The government is to go ahead with introducing reforms to midwifery regulation legislation, despite the vast majority of people who responded to a consultation objecting to the plans.
In total, 84% of the 1,424 respondents taking part in the Department of Health’s consultation exercise disagreed with legislation changes that will see the removal of statutory supervision for midwives.
Meanwhile, 91% said they did not want the legal requirement for the Nursing and Midwifery Council to have a midwifery committee to be removed.
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Midwives responding to the consultation said the changes raised concerns about patient safety and would reduce support for registrants in practice. They also said there could be a potential loss of representation by midwives in the NMC, which could be detrimental to the profession.
Despite these concerns, the Department of Health said it will still go ahead with its plans. It wants to introduce the reforms after a number of reports – including the high profile one into University Hospitals of Morecambe Bay NHS Foundation Trust – identified problems with the current system of regulation.
“These changes will help to make midwifery and nursing as safe as it can be”
Under the current system, midwives can be investigated by supervisors locally, without the involvement of the NMC, when a complaint is made about their practice. However, the DH said the present system represented a conflict of interest.
In its response to the consultation results, which were published yesterday, the DH said it “acknowledges the concerns” that people raised about the removal of statutory supervision for midwives.
But it said this additional tier of regulation – which no other healthcare profession has – needed to be removed so the NMC had full control of regulation of midwives.
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In 2015-16, the NMC was only passed 5% of fitness to practise cases for further investigation from the local supervising authorities (LSAs) that deal with midwifery complaints locally under the current system.
In assessing the impact of the reforms, the DH noted that the NMC was expected to see an increase in the number of midwife FtP referrals as a result of the changes, which would increase its costs by of around £2m in the next 10 years.
It said it expected the NMC to manage this effectively and highlighted that the regulator believed that seeing more FtP cases than it does now and potentially being made aware of serious issues would ultimately improve regulation of the profession.
“[The DH] expects the NMC to provide assurance that appropriate arrangements are in place”
Government response to consultation
The DH also highlighted that a new system for supervising midwives was being developed by the four UK chief nursing officers to ensure registrants did not lose support in practice.
In response to concerns that the removal of the NMC’s midwifery committee would mean the profession lost its voice within the regulator, the DH said it “expects the NMC to provide assurance that appropriate arrangements are in place in relation to obtaining midwifery expertise”.
Under the changes, the NMC will not be prevented from setting up midwifery groups and the regulator’s statutory duty to consult midwives on relevant matters will remain, said the DH.
The reforms were consulted on as part of wider legislation changes affecting the NMC that will allow it to deal with FtP cases more quickly.
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Health minister Phillip Dunne said: “We want the NHS to be the safest healthcare service in the world – by giving the NMC direct responsibility for regulating midwives, and making the NMC’s assessment of midwives’ and nurses’ fitness to practise more efficient, these changes will help to make midwifery and nursing as safe as it can be.”
Jackie Smith, NMC chief executive and registrar, said: “I have long maintained that our current legal framework is out of date and in need of significant reform and I am pleased that the government has recognised this.
“We have worked closely with the Department of Health on these important changes which will enable us to become a more efficient and effective regulator, better able to protect the public.”
In a report published in 2013, the Parliamentary and Health Service Ombudsman identified a conflict of interest between midwifery regulation and supervision.
Responding to the new legislation changes, ombudsman Julie Mellor said: “The government acting on our midwifery recommendations is an important step to improve the safety of mothers and babies.
“Separating midwifery supervision and regulation will encourage learning and improvement when things go wrong and remove any conflict of interest,” she said.
”This legal milestone would not have happened without the brave families who came to us seeking justice after suffering harrowing ordeals. We owe them a debt of gratitude,” she added.
“Some of the outcomes are a disappointment for the RCM”
Cathy Warwick, chief executive of the Royal College of Midwives, said she was disappointed that the NMC’s midwifery committee would be disbanded, despite the depth of feeling against its loss in the consultation, and called on the regulator to stick to its promise to ensure midwives had a “significant voice” within it.
She also called on the four governments within the UK to outline “robust plans” on the future shape of midwifery supervision following its removal from the NMC’s remit of responsibilities.
The NMC told Nursing Times it recognised concerns raised by some midwives about the changes.
However it said plans for new models of supervision were now ”well advanced” in each of the four countries of the UK and that it was ”confident that the things about supervision most valued by midwives will continue in the future”.
It reiterated that the NMC would continue to need ”access to sustained, four country midwifery expertise in order to regulate midwifery effectively”. It said its council would ”shortly be discussing how best to secure this”.
RCM comment in full on changes to NMC governing legislation
Cathy Warwick, chief executive of the Royal College of Midwives, said: “We recognise that the intention behind these changes is to ensure more streamlined, efficient and quicker processes around fitness to practise. We support a focus on regulation that provides assurance for the public and provides professionals with a fair and transparent process.
“Midwifery supervision will be removed from the remit of the NMC, and its regulatory aspects will go, but the RCM has worked hard to ensure that it continues in some form. All four UK countries recognise the importance of this and are keeping this role. What we need to see now are robust plans from each of the UK countries outlining the way forward for midwifery supervision. We are working closely with each of the UK governments on these plans, and we will be monitoring implementation to ensure that professional support, development and restitution remain a part of delivering safe maternity services.
Professor Cathy Warwick
“Some of the outcomes are a disappointment for the RCM and I am sure for our members. The loss of the NMC Midwifery Committee is something we campaigned against. Its loss is disappointing given that 91% of midwives responding to the consultation were against removal.
However, the NMC has given assurances that midwifery will continue to have a significant voice. I look to the government and the NMC to come through on their promises in this area. We will be working with them to determine what form this will take and to ensure that the midwifery voice continues to have a strong presence within the NMC.
“The fact that the NMC will be able to issue warnings against a registrant in a fitness to practise case, even when there has been found to be no case to answer, is a huge concern. What is important now is that when this happens the registrant is supported by their employer to resolve the issue, and additional training, if needed, is provided.
“What we all want out of this is an effective and efficient regulator that protects the public. What is important now is that we all come together to make the new system operate effectively for the benefit of the public and for midwives. The RCM will be working hard to ensure that this happens.”