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Midwifery regulation in the United Kingdom.London: King's Fund; 2015

The end of supervision as we know it?

02 February 2015
Volume 23 · Issue 2

In December 2013, the Parliamentary and Health Service Ombudsman (PHSO, 2013), raised concerns about the public protection allowed by midwifery supervision following failures at the Morecombe Bay NHS Foundation Trust. The Ombudsman's report recommended that midwifery supervision and regulation should be separate and the Nursing and Midwifery Council (NMC) should be in direct control of regulatory activity. Following this report, the NMC commissioned an independent review of statutory supervision by the King's Fund. The King's Fund report (2015) concluded that although supervision is useful and valuable to midwives, it should not be the role of the NMC to carry out. It recommends that the NMC should restrict its role to the ‘core functions’ of regulation, and that other organisations in the health system pick up the remaining functions. On 28 January 2015, the NMC accepted the changes suggested by the King's Fund to uncouple regulation from supervision.

Introduced in the 1902 Midwives Act, statutory supervision has long provided a mechanism for support, development and guidance to every midwife practising in the UK. The purpose of supervision of midwives is to protect women and babies by actively promoting safe standards of midwifery practice. Over the years, the role of supervisor has evolved, but continues to maintain the essence of midwifery—to be with woman. Currently, the NMC's role in supervision is to provide ‘guidance and advice to local supervising authorities and supervisors of midwives and is accountable for ensuring that the rules and standards relating to supervision of midwives and midwifery practice are met.’ (NMC, 2009: 4). What does it mean for the future of midwifery if the NMC's role in supervision is lost?

The Royal College of Midwives (RCM) made a strong case to the King's Fund that supervision is an important part of protection to the public. However, it seems to have fallen on deaf ears. Despite this, the RCM has accepted the NMC's decision. Cathy Warwick, CEO of the RCM said: ‘The King's Fund review highlights that many important issues which impact on public protection are currently picked up by the system of statutory supervision of midwives. If this system is removed from the NMC's regulatory framework there is a danger that these are lost. Examples include support for women making birth choices which fall outside maternity service norms, expert midwifery advice and proactive support for individual midwives. It is critical that it is made crystal clear who and how these critical aspects of the system are maintained.’

At times where there appear to be so many failings in the health service, it seems counterintuitive to lose a system that plays a key role in public protection. Removing supervision will not ensure better care for women and their babies. I suppose we can only wait and see how this pans out.