Hannah Travis, senior associate in the women’s health and medical negligence teams at Bolt Burdon Kemp, explains how the scheme will help address demand for maternity services.
NHS employers will be able to hire newly qualified nurses and midwives more quickly in a bid to boost numbers and improve patient care – but will this actually take the pressure off a buckling NHS service, or is it just a temporary solution to a deeper problem?
The Department of Health and Social Care and NHS England announced what they have called the Graduate Guarantee to reduce red tape, simplify regulations and, overall, speed up the recruitment process.
There are up to three times as many graduates as vacancies in some areas after record numbers chose to study nursing during the Covid pandemic. Trusts have previously been unable to employ staff until vacancies arise, but the new policy will allow hospitals to hire staff based on what they think they might need, rather than relying solely on headcount.
Health secretary Wes Streeting wanted to make clear that there will be support from day one for those who choose to dedicate themselves to a career in nursing or midwifery.
Among many provisions included, one measure aims to create new opportunities specifically for newly qualified midwives, backed by an £8 million investment.
This is commendable, and clearly those involved are listening to the needs of their trusts. One of the key reasons why the NHS is under such strain is the lack of manpower to provide safe levels of care. These new measures aim to tackle understaffing, but is this merely just one step in many needed?
A great starting point
While this is a great starting point to ensure graduates fill roles, what is the plan to keep these confident clinicians feeling like they remain supported and ensure retention later on in their careers?
One of the main reasons we hear nurses and midwives leaving the profession in droves is due to feeling underappreciated through low pay and poor working conditions, as well as the impact of delivering unsafe care, and the sense of job dissatisfaction when things later start buckling under the inevitable pressure of the NHS.
If, on the one hand, graduates are supported into roles, there needs to be a wider plan to retain staff at different stages in their careers and at each band level. Otherwise, all you will have is a revolving door, with too many inexperienced clinicians, and not enough experienced nurses and midwives in a department.
I spoke to Angela Johnson and Lois Peynado, both midwives and directors of maternal health charity Mama’s Embrace, for their thoughts on this. They see daily the impact on their colleagues who are pushed to their limits, especially in overstretched and failing maternity units. They both told me that the Graduate Guarantee is a positive step, but its impact remains uncertain due to limited details on job numbers, timelines, and alignment with workforce needs.
“To truly strengthen midwifery, this must be part of a broader strategy,” they said and include retention incentives, debt relief, adequate training capacity, and transitional support.
“A job guarantee can attract new entrants, but retention depends on making midwifery a sustainable, respected, and well-supported career. Without addressing pay, workload, workplace culture, and career progression, the profession risks continuing the cycle of recruitment followed by high attrition,” they continued.
These are all very important points. The first step would be to retain the dedicated nurses and midwives already working in the NHS, given daily news stories about yet another maternity scandal and the picture looking quite bleak for what conditions and additional scrutiny they face on a daily basis.
Systemic issues
The National Maternity Inquiry, which is set to start now with the first report being ready by December this year, will no doubt further examine the systemic issues resulting in inadequate maternity services. One of those issues will be around staffing, either how there is not enough staff, or those already present are broken and exhausted.
Any findings and recommendations made by the inquiry need to try to resolve the other key issues that have caused nurse and midwife retention to fall to an all-time low.
A recent review by the Care Quality Commission (CQC) of 131 maternity units found nearly half were rated as inadequate or requiring improvement, with 65% failing on safety. One of the recurring issues identified was staffing shortages and a lack of experienced personnel, among many others, which will still need to be addressed.
It is the experienced personnel who now need to be protected.
The CQC identified this in the findings of its national maternity inspection programme, which said many patients were not receiving safe care because of the pressures on staff. Staff also reported that this meant they were not always able to provide the level of care they wanted to deliver.
This scheme will help address demand for maternity services, but not if there is variation across trusts, or if they simply look at staff numbers, rather than experience levels.
Unsafe staffing levels directly impact quality of care, and any deviation from best practice will result in a negative outcome for patients.
Mothers and babies in midwifery units, for example, are at increased risk of complications and can suffer unnecessary harm as a result of not having enough staff. Induction of labour is delayed, elective c-sections are cancelled, regular monitoring of progress or foetal heartbeat is delayed, and the deterioration of health in both mothers and babies can go undetected.
It is therefore imperative that once this scheme has been implemented, there has to be focus next on maintaining safe levels of experienced nurses and midwives already breaking their backs for their profession at all levels and across all trusts. Retention of the staff the scheme has recruited has to be an ongoing priority.
