Will supervision changes lead to more Fitness to Practise referrals?

Last month, I was asked to present at the Local Supervising Authority (LSA) summer conference focusing on ‘the midwife in the dock’, from Nursing and Midwifery Council (NMC) fitness to practise (FtP) procedures through to attendance at the coroner's court. There was a range of experience among the speakers and supervisors of midwives (SOMs) present, and they all acknowledged how stressful such proceedings are for those involved. While the future role of the SOM is under discussion, with new models being piloted, it is envisaged that there will still be some involvement in preparing and supporting midwives through investigations. It is also likely that the number of midwives referred to the NMC will increase once supervisory local action plans and practice programmes (LSAPPs) are abolished.

In the current system, midwives might be investigated via management and supervisory routes independently, with the possibility of conflicting outcomes. For example, a midwife might be dismissed following a management investigation, but the supervisory review may recommend a LSAPP with the aim of remediating the misconduct or lack of competence that has been established. If the midwife is no longer employed, it is not possible to complete the LSAPP unless an alternative placement is found. The employer may then have no alternative but to refer the midwife to the NMC on the basis of protection of the public, because there are no structures in place to prevent midwives seeking alternative work without addressing the behaviour (not everyone will have the moral fortitude to declare their disciplinary action to future employers). At present, the LSA has a national database that holds this type of information and would prevent midwives working without a future employer being aware of an outstanding training need. Some of these positive aspects of statutory supervision are likely to be lost, being replaced by the formal NMC FtP processes.