Like all trusts, we have been working hard to ensure we are compliant with the recommendations of the Ockenden review that was written in the wake of the failure of maternity practices over many years at Shrewsbury and Telford NHS Trust. 

One of the Ockenden recommendations is that the Midwifery Continuity of Carer Model (MCoC) should be suspended until safer staffing levels are in existence. MCoC allows for a small team of midwives to provide care all the way from ante natal appointments, through delivery - where 24-hour care during labour is available - to post-natal check-ups. 

With MCoC, the accepted ratio across the country is one midwife to 36 women. This is a much lower ratio than is seen elsewhere in the community where, typically, one community midwife looks after around 150 women. It is a service that is designed to offer support to those women who are most at risk during their pregnancies. When we introduced it as a pilot, we worked in Upminster, Cranham and Harold Wood where we tend to care for lower risk mothers. 

We have assessed our current staffing levels (including our vacancy rate) and to be compliant with the Ockenden recommendation on MCoC, we will suspend the service we currently offer from 23 May. We will continue to have community midwives in all our boroughs. 115 women affected by this change are more than 28 weeks into their pregnancies. We will strive to provide them with the MCoC service up to the point of labour.

MCoC is usually offered from the 28-week stage, so 152 women who are less than 28 weeks pregnant will receive their care from a community midwife rather than a MCoC team. The key difference is that the community midwives have larger caseloads and can’t provide support during labour.

Pausing the provision of MCoC allows us to redeploy several of our community midwives to parts of our three boroughs where there are more ‘at risk’ mothers and babies. We cannot sustain a service where in one borough there is a midwife for every 36 women compared to another of our boroughs of one to 150. We need to use our resources fairly and where the most benefit will be delivered.

We have a shortfall of 34 midwives which is a ten per cent vacancy rate. These posts will be filled in the coming months by the overseas midwives we have recruited and by the students who will be joining us in November. 

We intend to resume our MCoC provision when we have reached safer staffing levels. Our pilot has shown it is a very worthwhile service. When we re-introduce it, we will use MCoC to tackle some of the inequalities and deprivation that exist in Barking and Dagenham, Havering and Redbridge and we will focus it on those most vulnerable and most at risk. 

Matthew Trainer, Chief Executive