The future for Midwifery without
Statutory Supervision
Joy Kirby
RM RN BSc PgCert MA
LSA Midwifery Officer
Statutory Supervision of Midwives
and Midwifery Practice
• Supervision is currently a statutory
responsibility which provides a mechanism
for support and guidance to every midwife
practising in the United Kingdom.
• The purpose of supervision of midwives is
to protect women and babies by actively
promoting a safe standard of midwifery
practice.
Midwives Act 1902
• Created Central
Midwives Board
(CMB)
• Supervising &
monitoring of
practice delegated
to Local Supervising
Authority(LSA)
The Local Supervising Authority
• The LSA is responsible for the supervision
of all midwives within its geographical
boundary, including those working in the
private sector, agencies, independent
practice and prisons and those employed
in the NHS
Role of LSA
• Inspection of
midwives notifying
intention to practice
• Investigate
malpractice,
negligence or
misconduct
• Report midwives
guilty of above to
CMB
Role of the Local Supervising Authority
Midwifery Officer
• Responsible for the Statutory Supervision of
Midwives and Midwifery Practice
• Carries no management responsibility to Trusts
• Does not represent the interests of providers or
commissioners of maternity services
• Focus on midwifery practice
• Appoints Supervisors of Midwives who remain
accountable to the LSA
Health Service Ombudsman's
Report 2013
• Report into three cases arising from failures
in maternity care at Morecambe Bay .
• Midwifery supervision and regulation should
be separate
• The NMC should be in direct control of
regulatory activity
• NMC accepted that: ‘Supervision structurally
flawed’
Kings Fund Review of Statutory
Supervision 2014
• 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 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.
Continued….
• The LSA structure should be removed
from statute as it pertains to the NMC
• The sub-FtP process involving additional
investigations and sanctions should be
removed from statute
What will change ?
• Midwives Rules and standards
• Notification of Intention to Practise
• Suspension from practice
• Supervisory Investigations
• Referrals to the NMC
• Employers responsibilities in approach to
professional regulation
• Women and complex care needs
Potential Impact
• Increased risk of “conflict of interest” as midwifery
•
•
practice investigations are undertaken within Trust
Governance frameworks by peers and in the
absence of an independent review process.
No further analysis of practice themes from
supervisory investigations will result in a lack of
proactive, preventative measures being
implemented to provide assurance of good public
protection methods
Increased referrals of midwives to FTP department
at the NMC
Potential Impact
• Increased appeals following investigations based
on perception of process being undertaken
despite “structural flaw” being accepted
• No local provision for the support of ‘Conditions
of Practice’ when applied to registrants during
the FTP process, especially those who are selfemployed leading to loss of midwives from the
profession
• There will be inadequate data protection
policies for the retention of midwifery records.
• Midwifery records holding personal information
and data will not be securely and adequately
retained
Potential Impact
• Loss of expertise and professional leadership
•
•
•
exercised within the LSA Midwifery Officer role
Loss of strategic oversight of maternity services and
midwifery practice and also innovative means by
which to address regional issues.
Loss of professional midwifery advice provided
regionally / Country wide
Loss of organisational information and data held
within the LSA including midwifery workforce data /
Maternal Deaths / themes arising from practice
investigations / Suspensions of services etc
Potential Impact
• Loss of ITP submissions will result in loss of data regarding
current numbers of practicing midwives in the UK on an
annual basis.
• There will be an inability to assure the public that each
practicing midwife has verified their PREP and is fit to
practice on an annual basis.
• There will no longer be a process in place to ascertain where
midwives with highlighted development needs are practicing
which could increase risk to the public this is particularly
relevant to agency midwives and self-employed midwives
Future Professional Implications
• Professional Midwifery leadership
• Advocacy for women
• Support for midwives –
– outside of NHS
– where practice puts women at risk
• Independent view of services
Conclusion
• The dismantling of Statutory Supervision will
leave a void that will impact on midwives,
women and maternity services.
• The NMC have a ‘moral obligation’ to ensure
that the supporting elements of supervision
are carried forward - will require innovative
thinking
• The LSAMO’s will work with the SOMs and
other stakeholders to try to minimise the
inherent risks to mothers and babies during
the transition period