Midwifery leaders must have more say over the services their teams provide

A Royal College of Midwives leadership manifesto sets out seven ways to improve care

A Royal College of Midwives leadership manifesto sets out seven ways to improve care

Picture: iStock

There has never been a more important time to commit to strengthening midwifery leadership.

Maternity services are rightly under the spotlight. The recent survey by the Care Quality Commission (CQC 2019) shows, for example, that not all women have the same-standard birth experience. Even more shocking, stillbirths and neonatal death rates, while reducing, are still unacceptably high, while variations in outcomes among maternity units cannot be ascribed to differences in population.

Maternity is the main reason for admission to hospital (CQC 2017) and the most costly in terms of litigation (NHS Resolution 2019); getting things wrong in maternity care comes at a high human and financial price.

NHS shop window

Delivering the government’s aspirations for the safest maternity services in the world requires skilled, innovative and motivational leadership, with direct access to the decision makers who influence the corporate NHS agenda.

Maternity services are often seen as the NHS’s shop window and yet our surveys of members show that midwifery leaders can become lost in structures and hidden in the nursing hierarchy.

Many heads of midwifery have not been developed strategically to have wider influence over the shape and direction of their service.

Service improvement

At the Royal College of Midwives (RCM) we are putting leadership at the heart of everything we do. 

We have expanded our leadership development courses and we are seeking to work with other providers to tailor opportunities, making them relevant to the maternity setting.

Our i-learn courses include programmes for members at all levels, from support workers through to heads of midwifery. The programmes focus on leading for service improvement, leading for safety and leading for cultural change.

Manifesto for leadership

Most importantly, we are launching at the end of May a manifesto for leadership with seven aims:

  1. A director of midwifery in every trust or health board, and a head of midwifery in every unit. This is not simply about titles; directors of midwifery are strategic professional leaders and advocates for safe, high-quality maternity care. They manage the strategic and operational delivery of maternity services locally.  
  2. A lead midwife at a senior level in all parts of the NHS at national and regional level. There are still NHS arms-length bodies with roles in monitoring, inspecting and overseeing maternity care in which there is no chief midwifery office to ensure their programmes and approaches are rooted in an understanding of services.
  3. A consultant midwife in every maternity unit. Consultant midwives are highly experienced and acknowledged clinical experts. They lead, support, coach, mentor, inspire and empower their midwifery colleagues, and are responsible for evaluating, developing and improving maternity service provision.
  4. Funding for midwifery leadership development. Investing in midwifery leadership sends a clear message that the NHS values its people. Programmes that include developing, mentoring and coaching can be the catalyst for a maternity unit to become a great place to work.
  5. More specialist midwives throughout the NHS. Specialist midwives provide expert advice to colleagues, and to women and their families. They also act as a resource for colleagues and champion improvements in services.
  6. RCM to be involved in the appointment process of midwifery leaders. Heads and directors of midwifery must have the skills and experience to lead and manage maternity services, professional credibility, and the confidence of their midwifery colleagues and peers.
  7. To strengthen and support sustainable midwifery leadership in education and research. A strong midwifery workforce is the responsibility of not only the NHS, but also our universities. These are where the next generation of midwives are trained and where academic researchers who expand the evidence base are employed. Lead midwives for education help to ensure high standards in midwifery education, and are a vital intermediary between the Nursing and Midwifery Council and universities.  

The RCM believes nurse leaders should welcome and support these aims. They should not be responsible for a separate profession, nor for services they do not deliver.

We should all be ambitious for our maternity services, but we should know they can be improved if midwifery leadership is strengthened.


Care Quality Commission (2017) Maternity Care Experiences.

Care Quality Commission (2019) Maternity Services Survey 2018.

NHS Resolution (2019) Maternity Incentive Scheme.

About the author

Gill_WaltonGill Walton is chief executive at the Royal College of Midwives

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