Matching Workforce To Demand In A Time Of Change

At this present time many maternity services are facing change, including the merging and development of services, and need to review their staffing needs.

Although a number of services have commissioned a full BR+ study, others may find that this is not practical either because of time/financial constraints , or because of major changes in services which mean that staffing needs to be based upon projected annual numbers of hospital or home births and the likely volume of community care.


Option 1 – Comprehensive Review

This will enable a comprehensive review based on ‘models’ of care, such as a Birth Centre/Midwife Led Service, together with a detailed breakdown of staff per area and model(s) of care. It will aid with deployment of staff and identify where there are specific shortfalls or surplus of staff.  Data collection for 3 months will provide a reliable and valid casemix along with other intrapartum and ward activity.  The intrapartum casemix has the major impact on the midwifery establishment and thus it is recommended to collect current data, rather than use figures from a previous study.

The collection of casemix data can be undertaken retrospectively from a Maternity Information System, the birth register and case notes and/or concurrently. The actual method will be determined by the easy availability of the clinical dataset and preferred timescale for having staffing figures. A midwife is best to oversee/undertake the collection of data as the casemix is based on clinical indicators. There is other intrapartum data required and the source of this data can be confirmed at the planning and training meeting. The annual activity in a co-located birth centre is generally available.

It may be necessary to set up a simple data collection process for the antenatal & postnatal ward activity if the information is not available, but this will be discussed at the planning & training meeting.

Assessment of outpatient and community services does not require intensive data collection and will be based on a typical weekly profile of clinics and day units, plus annual activity for community. There may also have been other service changes that require assessment in order to provide a robust establishment. The BR+ dataset for outpatient services will be completed in a meeting with the manager for the services.

Community data is usually available so should not require specific collection. Current maternity statistics will also contribute to the BR+ dataset.

The skill mix in terms of non-midwifery posts is included, along with non-clinical midwifery roles.

From this approach, it will be feasible to produce ‘local’ births/cases to wte midwife ratios, which will assist with future planning of services as well as enable a more accurate comparison to nationally cited ratios.

The Birthrate Plus Team will provide the following services:

  • Planning & scoping of maternity/midwifery services with midwifery management team
  • On & off site support to project midwife to ensure robust data
  • Provision of all material needed both for training, data collection and analysis
  • Data validation & analyses both on & off site
  • Feedback and confirmation of final results with midwifery & skill mix recommendations
  • Report of findings including presentation of ratios for future planning purposes

Some local project midwife time is needed to be primarily responsible for collection of the casemix, which is approximately 15 hours per week for the time it will take to produce the 3 months’ casemix. The plan will be based on availability of the necessary clinical data from a Maternity Information System and/or the birth register & case notes.

Option 2 – Ratio Based Profile

This option will use ratios of women/births to midwives for the intrapartum care of women, home births, and ante & postnatal wards. The ratios are based on data from similar units and will calculate the staffing for delivery suite and the ward(s). The co-located birth centre can be assessed as a specific model of care based on an annual dataset. Outpatient’s services and day units/triage are assessed, as with option 1 – a detailed weekly profile is produced so specific staffing calculated. Staffing for the community services is based on total women receiving ante &/or postnatal care irrespective of place of birth. A judgment of the current casemix will be made based on intrapartum statistics for types of delivery. No additional data collection is required.

This approach is useful when a baseline is required, rather than information based specially on the clinical profile. Whilst this provides a realistically accurate assessment of the intrapartum and ward requirements, it does not give precise results.

Fewer resources are needed, as it is not necessary to collect the casemix and ward activity.

This approach is completed within a shorter timescale.  On receipt of the data and following any further follow up; the information is analysed to produce a staffing profile. A report would then be produced and presented on site so that discussion and clarification can take place. The skill mix in terms of non-midwifery posts is included, along with non-clinical midwifery roles.

 See also: Birthrate Plus Report 12pp Feb 2014_3