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Staffing in maternity units: getting the right people in the right place at the right time

Getting the right people in the right place at the right time


  • Jane Sandall

  • Caroline Homer

  • Euan Sadler

  • Caroline Rudisill

  • Ivy Bourgeault

  • Susan Bewley

  • Pauline Nelson

  • Luke Cowie

  • Chris Cooper

  • Natasha Curry

Maternity services – in common with the rest of the NHS – need to focus on new ways of working to maintain and increase levels of safety and quality of care within the resources available. There are particular pressures on maternity services because of the rise in birth rates and the increasing complexity of many births.

Following on from its previous inquiry into the safety of maternity services, The King's Fund commissioned further research to answer a fundamental question: Can the safety of maternity services be improved by more effectively deploying existing staffing resources?

Staffing in maternity units: getting the right people in the right place at the right time concludes that using midwives and other maternity staff more effectively is the key to improving maternity care. The report considers the available evidence about the relationship between staffing levels and deployment practices and safety of care for mothers and babies, focusing specifically on labour and birth. It sets out the policy background and the workforce issues currently faced by maternity services. It reviews evidence particularly on:

  • the relationship between staffing levels and outcomes

  • the potential for shifting tasks between various health professionals and making use of new and extended roles

  • the effectiveness of different models of care

  • the impact of these on use of resources.

The report includes a small number of case studies to illustrate innovative approaches to staffing in maternity services in England. Some of these have the potential to improve safety and women's experience of labour while also saving costs.

The report's conclusions include the following.

  • Midwife-led models of care should be deployed across the service for low- and medium-risk women, releasing obstetricians to focus on women with more complex needs.

  • New and emerging models of care suggest there is potential for cost savings while maintaining levels of safety, particularly the shifting of tasks between nurses, midwives and doctors, as well as the use of maternity support workers and doulas.

  • The Birthrate Plus tool needs to be developed into a multi-professional tool to allow effective planning across the different professions.

Find out more about our Safer Births programme