Annex A

Q. Are there jobs for all the midwives who return to work after training? Do I understand correctly that some nurses in midwifery training are paid while others are not, which is hardly an incentive to return to the profession? Is there currently a crisis in neo-natal midwifery unit in the Royal Maternity Hospital: are nurses having to go to England for specialist courses in this field? [Ms McWilliams]

A. Yes, there are jobs for all those midwives returning to work after training. However, there is not consistency across the board in terms of payment for nurses in training. For example, a number of nurses currently in midwifery training who responded to the RMH's advert are being paid, while others are not.

Nurses have to undergo a six-month training course to work in a neo-natal midwifery unit, where the nature of the work is extremely stressful. The further advanced course for a neo-natal nurse practitioner is only available in the south of England. There would not be sufficient expertise in our NI universities to meet the local demand for, say, one or two such specialist places per annum, though that could change if the numbers indicating a desire for this training increased substantially. At present recruitment is difficult in this area nationwide. It is a vicious circle with units poaching from one another. While the finances are available for new staff, the RMH's neo-natal unit has currently 10 nurse vacancies.

Q. Can you explain the reason for the statistic that some 63% of trained midwives are not working in their own field? Is there any potential for developing facilities for older people to come back into the profession and redress the shortfall in numbers? [Mr McFarland]

A. Historically, in order to get promotion nurses were encouraged to obtain an extra qualification, as this was seen as advantageous. In many instances nurses trained to become midwives to advance their career and not necessarily because they had a particular interest in that field. Once they had the qualification, many transferred back into general nursing. Nowadays there are specialist courses for A&E nursing, for example, and we are trying to attract those trained midwives back into the profession. Many, though, return into mainstream nursing rather than having to undertake a refresher course in midwifery. Also, the changing nature of modern work patterns has meant too that more midwives work part-time and job-share, which affects the continuity of service.

The problem for older people coming back into the profession after a lengthy absence is that the sheer pace of work now in maternity units is incomparable with, say, 10 years ago. The throughput of expectant mothers has tripled - 24-hour turnaround is now the norm - and there have also been major changes in technology, such as epidurals, and the use of IT. Additionally older people generally want to work part-time, which presents difficulties for continuity of care.

Q. I appreciate that it would be daunting for someone to go back to midwifery after 20 years. Given that the service is understaffed and under pressure, how can we counter the problem of not having enough nurses return to midwifery by attracting more people into the profession? For example, the direct-entry system that you mentioned seems a good idea. [Ms Hanna]

A. It is something of a chicken-and-egg situation. More staff are needed to tackle shortages across the profession, yet as more people leave, thus making the conditions for the remaining midwives more stressful, this inevitably lessens the appeal for anyone considering such a career. Certainly people need to feel supported. On a positive note, there is no shortage of interest in midwifery training places. Next week, 170 applicants are being interviewed for 30 places on the course at Queen's University. We would like to see the number of places increased to 40 in order to tackle current shortages.

Q. Has the panel any ideas on how to reduce the very high proportion of midwives working part-time, which I understand stands at 70%? [Mr Berry]

A. This is a great dilemma right across the public sector as women try to balance work commitments with family needs. The closure of smaller maternity units has meant that many midwives now have to travel much further to work and consequently choose to reduce their hours. A big factor is the length of time that it takes for a nurse to train as a midwife in NI compared with GB, which means that the age profile for qualified midwives (28 to 30 years generally) coincides with child-rearing years and part-time work patterns. There would be potential for full-time employment in the intervening years if they were qualifying younger through the direct-entrant scheme available in GB.

Q. Do I understand you correctly that a fast-track model for midwifery training which bypasses the three-year general nursing course is operating already in GB? [Mrs Robinson]

A. Yes, a three-year direct entrant midwifery training course is operating in England, Scotland and Wales, and recent UKCC statistics show that over 50% of midwives now registering are direct entrants. Moreover, research shows that they tend to stay in the profession. A similar scheme is being piloted in the ROI in Trinity College Dublin, where 20 midwives are in training.

Q. Has the panel been in discussions with the Department on the issues of concern, and if so what was the response? [Ms Ramsey]

A. We met with the Minister in December last in relation to the recruitment and retention problems and the demand for a regional strategic plan for the future delivery of maternity services. As yet, there is no commitment to meet our request to increase the number of student places from 30 to 40, but the Minister is considering the introduction of the direct entrant scheme, possibly from September 2002.

At last week's annual conference of the Royal College of Midwives in Torquay an emergency motion to lobby the Government for aid for Northern Ireland, Scotland and Wales to help modernize maternity care, as the Health Secretary has promised for England, received unanimous support.

Health and Social Services Minutes 9 May 2001