NMC Consultation: Midwifery Committee Concerns

Guest Blog By Beverley Lawrence Beech and Emma Ashworth of AIMS

Last week I wrote about the proposed changes to the NMC that the DoH is currently consulting on.  While they work on removing Supervision, they are trying to slip in the removal of the midwifery committee at the same time.

This is how the NMC describes the Midwifery Committee:

The Midwifery Committee advises the Council on:

· any matter affecting midwifery, such as policy issues affecting midwifery practice, education and statutory supervision of midwives,

· responding to policy trends,

· research, and

· ethical issues affecting all registrants.

The Midwifery Committee’s recommendations and subsequent Council decisions influence midwifery development in the UK, which affects the lives of individual women and their families under the care of UK midwives.

(for full text, click here)

The consultation states, “Although the NMC regulates two professions, nurses and midwives, the NMC is only required by its legislation to have a statutory midwifery committee to advise the NMC Council on matters relating to midwifery. It has no similar requirement to have a statutory nursing committee and none of the other healthcare professional regulators have a comparable statutory committee. The government has a policy objective to streamline and rationalise regulatory legislation.

However, let’s look at how the NMC is made up.  For every 1 midwife there are more than 12 nurses.  The other healthcare professional regulators do not need to have their own representatives because they are their own representatives, not lost in the noise of another profession. Of course it did not have a requirement to have a statutory nursing committee, the government was forced into legislating for a statutory midwifery committee as a result of the protests from midwives and lay groups who felt that without a statutory requirement midwives would just be absorbed into the nursing profession.

Let’s look at some more history.  When in 1983 the government proposed a single ‘nursing’ professional council, despite opposition from midwives, AIMS and other groups, they amalgamated the Central Midwives Board into the UK Central Council for Nursing, Midwifery and Health Visiting which, in 2002 became the Nursing and Midwifery Council.  The midwives fought for a separate Midwifery Council but lost, although as a sop to their concerns, a review in five years was promised.  It never happened.

Since 2002 the Midwifery Committee has been gradually reduced so that there are now only seven members, of which only two are practicing midwives, and in recent years  its support staff have been withdrawn, the dedicated office closed down,  and there is now only one midwife on the main Nursing and Midwifery Council.

A few years ago the NMC was awarded a £20m government grant for the NMC to address ‘the problems it faces in terms of administration and management’.  But this is but one of the problems.  As far as midwives and users of the service are concerned there is a far greater problem -the dichotomy between nursing and midwifery practice.

Over recent years, too many excellent practising midwives (most of them independent midwives) have been reported to the NMC, and some have been struck off.  Unfortunately, midwives are no longer judged by their peers.  AIMS members have observed hearings where, for example, a community midwife was judged by a labour ward manager who, clearly, was not up to date with the research and, from his questions, had no concept of the principles of informed consent.

Take the case of Beatrice Carla for instance.  AIMS members observing the case soon realised that this case was not only about Ms Carla’s individual practice, but encapsulated the struggle between midwifery evidence, knowledge and skills, and accepted medical evidence, protocols and policies. This struggle was very apparent among the panel members. Perhaps the most worrying aspect of this case was that while the Chair of the panel, Professor Paul Lewis, who was an exemplary Chair, showing fairness, care, courtesy and regard towards all concerned, he had repeatedly to draw the attention of the other panel members to the research evidence on maternity/midwifery care.  It is a serious issue that the NMC has failed, and is continuing to fail, to address.

Until midwives have their own Midwifery Council and allegations of failure in practise are judged by expert midwives these injustices will continue and women will be deprived of skilled midwives who really understand the meaning of normal, undisturbed, physiological birth, informed consent and women-centred care.  The removal of the midwifery council from the NMC leaves midwifery practice being judged by those who are in an entirely different role.  Would doctors accept their cases being considered by nurses?

The real fear is that the changes will lead to midwives being forced to become obstetric nurses, losing the autonomy that has been fought so hard for, for so many years.

There is a General Medical Council and a General Dental Council, so why is it not possible to have a General Midwifery Council?

Please, respond to the consultation and raise these concerns.  Your response is desperately needed.

Consultation link: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/518039/NMC_regulation_consultation_document_A.pdf

Proposed NMC Midwifery Changes: Modernisation or Mutilation?

Guest blog by Emma Ashworth

The Department of Health has released its consultation document on proposed amendments to the NMC and ALL midwives should read it, understand it and comment on it.  This consultation has put together a number of different proposals, each of them hugely important in and of themselves, and each which need to be addressed and considered separately.

I have long been irritated by the fact that when consultations are drafted, their wording is directive, designed to influence the outcome to that which the Consulter wants.  This NMC consultation is no different.  The title, “…amendments to modernise midwifery regulation and improve the effectiveness and efficiency of fitness to practise processes” states that this is what the amendments will achieve.  Who doesn’t want modernisation? Who would disagree with improving effectiveness and efficiency? Who wouldn’t want fitness to practice processes improved?  And yet… let’s look at those words.  “Modernise”.  Not changes, but modernisation.  Removing Statutory Supervision is not an alternative way of supporting midwifery practice, but a “modernisation”.  As is pointed out to Arthur Dent, “there’s no point lying down in the path of progress!” but when there’s a large yellow digger coming to knock down your ability to support women to access services outside of guidelines then shouldn’t we all be lying down in the mud?  (Note: if you don’t know why people are lying down, or why diggers, once you’ve read and commenting on the DoH’s proposal, go get a pint of beer, a towel, and read “The Hitchhiker’s Guide to the Galaxy”)

Statutory Supervision was torn apart following the Morecombe Bay enquiry, where it was decided that there was a problem with the combined role of the Supervisor to both support midwives in their caseloads and at the same time be responsible for investigating complaints against them.  This has been a concern of a number of people before the enquiry, but a solution that did not remove both functions was not investigated by either the DoH or the NMC.  A “modernised” Supervision role should surely create a way that both roles could be fulfilled without any conflict of interest.  For example, two different roles might be created with different people in the Trust holding them, or the investigation of complaints might be moved to the LSA, and the supportive role of the Supervisor be kept within the midwives as is the current position.  There may be a number of ways that this could happen which would not remove the vital role of supporting midwives to support women, and it is this role which is being removed from being statutory.  This is the absolute crux of the issue.  If something is not statutory Trusts will not do it.

The devastating, NHS destroying Health and Social Care Act meant that the CCGs have absolute power to decide on care services, with nothing other than emergency care being mandatory.  We have all seen the catastrophic slashing of services across all areas, not just maternity. We can’t even invest to save, for instance by creating a continuity of carer service which we know would drastically improve outcomes and save vast amounts of cash, even if it takes work and a small investment to set up.  There is a cost to supporting Supervision. How likely is it that it will continue when it is not a requirement?  What will midwives do, then, when they are trapped between women’s needs and wishes, and “guidelines”?  What will you do?

Have your say and respond to the consultation here: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/518039/NMC_regulation_consultation_document_A.pdf

Read more: https://www.rcm.org.uk/news-views-and-analysis/views/department-of-health-releases-consultation-on-nmc

Next: Abolishing the statutory Midwifery Committee