In a few weeks’ time, Parliament will debate midwifery regulation.
The RCM has been at every step of the process over the last two years, helping our members take regulation from its Edwardian roots to a new 21st century model, keeping the things we know that work and are in your interests. It hasn’t been easy, but we have ensured that the midwifery voice is heard loud and clear across the four countries. Before this next step, we thought it was good to outline the story from the start and how we got here.
How did we get here?
Back in 2013, the Parliamentary and Health Service Ombudsman (PHSO) followed by the King’s Fund in 2015 released reports outlining the way midwifery supervision needed to change to better protect women and babies.
Supervision, as it currently works, is based in legislation from 1902, and updated in 2001. In July 2015 the Government announced it would change this legislation, in line with the Nursing and Midwifery Council’s wishes. The main effect of this was to take supervision out of legislation and give the NMC, as the regulator, responsibility for all regulatory decisions regarding midwives.
So what would this new form of supervision, and regulation more widely, look like? The RCM took the opportunity to lay out our vision in March 2015. Like the PHSO and the King’s Fund, we reasserted that clinical midwifery supervision has real potential to positively influence the care that women receive, so we wanted it, in some way, to remain in place. Beyond regulatory investigations, supervision is about support, development and leadership. The NMC and the RCM agreed that taking supervision out of the legislation need not affect those activities – it simply confirms that those are not part of the NMC’s role.
But we still had serious concerns about the other changes the NMC was proposing as part of the changes to the legislation. Supervision isn’t the only thing that would be affected by legislative change. The NMC were proposing to remove the entire ‘Midwifery’ section of the Nursing and Midwifery Order 2001, which also provided the statutory basis for the Midwifery Committee in the NMC, and the Rules as to midwifery practice.
The Midwifery Committee is currently the voice of midwifery within a nursing dominated NMC. Midwives make up less than 10% of the Register. It’s inevitable that without the Committee, regulation for midwives will be largely determined by the nursing profession, and that’s not right. We are also worried that without the Midwives Rules and standards, the NMC must step up and provide guidance to employers and others on the role and responsibilities of midwives, delegation, safe staffing and skill mix to ensure the public is protected through care being provided by the most appropriate health care professional. We outlined all these concerns and where we think progress could be made in a briefing paper in September 2015 and on our blog.
The Department of Health (DH) is the part of the government responsible for removing the legislation, through Parliament. We were happy to see our ideas for a new model of supervision taken forward when they outlined their plans in January 2016. The four Chief Nursing Officers (CNO) in the UK, led by the DH, began working on a system of non-statutory supportive supervision and leadership in midwifery. In short, their proposals were:
- To create of a new system of midwifery supervision when statutory supervision is removed, being an employer led, professional model
- That the NMC will focus on using its regulatory functions (to include revalidation from April 2016) to protect the public
- Each UK country will convene a task force (led by the CNO of each country) to bolster the preparation of heads of midwifery as leaders and stewards of quality and to oversee the transition from a statutory model of supervision to an employer led, professional model
We were happy to see these measures proposed, but were still very concerned about the proposed loss of the midwifery committee and of a loud midwifery voice throughout the NMC. The Department of Health then took these proposals out to a public consultation in April 2016. We asked to you give your views and over 800 of you did, thank you! In our response, we reiterated our commitment to developing a new model of supervision working with the CNOs. But we were still concerned about the abolition of the Midwifery Committee and aspects of the Midwives Rules and standards, especially over fitness to practice (more on that later). We vowed to raise our concerns at the highest level, so we spoke to a number of MPs and Peers -including Dr Sarah Wollaston, the Chair of the Health Select Committee, and ministers in the Department of Health - to explain how the NMC had got it wrong.
In January 2017 the DH published the results of the consultation and what it planned to do in light of the comments received. Many respondents were against what was proposed and in the case of the abolition of the Midwifery Committee, 92% of respondents were against. We were as disappointed as you were to see the DH and NMC announce they would press ahead regardless of our views. But it wasn’t over.
On 25 January 2017 we heard from the NMC that your concerns really were heard. Protections will now be put in place to keep the Midwifery Committee a powerful voice in the form of a non-statutory Midwifery Panel. As our Chief Executive Cathy explained in her blog:
An enhanced Midwifery Panel will have a remit to provide “strategic input into policy or regulatory proposals affecting midwifery matters”. The NMC is now committed to promote the Panel too, to raise recognition of it and its work. Additionally, the NMC has stated in clear terms that they remain obligated in law to consult midwives on matters that affect the profession. That legal requirement will not be affected by the planned changes. There will also be more midwives employed in key posts in the NMC itself.
Statutory supervision of midwives is set to end, as will the legal requirement for NMC to have a Midwifery Committee. But thanks to sustained pressure from the RCM and from individual midwives, we have now hopefully secured an enhanced professional voice at the NMC. It may not be guaranteed in statute, as before, but it is there – and we will fight to keep it.
So where are we now?
The DH now has to take the legislative change - The Nursing and Midwifery (Amendment) Order 2017 - through the parliamentary process. We’ve been briefing MPs and peers on what we’d like them to raise with the government during the parliamentary debates.
We’ve got five things we want the House of Commons and House of Lords to debate as the Order progresses through Parliament:
- We want to make sure the NMC keeps it promise to give due regard to the midwifery profession, even when the Midwifery Committee us taken out of statute. The NMC must put in place robust systems to ensure that they continue to be advised by the midwifery profession on all matters that relate to midwifery.
- Work on a new model for clinical supervision is underway in all four countries, but it’s likely there will be variation in the systems finally put in place. As supervision is taken out of statute, we’d like to see assurances that there will be robust arrangements in place for Health Boards and Trusts to provide supportive clinical supervision for midwives and adequate funding for training of these new supervisors.
- The current Midwives Rules and standards will be withdrawn with the removal of the Midwifery Committee and Supervision of Midwives from statute, so we’d like Parliament to ensure that the NMC continues to provide standards and guidance of relevance to midwives.
- We’d like to see stronger midwifery leadership at the highest level of government and in the regions, which is even more important when the post of Local Supervising Authority Midwifery Officer (LSAMO) is taken out of statute. The DH and NHS England should appoint a Chief Midwifery Officer at national level and Directors of Midwifery at regional level, like they do for nursing.
- We have some concerns with the changes to Fitness to Practice, which could see the introduction of a range of new sanctions including ‘warnings’ for midwives which could be disproportionate and unfair. We’re calling for these warnings to be put in place only where there is a valid concern and risk to public protection, with consent from the registrant, who has the right of appeal. Any new sanction should also be consistently and transparently applied by the Case Examiners.
We’ll update RCM members as MPs and peers in both Houses of Parliament raise these issues, and the commitments and assurances the government give us. This has been a long journey for the RCM and its members, and it’s been our highest priority in the professional agenda. After attending dozens of meetings, writing briefing papers and blogs, responding to emails and calls for evidence, meeting with our members and external stakeholders, we sincerely hope that what will emerge is a system which values midwifery leadership and expertise and keeps mothers and babies safe. Watch this space!
Timeline of events
March 2015: After independent reports into statutory supervision, the RCM publishes a discussion paper entitled Re-framing supervision which lays out our vision for a new model https://www.rcm.org.uk/sites/default/files/Re-framing%20supervision%20-paper%20for%20discussion%20final%2023%203%202015.pdf
September 2015: The RCM publishes a briefing paper for members on the Review of midwifery regulation by the NMC following the decision to remove supervision from statute. https://www.rcm.org.uk/sites/default/files/Review%20of%20Midwifery%20Regulation%20by%20the%20NMC.pdf.
3 November 2015: We blog about the Review of midwifery regulation by the NMC https://www.rcm.org.uk/news-views-and-analysis/views/review-of-midwifery-regulation-by-the-nmc
January 2016: In response to the RCM discussion paper, the Department of Health publishes proposals for changing the system of midwifery supervision in the UK which sets out the key principles agreed by the four Chief Nursing Officers for the design of the new model of supervision.
26 January 2016: We publicise these proposal for midwifery supervision in a blog post https://www.rcm.org.uk/news-views-and-analysis/news/proposals-for-midwifery-supervision-published
27 May 2016: RCM encourages members to respond to the DH consultation and lobby MPs to save the Midwifery Committee https://www.rcm.org.uk/news-views-and-analysis/news/30-days-to-save-your-midwifery-committee
June 2016: RCM responds to the Department of Health consultation on The Nursing and Midwifery Council - amendments to modernise midwifery regulation and improve the effectiveness and efficiency of fitness to practise processes https://www.rcm.org.uk/sites/default/files/Response%20to%20DH%20consultation.pdf
September 2016: Following the submission of our response we also lobbied a number of MPs including the Dr Sarah Wollaston, the Chair of the Health Select Committee.
January 2017: DH publishes its response to the consultation https://www.gov.uk/government/consultations/changes-to-nursing-and-midwifery-council-governing-legislation. The Government chose to ignore the fact that the RCM and midwives overwhelmingly disagreed with the majority of the proposals.
21 December 2016 : We blog about Midwifery Regulation to provide an update and information with regard to the arrangements for the non-statutory employer-led model of supervision
January 2017: The Draft Nursing & Midwifery (Amendment) Order) is laid in Parliament and considered by the Lords Scrutiny Committee, https://www.publications.parliament.uk/pa/ld201617/ldselect/ldsecleg/101/10103.htm
Evidence submitted by the RCM to the Committee can be found here http://www.parliament.uk/documents/lords-committees/Secondary-Legislation-Scrutiny-Committee/RCM-Submission-to-SLSC.pdf and the DH response here: http://www.parliament.uk/documents/lords-committees/Secondary-Legislation-Scrutiny-Committee/DH-Response-to-SLSC-on-RCM-letter.pdf
26 January 2017: We blog about us winning key commitments from the NMC on midwifery regulation https://www.rcm.org.uk/news-views-and-analysis/views/victory-as-rcm-secures-win-on-midwifery-regulation
And a podcast from our Chief Executive Cathy Warwick: https://www.rcm.org.uk/news-views-and-analysis/views/the-latest-really-good-news-from-cathy