NHS trusts could be risking the safety of mothers and babies by using maternity support workers to do the work of trained midwives, according to a report.

An independent study for the Department of Health found that a number of trusts across England were converting midwife positions into posts for lesser-qualified maternity support workers.

When challenged by midwives, Patricia Hewitt, the Health Secretary, has always insisted that support workers would not be used as substitutes for professionally qualified midwives. The report found, however, that in some places they were doing tasks deemed to be within the role of midwives and requiring specialist knowledge and training.

The report said that a lack of consistency in the training and role of support workers had the potential to leave midwives and hospital managers uncertain about their competence, and placed patients at risk from a low standard of care.

King’s College London, which surveyed trust managers in England, noted that there was no statutory requirement for support workers to undergo training, nor any regulation to ensure public protection.

Midwives have legal responsibility for the work of their support workers, but systems to enable them to fulfil this task were variable, the report said. It recommends a national framework to set training and standards and said that the tasks that could be delegated needed to be identified urgently.

The NHS collected little data on support workers’ cost-effectiveness and the report called for scrutiny where they were being trained to take on complex new roles. It found that they made an important contribution to maternity care and managers were enthusiastic about their role, reporting that they freed midwives to spend more time with women and babies. Their role included breastfeeding advice and support; outreach services to vulnerable women; running antenatal and postnatal groups; assisting midwives at home births and in birth centres; and working in operating theatres.

Ms Hewitt promised last month that support workers would not act as a substitute for qualified midwives, as she outlined plans to guarantee expectant mothers a “full range of birthing choices” by 2009. She described reports to the contrary as completely untrue: “They are there to support the midwife and free up a midwife’s time for the work that only she can do. They are not a substitute for a midwife.”

Professor Jane Sandall, who led today’s research, said: “There is a danger that support workers could cease to become ‘another pair of hands’, freeing the midwife and other members of the maternity team from administrative and routine duties in order to look after women. Instead, they may be called upon to substitute care provided by midwives, without sufficient investment in their training or development.”

A Department of Health spokeswoman said: “This study shows that in only a tiny proportion of trusts were inappropriate tasks such as minor examinations being undertaken by maternity support workers. It is completely unacceptable if a hospital is using a maternity support worker as a substitute for a midwife and the Chief Nursing Officer has written out to all trusts to clarify this and asked that they review the working practices of all support workers, ensuring maternity services are provided safely.

“We are very clear about what the role of a maternity support worker is: to support the maternity team in their day-to-day duties, such as clerical work, supporting women with breastfeeding, increasing access for vulnerable women and enhancing the quality of care. In trusts where maternity support workers have been introduced, up to 64 per cent of midwifery time was saved each week and new mothers gained greater choice over where to give birth. This means that midwives have more time to undertake tasks that only they are trained to do.

“Every baby must be delivered by a registered midwife or a doctor. This is a legal requirement not an option.”

Jon Skewes, director of employment relations at the Royal College of Midwives, welcomed the report, saying: “It identifies some major problems regarding the introduction of support workers in England. “Chief among those is the uncertainty about what support workers can and cannot do, and what a midwife can delegate to them. There is a need for greater control, and the report suggests there needs to be better standardisation of training.”

— 3 years - Minimum length of training to become a midwife

Source: Royal College of Midwives

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