NHS staff have had a 14% pay cut in real terms since 2010. The following article was submitted by an NHS worker, who wishes to remain anonymous, who is increasingly concerned about the challenges the NHS and midwifery face. She talks about the effect of Tory policy implementation, how the lifting of the pay-cap is tokenistic and doesn’t go far enough and why nursing bursaries must be reinstated as a priority.
I began my midwifery training in 2004. At 31 years old, I was a mature student. Having left school at 17 with few qualifications and having my first child just a year later followed by another when I was 21, I spent my children’s early years caring for them at home whilst attending adult education classes in the evenings and working part-time at weekends to fit around my husband’s shifts.
I studied one course per year; including GCSEs in English and Maths and various computer literacy courses. I then did an ‘Access to Further Education’ course which enabled me the points I needed to start my training at University.
Midwifery training was tough. I went to University for my theory lessons, which were usually for about 4 weeks per term of solid study and then one day a week for the rest of the term. My practical training involved working either in the hospital wards, working alongside my mentor, working shifts of 30 hours per week, or in the community. I also attended other placements within the healthcare setting such as A&E, Mental Health, Intensive Care and the Special Care Baby Unit.
Unlike other university students, Student Midwives and Nurses have little time for anything extracurricular. The working hours and endless essays and assessments are extremely stressful and time-consuming. Add to that a family and it can be torture, physically and mentally.
My own birth experiences and that of friends is what led me to pursue a career in midwifery – prior to that, I had no thoughts or desires to enter the profession. When I had my children, I noticed how hard that midwives worked but I also saw many holes in practice – primarily a lack of communication and doctors constantly changing their minds leaving me feeling baffled, frustrated and frightened. I felt that I could make a difference by using my experience to apply better practice: it often upset me to hear women say that they had had a poor experience of having their babies. Not at any time, did I think about the monetary reward for the career, nor did it bother me.
During my training, I received a small student bursary which covered my travelling expenses and helped a little. Also, my tuition fees were paid by the NHS. I could have potentially managed, with a struggle without the bursary but had I had to pay for my student fees, I can almost certainly say that I would not have become a midwife.
I have heard it argued by the government that nursing and midwifery students should be prepared to take student loans to cover their fees and expenses, the same as any other university students – but how are the two comparable? Healthcare students, whilst shadowing their mentors actually work 30 hours a week. They do not sit around watching their mentors do the work, they actually do it themselves – as would an apprentice. The students actually tend to do much of the menial work, emptying bedpans, cleaning up spilt blood, urine, faeces, vomit, listening to people’s woes and anger when things don’t quite go to plan. In what other field would you expect someone to do this for 30 hours a week without pay – and worse, having to actually pay £9,200 (as it is now) per year for the privilege?
Don’t get me wrong – it’s not all bad. There is no better honour than being in the delivery room or the woman’s home when she gives birth. Seeing her face when she greets her newborn for the first time, seeing the usually hardened partner’s face crumble and his arms shake as he holds the precious little being and his life changes forever. Seeing the grandmother greet her first grandchild, having watched her daughter go through the most dramatic time of her life.
My role is very varied, delivering babies is just a small part of it. I get to meet women and their families and care for them throughout their pregnancy and for a couple of weeks after their baby is born. I get to know them intimately – sometimes this is wonderful, other times not so much but it is always rewarding. I get to support women going through a really tough time sometimes – they may be bereaved, suffering from mental health issues, domestic violence or substance misuse, to name but a few. I have to attend multi-disciplinary meetings including police, health visitors, probation officers and social workers – all with the one aim of safeguarding the child/children and where possible, the mother too.
The challenges within midwifery are growing all the time – mainly due to the constant addition of endless paperwork, protocols and ever-changing guidelines. This is not all bad as evidence shows that it leads to better outcomes for women and their babies, such as a reduction in the rates of obstetric emergencies and stillbirths. However, we are being stretched to breaking point, having more and more expectations placed upon us, yet no extra time or staff members to help. Again, pay, for me at least is not in question.
I consider myself fortunate in that I have a husband with a good wage and so mine is secondary to the household – many of my colleagues are not this fortunate and are either the main or sole earners. During Tony Blair’s government, he introduced ‘Agenda for Change’. For the first time in decades, many healthcare workers felt valued when their pay was increased in increments in line with performance and experience. With each increment, we have to demonstrate that our experience and skills have advanced and our line managers sign to say that we are competent to move up to the next pay level. At 9 years post qualification, I now only have one more increment and then I will be at the top of my pay scale. For my colleagues who are already there, due to the pay freeze for the last 6 years and now the 1% pay cap – their pay has increased by a total of 2% in 7 years! Rumour now has it, that the pay cap will soon be lifted – I am certain that the government’s new offer will still be an insult compared to what the profession has had to endure, and still below the rate of inflation, so in reality a real terms pay cut. However, anything is better than nothing, isn’t it?
The stripping away of the student bursary by the Conservatives and forcing new students to pay for their tuition fees has led to a dramatic reduction in applicants into nursing and midwifery. When I applied – I was one of 400 applicants for 20 places. Nowadays, they are lucky to even fill a cohort – is this a good thing? Well, you could say that it means that the application process won’t be quite so tough as there is a lot less competition but on the other hand, this will lead to the recruitment of students who may not be so suitable, leading to a high dropout rate or worse, students or subsequent professionals being struck off the register due to malpractice. Furthermore, the age of applicants is affected. When I trained – at least 50% of student midwives were over the age of 30, now, this is more of a rarity, with the majority of applicants being 18-25. Not that this is a bad thing, but a variety of ages and life experiences is vital for the profession, and candidates who would be excellent for the role are likely being priced out.
So yes, pay increases are important, recruitment and retention of staff is only achievable by making staff feel valued. Most importantly though, for me anyway, is that student bursaries are reinstated so that we can attract people with life experience to the profession.
Given the choice, should there be only one choice, I would happily forego another 5 years of pay increases and safeguard the future of the midwifery profession by embracing passionate and determined people into the profession, with a variety of life experience, who are as things stand unable to make the career jump because of the financial implications of doing so.