Reform Local Supervising Authority for midwives
The Local Supervising Authority system for midwives was ineffectual at detecting manifest problems at the University Hospitals of Morecambe Bay NHS Foundation Trust, not only in individual failures of care but also with the systems to investigate them. As with complaints, our remit was not to examine the operation of the system nationally; however, the nature of the failures and the recent King's Fund review (Midwifery regulation in the United Kingdom) lead us to suppose that this is not unique to this Trust, although there were specific problems there that exacerbated the more systematic concern. We believe that an urgent response is required to the King's Fund findings, with effective reform of the system. Action: the Department of Health, NHS England, the Nursing and Midwifery Council.
How was this assessed?
Response
Accepted
Response
Accepted83. We accept this recommendation. We will therefore modernise the regulatory
regime for midwifery.
84. The statutory supervision of midwives was designed in 1902 to protect the
public. It no longer meets the needs of current midwifery practice. Reports and
recommendations by the Parliamentary and Health Service Ombudsman and Kings
Fund found that midwifery regulation was structurally flawed as a framework for
public protection, and highlighted that statutory supervisory structures encourage
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.
85. In addition, the Government committed in March to the removal of the Nursing
and Midwifery Council’s oversight of midwifery supervision, and will 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. Our intention is to act as swiftly as possible
to legislate, and we intend to do this by introducing an Order in Council made under
s60 of the 1999 Health Act.
86. Midwifery supervision is important for providing clinical supervision and
professional development for midwives resulting in high standards of safe care for
mothers and babies. 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 Nursing and Midwifery Council) and the
supervision of midwives. England, Scotland, Wales and Northern Ireland are already
working together to design this new system, which will include how the system will
operate in future and where responsibility for its oversight will go. However, statutory
supervision must continue until the law changes and a new system is in place and so
as the Nursing and Midwifery Council and Government nurse leaders in the four
countries have made clear, Trusts must not disestablish supervisor posts or other
structures until that time.
National protocols: 33-35