Midwives should no longer be investigated by supervisors, according to a recommendation from a major independent review looking at how to improve regulation of midwifery.
The review, which follows the maternity care failings at Morecambe Bay NHS Foundation Trust, said this “additional tier of regulation” by local supervising authorities – for which there is no equivalent in nursing – was not justified.
Instead, the Nursing and Midwifery Council - which currently oversees the work of LSAs and takes fitness to practice referrals from them – should have “direct responsibility” for regulating midwives, said the King’s Fund, which led the review.
“The additional layer of regulation…for midwives and the extended role for the NMC over statutory supervision should end”
The King’s Fund
The change in the law this would require means the statutory requirement for midwives to have a supervisor would be removed.
The report noted that most midwifery stakeholders were concerned that this law change would result in supervisors being eliminated altogether, which would remove an important source of support for them.
The Royal College of Midwives said that if the NMC were to accept the King’s Fund recommendations, this would wipe out “an important aspect of pubic protection”.
RCM chief executive Cathy Warwick told Nursing Times: “The idea behind the supportive element of the system is that [supervisors] identify practitioners who may be feeling that they lack competence at an early stage and then do something to rectify that before it gets to the point of harming someone.”
While recognising the supportive role that supervisors play for midwives, the King’s Fund said that this should not come under the NMC’s remit and that in the future “others in the health care system should take on responsibility for ensuring these functions continue”.
“[Supervisors] identify practitioners who may be feeling they lack competence at an early stage and do something to rectify that before it gets to the point of harming someone”
But the RCM said it was “very worried” that no other body would be willing to take on this job.
The King’s Fund review was commissioned by the NMC following investigations by the Parliamentary and Health Service Ombudsman in England’s into failures in maternity care at Morecambe Bay NHS Foundation Trust.
The PHSO also recommended that the NMC should be in direct control of regulatory activity, and that midwifery supervision and regulation should be separate – because it led to a conflict of interest between midwives and supervisors.
In its review, the King’s Fund found that the extra tier of regulation for midwives did not appear to stop unnecessary referrals being made to the NMC or delay necessary referrals.
It also found that there was no evidence to suggest either way whether the risks associated with midwifery meant the additional layer of regulation was required, but said it was clear that it did cause confusion for patients and the public about where responsibility lay.
It concluded: “The NMC as the health care professional regulator should have direct responsibility and accountability solely for the core functions of regulation.
“The legislation pertaining to the NMC should be revised to reflect this. This means that the additional layer of regulation currently in place for midwives and the extended role for the NMC over statutory supervision should end.”
The NMC Council meets on 28 January to decide whether to accept the recommendations made in the King’s Fund review.