The committee considered the following reports which are available on the NICE website.

Evidence review 1: Warttig S, Little K (2014) Decision support approaches and toolkits for identifying midwife staffing requirements. NICE.

This report considered the following review questions:

  • What approaches for identifying midwife staffing requirements and skill mix at a local level, including toolkits, are effective? How frequently should they be used?

  • What evidence is available on the reliability or validity of any identified toolkits?

Evidence review 2: Bazian (2014) Safe midwife staffing for maternity settings: The relationship between midwife staffing at a local level and maternal and neonatal outcomes, and factors affecting these requirements. Bazian Ltd.

This report considered the following review questions:

  • What maternal and neonatal activities and outcomes are associated with midwife staffing requirements at a local level?

    • Is there evidence that demonstrates a minimum staffing threshold of safe midwifery care at a local level?

  • What maternal and neonatal factors affect midwife staffing requirements, at any point in time, at a local level?

    • Number of women pregnant or in labour.

    • Maternal risk factors including medical and social complexity and safeguarding.

    • Neonatal needs.

    • Stage of the maternity care pathway (for example, antenatal, intrapartum and postnatal).

  • What environmental factors affect safe midwife staffing requirements?

    • Local geography and demography.

    • Birth settings and unit size and physical layout.

  • What staffing factors affect safe midwife staffing requirements at a local level?

    • Midwifery skill mix.

    • Availability of and care provided by other healthcare staff (for example, maternity support workers, obstetricians, anaesthetists, paediatricians and specialist midwives).

    • Division of tasks between midwives and maternity support workers.

    • Requirements to provide additional services (for example, high dependency care, public health roles and vaccinations).

  • What local-level management factors affect midwife staffing requirements?

    • Maternity team management and administration approaches (for example, shift patterns).

    • Models of midwifery care (for example, case loading, named midwife, social enterprises).

    • Staff and student supervision and the supernumerary arrangements.

  • What organisational factors influence safe midwife staffing at a local level?

    • Management structures and approaches.

    • Organisational culture.

    • Organisational policies and procedures, including staff training.

Evidence review 3: Hayre J (2014) Safe midwife staffing for maternity settings: Economic evidence review. NICE.

This report systematically reviewed and assessed the economic evidence for all of the review questions covered in evidence reviews 1 and 2.

Economic modelling report: Cookson G, Jones S, van Vlymen J, Laliotis I (2014) The cost effectiveness of midwifery staffing and skill mix on maternity outcomes. The University of Surrey.

This report includes a statistical analysis to determine if midwifery staffing is associated with outcomes using delivery records from Hospital Episode Statistics from 2003 to 2013 linked to staffing data from the Workforce Census. An economic analysis was also developed using the statistical analysis and workforce costs.

Report on field testing of the draft guideline: presented results of testing the use of the draft guideline with midwifery staff.