How are midwives currently regulated?
Midwives are regulated in a very different way to other health care professionals, including nurses. The NMC, as the regulator of midwives, carries out all of the activities normally carried out by a health care regulator (registering and renewing registration of professionals; ensuring the quality of training; setting standards for professional conduct and practice; and investigating and adjudicating fitness-to-practice cases). In addition, and different to other health care professions, there is an extra layer of regulation where incidents are investigated locally and sanctions applied even if a case is not then referred to the NMC. In addition, midwifery regulation at a local level covers wider responsibilities that are not taken on by health regulators in other professions, including supporting and developing people; leadership of the profession; and strategic oversight of maternity services.
What was The King’s Fund commissioned to do?
In 2013, as a result of its investigations into incidents at Morecambe Bay NHS Foundation Trust, the Parliamentary Health Service Ombudsman found that there was a structural flaw in the way midwifery regulation is currently organised, because it combines investigation and support for midwives. The Professional Standards Authority also said that there was a lack of evidence to suggest that the risks posed by midwifery required an extra layer of regulation. In response to these findings, in 2014 the NMC commissioned The King's Fund to undertake a review of the regulation of midwives across the United Kingdom, taking the Ombudsman’s review as a starting point. The scope for the review required us to recommend a future model that would be fit for public protection, would be fair and proportionate and that would give the NMC sufficient regulatory control to be accountable for its outcomes. We were not asked to look at the quality or competency of regulation by the NMC, but at the model of regulation. See the terms of the review.
How did we carry out our research?
We used a range of research methods including a literature analysis, interviews with stakeholders identified by the NMC across all four countries, including family members of those affected by incidents involving midwives. We also looked at the available quantitative data on regulation, and reviewed written evidence from stakeholders. In addition, we used the work of Ipsos MORI who held focus groups and interviews with midwives, managers and members of the public across all four UK countries.
What did we find?
There is a lack of evidence about the safety and efficacy of different approaches to regulation. We did not find evidence that the existing way of regulating midwives is either less or more safe for mothers and babies than other regulatory approaches.
We did find that the current system of regulation of midwives, with its 'extra layer' of regulation, is confusing for patients and the public. It can also result in a lack of clarity for providers of maternity services over their responsibility when things go wrong because the provider carries out its own investigations at the same time. We recommend that the additional layer of regulation currently in place for midwives should end.
In addition, there are other tasks currently carried out by the NMC, including supervision and professional development, which are useful and valuable to midwives but should not be the role of the regulator to carry out. We recommend that the NMC should restrict its role to the 'core functions' of regulation, and that the governments in the four UK countries should consider other ways to ensure that these valuable functions are picked up by other organisations in the health system.