Local regulation of midwives should be scrapped according to a report by the King’s Fund which has found “no evidence” to justify its existence.
Midwives are currently regulated in a two tier process by local supervising authorities made up of senior midwifery staff which both regulate and support midwives. Midwives are also subject to the national Nursing and Midwifery Council code of conduct.
The review, commissioned by the NMC after concerns over failings of the supervisory system during poor maternity care at Morecambe Bay Foundation Trust, said midwives should have the same single tier regulation as nurses.
An independent inquiry into failures at the trust is due to report next month.
The report’s recommendation would require a change of the law to remove the statutory requirement for midwives to have a local supervisor.
The report said the NMC should have “direct responsibility and accountability” for midwives, adding: “This means the additional layer of regulation currently in place for midwives and the extended role for the NMC over statutory supervision should end.
“The de facto implication of this recommendation is that for the NMC the system of regulation for midwives would be the same as for nurses, as we found no risk based evidence to conclude that an alternative model is justified.”
It said the role of the local supervising midwifery officers in supporting midwives and mothers should be taken by other “players in the system.”
Fears over the local supervisory authority system were raised by James Titcombe, whose son Joshua Titcombe died at Morecambe Bay in 2008. Mr Titcombe secured an investigation of the system by the Parliamentary Health Service Ombudsman, which recommended changes to the system in December 2013.
He told HSJ that if the NMC accepted the King’s Fund report it would remove an “outdated and flawed” system that “exists nowhere else in healthcare and it’s a model that clearly failed at Morecambe Bay”.
Parliamentary and health service ombudsman Dame Julie Mellor said: “When things go wrong senior midwives are responsible for investigating these incidents on behalf of the regulator. At the same time they are responsible for the development and support of midwives. As a result safety may not always be at the heart of local investigations and lessons from serious incidents involving midwives may not be learnt.”
The proposals have been opposed by the Royal College of Midwives, which said the changes would wipe out “an important aspect of pubic protection”.
RCM chief executive Cathy Warwick said: “The idea behind the supportive element of the system is that [supervisors] identify practitioners who may be feeling that they lack competence at an early stage and then do something to rectify that before it gets to the point of harming someone.”