3. Inside the working lives of nurses and midwives

Nursing and midwifery form the backbone of the UK’s healthcare system, but the sector faces significant challenges - impacting both professionals' wellbeing and the quality of care patients receive. Administrative data collected by the Nursing and Midwifery Council (NMC) holds the key to understanding these issues, and research using this data offers a path to evidence-based solutions.

This episode unpacks the wealth of information the NMC collects, how it’s being made available for public good research, and the ambitions behind linking it with other datasets. From analysing workforce trends to revealing inequalities, this data has the power to drive policies and interventions that better support nurses, midwives, and the communities they care for.

Our guests, Caroline Kenny, Head of Research and Evidence at the NMC, and Fiona Gibb, Director of Professional Midwifery at the Royal College of Midwives, share their journeys into the sector and provide insight into the experiences of nurses and midwives. They discuss what’s missing in the current evidence base and the meaningful improvements they hope this research can bring to the field.


Wondering what administrative data is? Visit https://www.adruk.org/our-mission/administrative-data/.

If we used any terms you're not familiar with, check out ADR UK's glossary at https://www.adruk.org/learning-hub/glossary/.

For information about nursing and midwifery data recently made available by ADR Scotland, go to https://www.adruk.org/data-access/flagship-datasets/nursing-and-midwifery-council-register-linked-to-census-2021-england-and-wales/ and https://www.adruk.org/our-work/browse-all-projects/exploring-the-dynamics-of-the-nursing-and-midwifery-workforce-749/. 

Connecting Society is brought to you by ADR UK (Administrative Data Research UK). Find out more about ADR UK on our website, or follow us on X (formerly Twitter) and LinkedIn. This podcast builds on a pilot series known as DataPod, produced by ADR Scotland.

Transcript

Shayda: Hello, and welcome to Connecting Society, a podcast about how everyday data can shape our lives. I'm Shayda Kashef, Senior Public Engagement Manager for Administrative Data Research UK, or ADR UK to me and you.
 
Mark: And I'm Mark Green, Professor of Health Geography at the University of Liverpool. We are your co-hosts and guides around the wonders of administrative data.

Oh, episode 3! We’ve made it here so far. It’s good, isn’t it? It's like the long jump—you put in a couple of tries. You know, the first two goes, you get into the sandpit, but you really want to make the third jump count to get into the finals. That’s how I’m feeling today.

Shayda: We’re going for gold today, Mark! Are you excited, because we’re talking about health data?

Mark: I mean, I feel like you’ve set me up here because now the pressure’s on—I’ve got to say something interesting. I’m a bit worried you might find out it’s all just a charade. You know, maybe I don’t know anything about health data, I got my professorship by saving up coupons from the backs of cereal boxes over the years.

Shayda: Coupons from the backs of cereal boxes? Makes me nostalgic.

But on the topic of health data, we are specifically talking about data on nurses and midwives. I don't know if I ever mentioned this, but my sister is a nurse, and it's pretty strange when the silly person that you grew up with is actually a serious professional in a very important job. But unfortunately for me—and probably fortunately for you—she wasn't available to be featured in this episode.

Mark: Yeah, I’m a bit disappointed we don’t have any embarrassing pictures or stories of you growing up. Maybe we’ll save that for another episode.

But speaking of nurses and the U.S., and my segue from that: did you know, Shayda, that one of the longest-running cohort studies is centered around nurses in the U.S.? This is the Nurses’ Health Study, and it has been following nurses since 1976. It’s actually one of the best resources we have for a longitudinal follow-up of health and understanding the risk factors around health, particularly focused on nurses. 

Shayda:  Wow! Go nursing! Although, I’m wary about our producers intervening here, as this isn’t an administrative dataset, so we better move on.

In today’s episode, we’ll explore the potential impact of data from the Nursing and Midwifery Council being made available for public good research by ADR Scotland. We’ll discuss the data they collect, the ambitions behind making it available for research, what the data can help us understand, and how this might lead to real-world impact. We’ll also discuss the experiences of nurses and midwives on the ground, including their perspectives on what’s happening in the sector, what evidence we’re missing, and what changes they’d like to see. 

Mark: And to help us do that, we have two wonderful guests with us today: Caroline Kenny and Fiona Gibb. Welcome to the show, both of you. 

Shayda:  We’d like each of you to introduce yourselves to our audience.  Fiona, let’s start with you. 

Fiona: Okay, well, thank you very much for having me. My name’s Fiona Gibb, and I’m currently the Director for Professional Midwifery at the Royal College of Midwives.

I’ve been working with the RCM now for a couple of years. My role is across the UK, and my portfolio mainly covers anything to do with education, research, and leadership. That’s why I’m really excited to have this conversation with you today.

My background is as a midwife—I’m a registered midwife. I was always interested in women’s health from a very young age, and midwifery caught my attention because of what I saw on television. There used to be documentaries on old Sky channels, like Student Midwives, which was a fly-on-the-wall documentary about people at university studying to become midwives, and another one called Babes in the Wood about a birth centre.

I was fascinated by these. I initially wanted to do something in communications or media—I had a background in amateur dramatics. But at the last minute, I just thought: what am I doing? Here was a topic I was truly interesting in and fascinated by.

At 18, I applied for direct-entry midwifery and qualified at 21. I worked clinically in many areas across the northeast of Scotland and Aberdeen where I'm from. Latterly, I was a senior charge midwife in labour wards, but I also had a passion for teaching so, when an opportunity came up to teach formally at university, I jumped at the chance. I only intended to stay for a year but ended up staying for eight! I was a senior lecturer for the midwifery program at Robert Gordon University. That was a great job.

When this role at the Royal College of Midwives came up, I thought it was the perfect chance to work across the UK, advocating for midwives, promoting safety in maternity services, and creating career opportunities in midwifery.

Shayda:  Your journey in practice and education, from being a student midwife to training new midwives, and seeing how education, the curriculum, and exploring women’s health have changed, it's fascinating.

Fiona:  There’s been so much change in every aspect of the role. The role of the midwife has changed, the needs of women and families have changed, society has changed, and we’ve made it through global pandemics. The way we deliver care and education now is completely different from when I started in 2004. We've learned a lot and I’m sure the changes will keep coming. 

Shayda: Caroline, tell us about you.

Caroline: Sure! I’m Head of Research and Evidence at the Nursing and Midwifery Council (NMC). I’ve been with the NMC for about five and a half years now, which has flown by—it's a bit scary saying that out loud.

My background is in research. I started by exploring issues around social exclusion, poverty, and education, carried on doing a master’s degree, followed by a PhD. The logical next step seemed to be move into academia, so I spent five years there.

One of the things that drove me was, perhaps naively, I wanted to make a difference. I often felt frustrated that the link between my academic work and making a difference to people's lives seemed quite distant and it wasn't easy to see the impact that work was having. 

So I moved into Parliament for five years, which I absolutely loved. It was interesting work — I won’t lie, I loved flashing my pass to get into the Palace of Westminster. My role was all about increasing the use of research in parliamentary debate and scrutiny.

Then this opportunity at the NMC came along. The more I looked into the organisation and its role, the more taken I was with the possibility of making a difference. So that’s how I’ve ended up where I am today.

Shayda:  It's a huge relief to know that people in decision-making roles and positions of authority are motivated by things like wanting to make a difference. I really love your story of starting in one place, exploring social exclusion and issues facing disadvantaged people... I'm really pleased that someone like you is working for the NMC, because you're looking out for people like my sister. 

Caroline:  Yeah, well, I mean, we wouldn't be here without people like your sister and people like Fiona. So yeah, it's a privilege, if I'm honest. 

Mark:  I think it's great to be able to just flash your pass to get into the palace, you know. That's the sort of thing I'm quite jealous about. I wish I could flash my pass and get into Westminster. The closest we've got at University of Liverpool is we used to get queue jump at the pub chain Walkabout, but I don't think that's quite on the same level as Westminster. 

Okay, so we've been asking the same question to all of our guests as part of getting to know them a little better, although I feel like we know you both really well now.

So the question is, what is your favourite statistic? Fiona, do you want to go first?

Fiona: Yeah, I thought about this, and I have to admit my one was a bit of a comedy statistic. I once saw that 93% of people don’t fact check evidence they read on the internet, and that really made me laugh and kind of grounds me a little bit in terms of - statistics can tell you quite a lot of things, but they might not necessarily tell you the whole picture. It's about how you interpret them, how you use them, and how you translate that information to other people.

And it reminded me of that scene in Anchorman, if you're a movie fan, when you know, "60% of the time it works every time." So those kinds of comedy stats for me. I mean, I love a good stat, but I always take it with a pinch of salt. So sorry, it’s a bit of a comedy one for me, but yeah, it made me laugh. 

Mark: That's great, and we’ve got our first Anchorman reference in this podcast series. So that’s even better! That’s like two wins in one stat. Caroline?
 
Caroline: I have to admit this was a tough one for me, because I was like, "Oh, I don’t know what is my favourite?" So after much googling, I’ve gone with the fact that a cloud weighs a million tons, which did kind of blow me away.

Mark: It feels like in the UK, that’s all we’ve been dealing with—just very heavy clouds this whole year.

Shayda: Yeah, I’m pretty sure the UK variant of cloud is much heavier than the rest of the world. Let's move on to hearing about how data shapes experiences in your sector. 

Caroline, can we start with you first? Can you tell us a bit about the types of data the Nursing and Midwifery Council collects and how and why it’s used?

Caroline: Yeah, of course. So the Nursing and Midwifery Council is the UK independent regulator of nurses and midwives in the UK, and also nursing associates in England, which basically means that if anyone wants to work or practice as a nurse, midwife, or nursing associate in the UK, they have to be registered with us.

So we collect a whole host of data and information that supports our ability to regulate nurses, midwives, and nursing associates. As a regulator, the data is collected for our purposes, so it’s not always in a format that lends itself easily to analysis, but there’s lots of information that we have that is both useful for us but also increasingly, we’re aware that it is relevant and useful to people outside of the Nursing and Midwifery Council.

So we have information about the people who are eligible to practice, such as where they were educated or trained, both geographically and also the university or institution, information about their diversity characteristics, stuff about where they live. Bits of information about where they’ve been practicing, also lots of stuff about the qualifications they have, there’s a lot of information that we have that’s important for us as a regulator, but could also be really useful to wider researchers.

Mark: So these data are not really created for research purposes, but they clearly have lots of value beyond what they were originally collected for.

Can you tell us a bit about why the Nursing and Midwifery Council thinks sharing their data for academic research is important, and could you possibly give a few examples of how it has been used?

Caroline: Absolutely. I think it’s fair to say that we are on a journey, along with many other regulators, to try and get our information and data to a point where it can be shared more easily with others, so that they can use it to generate useful insights.

There's an awful lot of expertise out there that we want to benefit from ourselves and that we also want the professionals we regulate to benefit from, and ultimately we want to be used to improve people's care.

Mark: And Fiona, if I could bring you in here as someone who works more with people and less with data, how do you feel about all of this? Were you surprised that such data could be used by researchers? Are you happy with them having access to these kinds of data?

Fiona: Yeah, I think it can show us quite a lot about where we are, how far we've come, and where the gaps in knowledge and evidence are. 

Within the Royal College of Midwives, we collect data as well. But as we are a professional organisation, we're a trade union, run by midwives for midwives, we have about 50,000 members. We listen a lot to them in terms of who they are, where they come from, where they work, what's important to them. We collect quite a lot of qualitative data. However, the quantitative data we use is often from other organisations, people like the NMC, in terms of how many midwives are on the register, how many people leave the register, and when they leave the register.

We also look at things like UCAS - the University and College Admissions Service data - how many people are applying to be nurses and midwives, how many are graduating, what's that workforce pipeline? For us, this data is really important because it gives us a bigger picture of who's coming into the profession, are they staying, and have we got enough for the care we need to provide? It helps us in terms of campaigns and areas we might need to look at to support the workforce and ultimately improve the care we're giving.

Shayda: We're now aware that the data being collected isn't just being used for its original purpose. It's now being made available to researchers as well. 

Caroline, could you tell us a bit about how this data is being stored safely and securely, and what precautions are in place to ensure nurses' and midwives' privacy is being protected and that discrimination isn't taking place?

Caroline: I think it's really important to make it clear that we consider any request to use or share our data very carefully. As a public body, we must be clear about the legal basis for sharing any data. There are prescribed legal bases.

We also need to ensure the relevant paperwork is in place, so we have a robust data-sharing agreement, and then making sure we're being clear with people—in this case the professionals on our register—about how their data is used and give them the option to opt out. We have a privacy notice on our website to make this clear. 

Shayda: Thank you, that's very helpful. Fiona, is this the first time you're hearing about how the data is stored and shared? And if so, or even if not, how do you feel about these processes? Is it reassuring for you?

Fiona: Yeah, as a registrant myself, I don't think when I first joined the register, I understood the full scope of what a regulator does. If I’m being completely honest. You just trust that they've got your best interests at heart, and every three years, you provide evidence that you're still fit to stay on the register. 

As I’ve progressed in my career, I've learned more and started to see the NMC’s yearly reports, the more I’ve gotten interested in what can be gained from that information: where our staff come from, their average age, the roles they’re in. I think it’s really important to collect this data because it allows us to triangulate it with other data for example from the NHS, in terms of the number of people coming through the doors, do we have the right skill mix on the register and across the multi-professional teams to deliver that care?
 
I think it’s really important, and if people are listening to this podcast and starting to understand what the NMC does and what data they have, that can only be a good thing. A lot of professionals probably only know the bare minimum because, let’s be honest, they're very busy people.

Mark: If we can take this forward and think about the research done using these data, knowing that they're handled securely, has anything particularly surprised you about the process of sharing data for academic research and the outcomes that have come from opening up and sharing data?

Caroline: To be honest, I've been blown away by the response we've had—both from the professionals on our register and from the organisations we work with, as well as the research community. We've known for a long time that there’s a real call to action from these groups. They’ve said, "Look, you're sitting on a gold mine. Use this data to help improve the situation on the ground and support the professions you regulate to provide the kind of care we all want." 

Likewise, they want us to use data and insights from outside the NMC to improve our work. We've heard that message for a while, and initiatives like our collaboration with the Office for National Statistics and Edinburgh Napier University have been received really positively.

Another surprise is the topics that people come up with. It’s one of the great things about these initiatives: you collaborate with people who bring different perspectives and ways of thinking. They come up with topics we wouldn't have thought of.

Fiona: For me, it’s probably more practical. As someone who would use the data, I’ve been surprised by how difficult it is to obtain. Quite rightly, confidentiality and data safety are important, but coming into a role like mine now, when I'm looking across the UK and trying to think of solutions for current problems, to have a dashboard of data to get to the crux of what the issues are—not just doing it based on anecdotes but with evidence to back it up to say this is what the problem is and where it's happening, and you can do a more targeted approach - it sometimes feels like you’re driving blind. 

Mark: I can feel your frustration. Sometimes we think all these data systems are joined up, and we’re making the best use of our data, but the reverse is often true. We don’t make the most of all the available data, which, as you say, is frustrating.

Shayda: I’ve picked up on a similar sentiment doing public engagement. There’s a real want to make more use of the available data when it’s shared safely and securely. But, as you’ve flagged, Fiona, there’s a very cautionary attitude towards sharing data. .

Caroline, something you mentioned was there's an interesting list of research topics that came up from analysing this data. Any research that’s particularly interesting to you or that you’re excited about?

Caroline: We’re really excited about the ADR UK fellowship. This is the first time the NMC has been involved in such an initiative, so just being involved is a massive cause for celebration for us. We’re also really pleased that one of the proposals to use NMC data linked to the Census for England and Wales has been funded.

This project, by Dr. Iain Atherton at Edinburgh Napier University, will look at understanding the transient nature of the workforce. This is something we’re not able to do ourselves, so it showcases the power of this collaboration.

Shayda: Yeah, that's very interesting. Thank you. And to just take it back very quickly to what Fiona said about these datasets, they almost verify what we know to be true because they are so big. They are covering so many people. It's like whole population-level datasets. And so having that ability to be able to point to the data, and, have it sort of validate qualitative research or smaller quantitative research is extremely powerful. 

I think we’re kind of close to the end now. Is there anything else that you want to cover before we wrap up? 

Fiona: Well, I was just gonna say, I suppose in terms of, the projects and what would be really useful for us is just learning a bit more about, who are our nurses and midwives? We know they are predominantly female, but how does that relate to things like having children or caring responsibilities? How does that relate to equality, diversity, and inclusion? We know as a profession that we don’t proportionately represent the diversity of people that we care for, who are these people? When do they start? How can we retain them? When do they leave? 

We know from some of the data we’ve done in the RCM that midwives are working significant unpaid hours to keep services safe. That information would make it really interesting for people in government as well in terms of how we make our strategic decision-making and conversations about safe staffing, safe pay, and ultimately attracting people to the profession.

Shayda: Absolutely, Caroline. I know you mentioned Iain’s project. Do you think that would cover off some of the concerns that Fiona raised?

Caroline: Yeah, absolutely. I think, you know, the research project that Iain will be doing is a really good start on that journey. So it will give us really good insights which will hopefully help to influence funding of education and training places. It will give us insights into workforce planning. So we can see more clearly, whether people do move from the region, the geographical area where they trained, into other areas. And if so, you know, where do they go and what are they doing? Potentially, the movement between sectors. So, do people move from education and training into the NHS and end up staying there, or do they combine that with work in the independent or private sector? 

But what we really hope is that, this type of initiative and our efforts in this area raise awareness of us and the information that we hold, and that takes on its own life about generating interest in using this data. So that over time, what we get are more requests not just to use our data, but to have it combined with other sources. We know education is a big gap for us, so we’d love it to be combined with education sources. There’s so much of the data out there that it can be combined with, and as long as that’s done appropriately and safely, then I think that’s where the key will be. That’s where all of these questions will be able to get answered.

Shayda:  Absolutely. I’m personally a huge fan of a multi-pronged approach of combining quantitative data and qualitative data. So weaving in stories, testimonials, narratives in with data analysis. It’s exciting that we are at this point that we are now using this data for research. And I suppose it’s only up from here.

But on that note, I just want to say it’s been fascinating speaking to both of you and learning more about your individual stories and the inspirational work that you’ve been doing in providing healthcare and ensuring that those who do provide healthcare are taken care of as well.

As we’re coming to the end of our episode, we like to end each segment by asking everyone what the point of all of this is. So we’d really like to hear from you about what your work means to you, and how it makes lives better. I know this has sort of been the main topic of conversation, but in a sentence or two, what does this all mean?

Fiona: For me, there’s probably two meanings for this. It’s about the people who are working and providing that healthcare. What can we learn about them? How can we make sure that we keep them in the profession, how are we campaigning to support these people to stay and look after their wellbeing, their financial implications? So there’s that element for me, that it’s about the midwifery profession and making sure that stays strong.

Ultimately, as any midwife would tell you, and nurse, it’s about the people that we care for, and we want to make sure that maternity services are safe and effective.

Caroline: I'd agree with everything that that Fiona says. For us ultimately, it's about improving people's care, as a regulator. It's our role to protect the public. We want to encourage research that improves the quality and safety of people's care. And hopefully, through these types of initiatives and through encouraging research, we can do that.

Mark: Thank you. I mean, it's really important to think about these challenges in the sector more broadly, and about how we can respond to those. 

So, if we imagine that Keir Starmer has just entered the chat in this podcast, he's clicked the wrong link, he's ended up here somehow, and he's been listening to what you just said... he's really passionate now about dealing with these issues. What would you say to Keir now? And what would you like to see happen? What would the change you'd want this new government to bring in?

Fiona: Wow! That's like a million-dollar question, isn't it? I suppose I would want him and the wider government to value the work that we do and the care that is needed. And I don't think you really need to go a day at the moment in this current climate that maternity services are not in crisis in the UK.
 
And I think we have to understand that everyone has some contact at some point in their life with healthcare, with midwives at the moment, to help him understand who they are and fair pay, appropriate staffing. This is not just about numbers. This is about the complexity and the quality of care that's needed.
 
I'd probably talk his ear off about flexible working as well and safety at work, and, you know, understanding that we've got a multi-generational workforce with different priorities and different needs. And we constantly need moving, but that needs to be appropriately funded and supported and valued for what it is.

So, yeah, we will see what it brings, and I know there's a lot of work going on reviewing the NHS at the moment, and we'll be there making sure that we're constantly chapping on the government door to remind them of that. I don't have a pass like Caroline, so I think I have to wait in the regular line, like everybody else, but we'll still be constantly chapping on the door. They won't be able to ignore it.

Shayda: Well, that's everything from today's episode. Thank you to our guests, Fiona and Caroline, and for you for listening.

Mark, do you want to tell our listeners what's in store for next time?

Mark: On the next episode, we're going to sunny Old Wales. Well, not physically. We're going to be talking to ADR UK's Welsh branch about how they're using administrative data for planning for the health needs of the future. 

Until next time, stay curious about how your everyday data might shape society.