This is an unusual post for me. Below is the gist of a letter I have written to my MP to suggest that this game of chicken being played with NHS staff – vaccination or the sack – could become unstuck if it is introduced in April.

Mandates are common in other nations, with the US and Italy leading the way, but over here their widespread introduction is new and not without problems.

This applies particularly at the sharp end of healthcare, and no end is sharper than services for maternity. There are already considerable problems with stretched staff and problems covering shifts. Coupled with that, 96% of midwives have been vaccinated – in any terms that is a success – but now sacking the unvaccinated 4% would be inappropriate and dangerous. Let me explain why…..

Midwives are already struggling

Already, across the country there are problems with the care of babies and mothers. Even before the pandemic, 40% of midwifery units were rated as needing improvement. The pandemic is certain to have increased this already unacceptable number. 

The CQC suggest there has been some improvement, but from a very poor baseline.

Recruitment problems worsened in 2017 when midwives had to start funding their own training. The belated provision of a £5,000 annual bursary in 2019 only partially reversed this. Austerity driven pay cuts have also had an impact, and now the problem of overwork and danger have become commonplace. Experienced midwives, like GP’s, are retiring whenever they can due to unsustainable pressures at work.

A Royal College of Midwives survey from November 2020, found:

8 out of 10 midwives (83%) do not believe their NHS Trust or Board has enough staff to operate a safe service. Services are already stretched almost to breaking point, with 42% reporting that half of shifts are understaffed, and a third saying there are very significant gaps in most shifts.

These shortages are taking their toll on midwives and maternity support workers, with morale at rock-bottom. Seven out of 10 (71%) have considered leaving the profession, while over a third (38%) are seriously thinking about it.

Midwifery has become more difficult

Simultaneously, midwifery has got trickier. Women are getting older when they begin their first pregnancy, now delivering at an average age of 31. Obesity has also increased significantly with all its implications for pregnancy. The consequent increase in caseload, complexity and danger means we need corresponding increases in midwifery and obstetric provision. Yet, one in three midwives are approaching retirement and the number of young midwives is falling. This is worrying.

Chronic problems

Adding to this is the chronic underfunding of and understaffing in the health sector which underlies so many tragic problems – and then COVID19, with its particular impact on pregnant women and foetal health. The current avoidable problems for babies and mothers in Essex follow those elsewhere, but everywhere maternity services are under dangerous stress. It goes without saying that now is not the time to reduce the number of UK midwives, yet that is what enforcing the mandate in April will achieve. 

This shows how we are falling behind with spending on health as a share of wealth, and how this has taken place with successive Conservative governments.

Vaccine success and the mandate

I write as someone who has had all my vaccinations, and was a keen vaccinator all my professional life, and so understand the science behind the drive to ensure NHS frontline workers are vaccinated against COVID. I appreciate the incredible value of vaccination, and encourage vaccination through my blog.  

Nevertheless, you can’t convince everybody. That 96% of midwives have been vaccinated can be seen as a success, yet there many of the remaining 4% who would rather lose their job than have the jab – that is what will happen and we have to live in the real world.

It has been estimated that about 2000 midwives jobs are at risk. This will, according to the Royal College of Midwives, add to the shortfall of 2500 midwives we have right now. There are 53,000 midwives in the UK. So enforcement of the mandate could potentially lose 4% of our midwives.

Till now, almost all vaccinations have been accepted with encouragement and trust – without the need for enforcement. (Hep B for health care workers excepted) The vaccine mandate in Social care has caused problems where up to 60,000 staff (8% of the total) were at risk. As a result, two thirds of home care providers are now turning away new clients due to staff shortages according to a survey from the National Care Forum.  

The Social care Mandate has exacerbated the crisis of unacceptably high rates of bed occupancy in the NHS. It is even more difficult to place vulnerable people in the community.

That is bad enough, but there are many parts of the NHS where skilled experienced workers simply cannot afford to be lost, with Midwifery at forefront. 

I cannot put this any more strongly. Midwifery is the most important profession in the world, every mother and every baby needs their skills and experience, and for them to have the time and energy to do their job properly. Sadly this is no longer the case. There are tragic and lifelong consequences for families when things go wrong. There are also huge economic implications as short term savings lead to far more long term costs.

I know belated efforts are being made to improve the situation with midwives, but progress is too slow. Midwifery need immediate support, including funding for training and pay increases, but it is not all about money; it’s also about removing the anxiety and fear of working on understaffed labour wards. Any further sudden loss of staff could jeopardise the functioning of many units where there is no spare capacity – in other words, there will be more harm, injury and death. 

A Political Way Out

I hope you will see that in practical terms the decision to mandate vaccination or sack NHS staff must not proceed. With the Omicron variant spreading fast, leading to a milder illness and hastening widespread immunity, there is an acceptable political route to for a change of mind without loss of face. 

There are also ways of looking at the immune status of unvaccinated staff to see how well they are protected, including antibody levels and perhaps even their T and B cells which confer long term protection. This, coupled with regular testing would help keep these staff in work, benefit the patients they serve and prevent a dangerous loss of staff, along with their experience and expertise.

I would be grateful if you could communicate this to the Health Secretary. 


If you feel inclined, feel free to use the information in this post to lobby your MP. I have to say, copying and pasting seems not to work so well. MP’s don’t like mail-shots where they get lots of identical letters from different constituents. A short letter would do. To find out how to do this, click here.

In any case, thanks for reading the post and as usual, if you have any comments or questions, then do leave them in the box below.

Till next time, I wish you the best of health..

5 thoughts on “Mandates and Midwives

  1. Thanks Colin for writing this letter. Makes a lot of sense.
    But an important point seems to be missing which would further support the case for not sacking NHS staff:
    Vaccination has not been shown to significantly reduce transmission, hence the decision to get vaccinated or not, should really be left as a personal choice and should not be presented as an issue that really effects others.

    1. Hello Mr “The Truth”. I will cover this in the next blog post. The vaccines, along with public health measures are not as effective at reducing transmission against Omicron as with previous variants, but with boosters, they do reduce the risk of infection and thus transmission.

      To quote the latest (Jan 20th) surveillance data:

      “As described above, several studies have provided evidence that vaccines are effective at preventing infection. Uninfected individuals cannot transmit; therefore, the vaccines are also provide some protection against transmission. There may be additional benefit, beyond that due to prevention of infection, if some of those individuals who become infected despite vaccination are also at a reduced risk of transmitting (for example, because of reduced duration or level of viral shedding). Several studies have provided evidence of reduced risk of household transmission from vaccinated cases compared to unvaccinated cases”

  2. The graph is quite enlightening, despite Cameron’s boast to safeguard the NHS on his election in 2010, he continued to lower the portion of GDP spent on the health service.

  3. Thanks for this, and your support for midwives.
    I weep for the state of the NHS and what’s expected of it’s highly skilled and dedicated staff!
    Unfortunately, while they are propped up/ backed up by private health care and ‘locum’ staff on better conditions, I don’t see how we will improve working conditions of NH staff.
    I despair 🙁
    Is there any chance of the NHS getting the political & financial support that is vital for its survival, do you think?

    1. If we increased our spending on health to the EU average then things would be a good deal better. Funding training too. Personally, I think a Labour government would definitely help.

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