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Regulatory system for midwives to be reformed

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A new regulatory system for midwives is to be introduced, after statutory supervision was branded “ineffective” in the wake of the care failings at the University Hospitals of Morecambe Bay NHS Foundation Trust.

The Department of Health said today that it will work with the UK’s chief nursing officers to design a new system in which statutory regulation and professional supervision are separated.

It will replace the current system where local supervising authorities appoint local supervising authority midwifery officers who have responsibility for monitoring standards set by the Nursing and Midwifery Council.

The Department of Health today issued its full response to the Morecambe Bay Foundation Trust Investigation, which was published in March and led by Dr Bill Kirkup.

“The current set up is open to conflicts of interest which is not in the best interests of public protection”

Jackie Smith

The investigation was set up in response to a series of maternal and neonatal deaths at the trust between January 2004 and June 2013.

It concluded that the local supervising authority system for midwives was “ineffectual at detecting manifest problems” at Morecambe Bay, and the problem was unlikely to be “unique to this trust”.

The government today accepted the Kirkup report’s recommendation that the supervisory and regulatory system for midwives required reform.

In its report – Learning not Blaming – the DH said the statutory supervision of midwives was designed in 1902 and no longer met the needs of current midwifery practice.

It cited other warnings – made in a recent Health Service Ombudsman report and the another from the King’s Fund – that statutory supervision encouraged “confidentiality in a way that does not always contribute to improving practice or systems and can be perceived as protecting the midwife rather than women or babies”.

“This is borne out by the findings of the Morecambe Bay Investigation where the process of statutory supervision was ineffective at identifying the root causes for the many distressing incidents; at identifying and addressing poor practice amongst midwifery staff; and most importantly in addressing the families concerns,” the DH report said.

It reiterated a ministerial commitment made in March to remove the NMC’s oversight of midwifery supervision. “Our intention is to act as swiftly as possible to legislate,” stated the DH report.

The department said it would work with the UK chief nursing officers to design a new system of supervision “that is proportionate and recognises the importance of managing risks and promoting safety, as well as the professional development of midwives”.

“In the process of making the necessary changes we must ensure that the whole regulatory structure for midwives is not undermined”

Cathy Warwick

It added: “Removing midwifery supervision from statute provides an opportunity to design a new system that enables a clear separation between the regulation of midwives (the role of the NMC) and the supervision of midwives.”

It noted that UK-wide work already underway to design the new system, which will include how it will operate in future and where responsibility for its oversight will go.

The move was backed up by a statement made by health secretary Jeremy Hunt in parliament today, which also covered a range of other patient safety policy.

Mr Hunt confirmed he would be removing the NMC’s current responsibility for statutory supervision, and changing to a model of professional supervision similar to that of other health professionals.

However, the DH highlighted that statutory supervision must continue until the law changes and a new system is in place.

The NMC said it “fully welcomed” the announcement that supervision would no longer be part of its remit.

NMC chief executive and registrar Jackie Smith said: “In the interests of public protection and patient safety, the regulator must be in control of regulation carried out in its name.

“We have been pressing for this change following recommendations that the NMC should have direct control of regulatory decisions about nurses and midwives,” she said.

“As seen through the tragic events at Morecambe Bay, the current set up is open to conflicts of interest which is not in the best interests of public protection,” said Ms Smith.

“There is no doubt that access to good clinical supervision is essential for all healthcare professionals. However, it is for employers, not regulators, to take responsibility for this important function,” she added.

The Royal College of Midwives, however, cautioned against losing the value of aspects of the present supervisory system.  

RCM chief executive Cathy Warwick noted that, in the wake of the recent King’s Fund report on the issue, the NMC and UK governments had pledged to explore how the supervision system might be maintained outside a regulatory framework.

She said: “The RCM hopes that this work is completed quickly and that firm commitments are made to maintaining aspects of this vital support system, which aim to ensure midwives can provide high quality care.”

“We are now mindful that in the process of making the necessary changes we must ensure that the whole regulatory structure for midwives is not undermined,” she said.

“At a time when work is underway to ensure the UK’s maternity services deliver the very highest quality of care, it would be ironic if in resolving one particular issue the wider regulatory framework was dismantled,” she added.

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