roundtable article debated if environmental factors were also contributing to why staff find working conditions unacceptable and leading to some leaving the profession.

“….staff are working in buildings that lack natural light, ventilation, and connection with the outside world. Some staff are routinely exposed to excessive heat and stale air. One panellist revealed that she had visited a rest area for nurses which was windowless and “boiling” ’’

Overlay this desperate workforce situation with the expectation (for those remaining midwives) to also, simultaneously, adopt digital transformation in Maternity, and it’s clear to see that the adoption of digital isn’t without its challenges .

Both the Ockenden Immediate and Essential recommendations (published March 2022) and themes in the 3 Year Delivery Plan for Maternity and Neonatal (published March 2023) cite the need to invest in and retain the workforce to deliver safer care. The recommendations also cite how the use of technology has a pivotal part to play in transforming Maternity services.

Problem:

Much has been written around possible reasons for poor adoption of technology within healthcare. In Oct 2021 an excellent opinion article published in the nursing times, written by a midwife, discussed this very issue.

This article resonated with me as a clinician as I am sure it will have done so with many others who read the piece. However, based on my involvement with Maternity Information systems (MIS) implementations over the years in many maternity services across the UK – there appears to be common themes directly related to poor digital adoption as a consequence of shortage of midwives.

To begin with, the first problem occurs at the point of Systems pre-procurement, and the opportunity for Midwives to.

Fundamentally Trusts will be focused on finance, interoperability and data which is all very relevant for a Trust to meet CQC standards, and to deliver data to support the Clinical Negligence Scheme for Trusts (CNST), and the Maternity Services Data Set (MSDS) etc. However, Midwives generally look at the requirement from a clinical and professional perspective with drivers such as Clinical safety and quality of care being of paramount importance. It is therefore essential that Midwives have a voice at pre -procurement stage to contribute their expert opinion on requirements from a digital perspective and for the supplier to set out how their system will meet those requirements. This is a great way to secure important input and give midwives a voice at an early stage, and to help enthuse and motivate the workforce.

The role of the digital midwife and digital project champions is the next area of contention. Well before implementation is underway, it is crucial that there is a in post. This role is seen by the NHS England Maternity Transformation Programme as non-negotiable and they aspire for all Maternity services to appoint a Trust digital midwife. This role is pivotal to many of the project workstreams, from Business change to training, from system configuration to testing – the list is not exhaustive. Failure to fund and appoint a digital midwife will have a significant impact on the success of the project. Again, a MIS implementation is arguable a clinical / departmental project as apposed to a pure IT project. Having midwifery involvement is key to ensure new business processes allow for data capture required for local and National submissions such as MSDS v2. The Cost implications of getting this wrong because there is inadequate leadership and workforce driving data capture can have devastating financial implications such as not meeting CNST and Maternity services payment pathway requirements.

Digital midwives also need to drive the clinical safety agenda by ensuring that clinical guidelines and recommendations from national organisations such as NHS England and governing bodies such as the National Institute for Health and Care Excellence (NICE) and the Royal College of Obstetricians (RCOG) are adhered to. This can be extremely time consuming and cannot be expected to be carried out with rigor if the digital midwife is also expected to work clinically for a disproportionate amount of their working week.

If Maternity services struggle to ringfence time and funds to resource appoint a digital midwife, they may consider the power of division of labour, and seek to establish Digital champions from across all areas of the service that can dip in and out to support the project where required. This powerful cohort of enthusiastic midwives can reach out to the masses, reinforcing communications and providing hands on / practical help where a single digital midwife may struggle to achieve single handedly. It makes good sense to promote adoption of technology across a service by the support of likeminded peers who can encourage colleagues but equally support those that are struggling with the necessary skills.

There are key activities that play an important part in the successful adoption of Digital in Maternity services – again these are reliant on having a workforce that can reliably investigate, deliver solutions, and influence change. Running a documentation review alongside the MIS project with the objective of eliminating swathes of unnecessary paper will allow for true adoption of a digital record. The short-term investment ensures the long-term gain. Reducing duplication in record keeping saves time, which in turn goes a long way to help when there is a shortage of midwives. We often hear the frustrations of midwives who say, “Hands on care first – paperwork second”, an understandable statement but double edge sword when the same midwives are required to keep a contemporaneous record in a highly litigious specialty.

Another activity which will pay dividends when there is a shortage of midwives is to undertake a thorough connectivity audit to ensure that technology can be used remotely and outside of the acute setting. With most Antenatal care delivered in the community, in women’s homes, GP surgeries, children centres and within community hubs, this reduces the need for midwives to travel back to base to update records. Continuity of care and community teams are more likely to be effective if digital technology is available to help manage their caseload of women, particularly where there is a shortfall in workforce.

Once the service has decided how they want to implement and the project is underway, training is the next hurdle that is impacted by shortage of midwives. Training midwives to use technology can be a logistical nightmare for the Service. In addition to ensuring safety on wards by having sufficient capacity (helped somewhat by acuity tools such as Birth rate +), Managers need to factor in back-fill and release of staff for digital training in addition to clinical and professional updates.

Online learning has proven to be an invaluable innovation to assist with training particularly in software adoption and it is essential each department has champion users who can support staff in using the system until they feel confident. Effective guidance can be provided via remote classrooms and offers real time engagement with learner midwives. Training platforms have been built to mimic the classroom and are usually designed by professional system trainers. The main benefits include offering inclusivity regardless of location, where all learners can experience the same learning experience they would in a classroom except remotely. Midwives need to feel confident in what they have learnt so they can return to the workplace ready to embrace their newfound skills without introducing risk or delays in delivering and recording care.

The way ahead:

Despite the clear challenges outlined above, there are many positive examples of good practice published where Midwives have embraced technology.

These include:

In May 2023 Midwives from Southampton winning a National Award for an app they developed that improves Maternity care and safety for woman during pregnancy
Other Mobile Apps: offering educational resources, guidelines, and support tools. These apps provide access to up-to-date information, clinical calculators, drug references and interactive learning modules. The apps can improve decision making and stay informed about the latest research and best practice.
Telemonitoring and Telemedicine: The use of remote monitoring devices, such as wearables or home-based monitoring kits, to collect vital signs, fetal heart rate. This allows midwives to remotely review data and provide guidance, reducing the need for in-person visits and enabling more convenient and timely care.
Online collaboration platforms: allowing communication with colleagues, the ability to share information and seek advice from peers.

On 31 January 2022, NHS England – Transformation Directorate, Misbah Mahmood (digital Midwife) wrote:

“Digitising our maternity services is transforming the way we work. Digital midwives are leading change; digitising records, notes, and systems, so we’re no longer reliant on paper-based processes. This is empowering health and care professionals to safely and securely access, manage and share information as part of a multi-disciplinary team to make informed and timely decisions”.

On 30 June 2023 , the UK Government announced its ambitious workforce plan with the promise of 300,000 more NHS Clinicians by 2036.

The RCM response to the workforce plan was one of mixed sentiment. Whilst the plan undoubtedly delivers in many of the areas of concern such as the expansion of apprenticeships and greater investment into the retention of existing midwives, they point out the success of the plan is dependent on the Government making clear how much investment it is prepared to make. It therefore goes without saying that the continued and sustained adoption of technology in Midwifery services can only be achieved if the shortfall in Midwives is addressed.

With these great examples and some of the themes from the workforce plan, there are grounds for optimism for the future of maternity services, and for the adoption of digital technology which will be pivotal if we are to attract, motivate and retain the workforce, and make sure maternity services can deliver the safe, high quality and efficient patient care the public needs and expects in the years to come.

Apira has been providing Consultancy to the NHS for over a quarter of a century, with a track record of delivering a vast array of Digital projects including Maternity systems, with expertise in Business Cases, Procurement, Implementation, Transformational change, and Optimisation / Adoption.

If you would like to discuss how Apira could help you embark on your journey please get in touch with our Director of Growth, Rory Dennis – rory.dennis@apira.co.uk

Author: Sharon Hunt

Sharon is a seasoned Registered General Nurse with extensive experience in Business change and benefits, helping organisations to procure and adopt technologies and leading change to deliver improved patient care. She is accomplished at implementing complex EPR and clinical solutions in NHS healthcare settings as well as understanding and navigating the ever changing landscape for todays clinicians, driving the agenda for the delivery of equitable and safer care for all service users. Outside of work Sharon has a keen interest in theatre arts and enjoys the peace and tranquility of the beautiful beaches in the South West

Opinion – How the Midwife shortage is affecting digital adoption in Maternity services

Introduction:

Problem:

Much has been written around possible reasons for poor adoption of technology within healthcare. In Oct 2021 an excellent opinion article published in the nursing times, written by a midwife, discussed this very issue.

The way ahead:

Despite the clear challenges outlined above, there are many positive examples of good practice published where Midwives have embraced technology.

Author: Sharon Hunt