“Workforce fatigue”, training “gaps”, and a “reliance” on temporary staff are some of the factors that led to the suspension of Jersey’s home birth service, Express can reveal.
Following a request made by Express under the Freedom of Information Law, the Government has made public its review report into the suspension of the home birth service.
Prepared by midwifery director Roslyn Bullen-Bell, the report provides an “in-depth overview of the circumstances” that led to the suspension.
Ms Bullen-Bell wrote: “A thorough review of the existing home birth service framework will be conducted to ensure that any gaps or shortcomings are identified and rectified before the service resumes.
“We want to provide a safe, caring and effective home birth service as soon as possible, as we know this is crucial offering in providing expectant mothers choice in their delivery.”
The review revealed that the home birth service suspension in October 2024 was prompted by a combination of staffing shortages, training deficiencies, and equipment and infrastructure concerns.
Staffing issues
It explained that the current workforce could not sustain a 24/7 home-birth service, with a “growing demand” for midwives in other areas further straining the ability to maintain on-call coverage.
The report also highlighted “significant concerns regarding workforce fatigue”.
It said: “Staff well-being is essential, as exhaustion and burnout can lead to a decrease in the quality of care, which could compromise patient safety.
“The ability to provide reliable on-call services 24/7, 365 days a year, remains a significant challenge.”
Staff retention and recruitment was also identified as a “long-standing issue”, with the specialised skills and experience required for home births described as “difficult to maintain”.
“The reliance on agency staff to fill gaps in the workforce has only exacerbated the problem, as agency staff are often less familiar with the protocols and expectations specific to home birth services,” the report noted.
As a result, a “thorough assessment” of the current staffing model is due to take place to “determine the most effective and sustainable approach to workforce allocation”.
Training deficiencies
The review also highlighted “several training-related gaps” within the midwifery service, with emergency preparedness identified as “one of the most critical areas requiring attention”.
“It has been noted that current training protocols may not adequately address the specific challenges posed by home births, especially in the case of emergencies that require rapid decision-making and intervention,” it said.
The report also noted that inconsistent refresher training has led to concerns about the ability of staff to maintain required competencies for home births.
Specialised training for midwives and other professionals will therefore take place this month to address emergency and home birth-specific skill gaps, and become a regular part of the maternity training programme to keep staff competencies current.
Equipment and infrastructure
The report also revealed that a “comprehensive audit” of the current equipment and infrastructure will be undertaken to identify any gaps and ensure that necessary supplies are in place and meet current safety standards.
It said: “Ensuring that the necessary medical equipment is available and functional for every home birth is of paramount importance.
“This includes everything from basic medical supplies to more specialised equipment for managing complications.
“In addition, regular checks and maintenance are required to ensure that equipment meets safety standards.”
The report also explained that a “robust transport plan” is essential to ensure patients can be quickly transferred to hospital if complications arise.
“This requires collaboration with the Jersey Ambulance Service and the availability of transport at a moment’s notice,” it added.
Next steps
The report set out a series of steps that must be completed before Jersey’s home birth service can be reinstated.
These include a full review of staffing to ensure the service can be sustainably delivered, targeted training for midwives in emergency and home birth-specific skills, and a comprehensive audit of equipment to confirm it meets safety standards.
Updated clinical guidelines will be finalised and shared with staff, while new transport and emergency escalation plans will be developed in partnership with the ambulance service.
Ms Bullen-Bell described the suspension as a “necessary and responsible step” to ensure the “long-term sustainability and safety” of Jersey’s home birth service.
She explained that, once improvements are in place, a service review will be carried out in the third quarter of this year.