In terms of literacy and numeracy, the NMC Standards for Pre-registration Midwifery Education (2009) state that for an applicant to be accepted onto a pre-registration midwifery programme they must be able to ‘manipulate numbers accurately […] including using a calculator’ and ‘read and comprehend (in English or Welsh) and communicate clearly and effectively in writing, including a computer’ (NMC, 2009). In terms of inclusivity: ‘if a student has a disability, the above criteria can be met through the use of reasonable adjustments’ (NMC, 2009).
The programme must have at least 50% practice and no less than 40% theory and should include a range of learning, teaching and assessment strategies. In order to qualify as a midwife, students must demonstrate competency in the following four domains: effective midwifery practice; professional and ethical practice; developing the individual midwife and others; achieving quality care through evaluation and research (NMC, 2009). Clearly the demands of the programme are extensive and could be exacerbated if students with additional needs, disabilities or medical conditions are not provided with additional support services by their University.
The University of Northampton: A case study
At the University of Northampton, The Additional Student Support and Inclusion Services Team (ASSIST) supports students with an additional need, disability or medical condition that impacts on their day-to-day studies. Taking a random sample of 86 students who have accessed ASSIST since October 2016, 44% (n=38) were from the Faculty of Health and Society. There are currently 132 students enrolled on the BSc (Hons) Midwifery programme at the University of Northampton, ten of whom have a declared disability, with 5.3% (n=7) declaring a specific learning difficulty such as dyslexia.
What is ASSIST?
The support offered by ASSIST covers a range of services, from priority status accommodation for disabled students, to providing specialist study skills support for dyslexic students. ASSIST makes recommendations to academic staff to ensure the learning and teaching environment is inclusive and accessible, and that the University makes ‘reasonable adjustments’ for its disabled students.
The Equality Act 2010 places a duty on Higher Education Providers (HEPs) to make necessary adjustments and comprises three specific requirements:
Reasonable adjustments can vary greatly for different disabilities and different courses. Adjustments could, for example, include additional time in examinations for a student with dyslexia, ensuring a student using a wheelchair has safe and suitable access to lecture venues, or providing communication support, such as BSL, for a hearing-impaired student who is otherwise unable to access auditory content on their course.
ASSIST has a core team comprising a team leader, two coordinators, two disability advisors and a wider team of specialist staff that includes note-takers, practical assistants, mentors and study skills support tutors. The disability advisor's role involves working with students and assessing their needs to make recommendations for reasonable adjustments: this is done through a document called the Academic Inclusion Report (AIR). The AIR is then shared with academic staff so the student gets the necessary support required for the course (e.g. additional time or provision of amanuensis in exams). Another major role of the Disability Advisor is to support students for Disabled Students' Allowances (DSAs). These are government grants to help pay the essential extra costs students may have as a direct result of a disability; they are administered by funding bodies, such as Student Finance or the NHS Student Bursaries. They can help to pay for extra assistive technology, software and specialist support that students may need as a direct result of a disability, ongoing health condition, sensory impairment, mental-health condition or specific learning difficulty. However, DSA funding is not guaranteed and students have to undergo an assessment of their study-related needs to determine exactly what support and funding they may need.
Disability Advisors can also support students with seeking a diagnosis of a condition/additional need (e.g. by referring them for dyslexia diagnostic assessment). Recent changes in DSA funding and provision have placed more responsibility on HEPs to provide anticipatory support and to make reasonable adjustments for disabled students, meaning that the funding a student receives from the DSA is likely to be less, but the University/HEP will be required to consider the student's needs and put in place a plan to address those needs, even if DSA funding is not available for all of the required support.
To access support from ASSIST, students can self-refer or be referred by academic or specialist support staff within the University. Sometimes referrals do come in from outside agencies, e.g. colleges, social workers, and school Special Education Needs Coordinators (SENCOs). Students wanting to be tested for dyslexia can email ASSIST and ask to be booked in for a free screening. Disabled students applying for university places in September/October are contacted automatically by ASSIST in the spring/summer before they join us. Students can disclose a disability, additional need or medical condition on their Universities and College Admissions Service (UCAS) application forms.
ASSIST works closely alongside other teams within the University and within Student Services, such as the University's Counselling and Mental Health Team, the Residential Life team, Accommodation Services and the Financial Guidance team.
How ASSIST supports students
*Denotes an item that is usually funded through DSA
From student to qualified midwife
On qualification, midwives must practise according to The Code (NMC, 2015), which states they must prioritise people, practise effectively, preserve safety, and promote professionalism and trust. In the context of practising effectively, the midwife is expected to base care on the best available evidence and ensure record keeping is clear and accurate. As applications for revalidation are online, the NMC state they will make reasonable adjustments for those with a disability (NMC, 2017).
Requirements of revalidation
Conclusion
Successful completion of a midwifery pre-registration programme of study awards the student midwife a professional qualification and an honours degree. With this professional recognition comes a commitment to lifelong learning to ensure practice is evidence-based and documentation is clear and accurate. Student midwives with a disability, additional need or medical condition are fully supported in their studies whilst at university by services such as ASSIST at the University of Northampton; however an area warranting further research is how these students are supported after qualification to meet the professional requirements of the Code and revalidation.