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Naomi Todd considers recent proposals for changing the way that midwives are supervised in the UK and also separating the function of regulation of midwives.
By Naomi Todd
Although midwifery supervision has been around in England and Wales since 1902, it has long been considered that there should be a distinction between midwifery supervision and regulation, and that midwifery supervision and regulation should be separated.
Following numerous complaints to the Parliamentary and Health Service Ombudsman (PHSO) from families who had suffered during pregnancy and childbirth, the government pledged to change the way midwives have been regulated for more than 100 years to improve the safety of mothers and babies.
In August 2015, it was reported in the Guardian that the lives of mothers and babies could be put at risk because supervisors of midwives had two inherently conflicting roles.
Traditionally, when things go wrong, senior midwives are responsible for investigating incidents involving midwives on behalf of the regulator, the Nursing and Midwifery Council, whilst also being responsible for the development and support of midwives. As a result, safety was not always the focus of investigations and lessons from serious incidents involving midwives were not always necessarily learned.
The Morecambe Bay investigation of March 2015,which was established by the Secretary of State for Health in September 2013 following concerns over serious incidents in the maternity department at Furness General Hospital, chaired by Dr. Bill Kirkup, also highlighted concerns about the statutory supervision of midwives. The investigation found that the Local Supervising Authority system for midwives was ineffectual at detecting manifest problems, not only in individual failures of care but also with the systems to investigate them. The report recommended an urgent reform of the system.
The Department of Health Policy paper, published on 22 January 2016 (Proposals for changing the system of midwifery supervision in the UK) noted that statutory supervision of midwives has been criticised, closely examined and found to be flawed.
Guidance from the Department of Health outlines the changes to the statutory supervision of midwives, which will be introduced in 2017, whereby: midwifery supervision and regulation will be separated; regulation will be controlled by the Nursing and Midwifery Council; and employers and providers of midwifery services will be responsible for improving the quality of services and support for women through pregnancy, birth and the postnatal period.
The changes in the law will mean that midwifery supervision and regulation will be separated, changing a 113-year-old system. Now when things go wrong, investigations will be independent of the profession and involve lay people in the decision making, enabling poor treatment to be identified and improvements to be made.
Louise Silverton, Director for midwifery, reporting in The Royal College of Midwives on 22 January 2016 has welcomed this change, stating, “I firmly believe that clinical supervision is a key element of providing a safe and effective maternity service and that the new model if fully implemented, will provide a supportive environment for midwives”
These legislative changes do not mean the end of all forms of supervision for midwives, and it is recognised that the developmental and supportive nature of supervision is of vital importance to the midwifery profession. It is also imperative to ensure that the new system of supervision covers the full role of the midwife.
The Department of Health Policy paper noted that the developmental and supportive nature of supervision should be preserved along with 24 hour access to clinical decision-making and support. Supervisors of the future need to be adequately prepared and experienced enough to be both constructively critical and supportive.
The Royal College of Midwives has published a discussion paper, ‘Reframing midwifery supervision’, which sets out their views and makes 11 recommendations, including developing a framework for clinical supervision to support midwives, promote standards of care and to enable midwives to provide high quality safe care to women.
It is recognised that the removal from statute creates an opportunity to shape a new model and framework for effective clinical midwifery supervision. It is suggested that to protect women and babies from risk and harm, employers, providers of midwifery care and individual midwives themselves must have in place processes which support midwifery supervision and the development of midwives as skilled practitioners.
I and my colleagues frequently act for women and children who have suffered injuries during childbirth and therefore support any recommendations aimed to improve care at this time. There are a number of changes being considered at present, see for example my colleague Hannah’s blog last week, and further funds being pledged by the government, with the aim of improving childbirth safety in the UK and we will be monitoring these with interest.