Along with ‘thinking outside the box’ and ‘touching base’, another annoying phrase that corporate jargon has inflicted on the English language is ‘do more with less’. This little gem has been particularly popular since the 2008 recession, when many businesses were ‘downsizing’ and expecting their employees to achieve the same results as previously, but with far fewer resources.
Of course, this idea extends beyond the business world, as anyone who works in health care knows only too well. Funding has been slashed every year, as demand for services continues to rise. In the face of increasing pressures, various policies have aimed to reorganise services so that outcomes may be improved despite all the cuts. Among these is the new Maternity Transformation Programme. NHS England has called on local areas to act as ‘early adopters’ of the programme; they will be required to establish local maternity systems to ensure women and babies receive safe, personalised care, in line with the recommendations from the National Maternity Review (2016). According to NHS England (2016), there will be ‘a limited amount of funding available’ to these early adopters.
Funding—and its limits—is rather a sensitive issue in midwifery at the moment. Last month, the government confirmed its intention to push ahead with plans to axe the student bursary for midwives and nurses in England and introduce tuition fees (Department of Health, 2016). The Royal College of Midwives (RCM) has condemned the government's position; director for policy, employment relations and communications Jon Skewes said the RCM had ‘grave concerns’ for the future of maternity services and the midwifery profession in England. The changes to student funding are likely to exacerbate the current shortage of around 3500 midwives.
And it's not just student funding that is causing financial woes for midwifery. The RCM has also expressed concerns in the wake of an announcement that the NHS is set to take action to dramatically reduce the annual deficit in all Trusts. There are fears that this action could involve cuts to funding and staffing in services that are already stretched and, according to Skewes, ‘are being kept afloat by the sheer hard work and dedication of staff’. The RCM's Caring for You campaign has highlighted worrying problems faced by midwives and other maternity staff, such as feeling dehydrated at work because they don't have enough time to drink (Leversidge, 2016). This is a concern not only for the wellbeing of the workforce, but also for women and babies. If midwives are burned out and dehydrated, how can they be expected to perform their jobs to the highest standard?
There are some great ideas in the Maternity Transformation Programme and—if implemented effectively—there is a real chance that it could improve services across England. But it feels like policymakers are giving with one hand and taking with the other. Local areas cannot be expected to take responsibility for transforming services without national support. There is a limit to how far you can push the ‘do more with less’ ethos. As the latest financial policies look set to further reduce the number of midwives in England, we may be close to reaching that limit.