1. The future for Midwifery without Statutory Supervision
Joy Kirby
RM RN BSc PgCert MA
LSA Midwifery Officer

2. Statutory Supervision of Midwives and Midwifery Practice
Supervision is currently a statutory responsibility which provides a mechanism for support and guidance to every midwife practising in the United Kingdom.
The purpose of supervision of midwives is to protect women and babies by actively promoting a safe standard of midwifery practice.
Read Slide. Then
Cathy and John have reminded us that midwives are accountable for their practice. They must be competent to practice in a range of settings and supervision has a key role to play in supporting midwives in developing and maintaining this competence .
However I would like to stress here that for supervision to be effective there has to be commitment on the part of both the supervisor and the midwife.
And I hope to talk a little more about this later on.

3. Midwives Act 1902 Created Central Midwives Board (CMB)
Supervising & monitoring of practice delegated to Local Supervising Authority(LSA)

4. The Local Supervising Authority
The LSA is responsible for the supervision of all midwives within its geographical boundary, including those working in the private sector, agencies, independent practice and prisons and those employed in the NHS

5. Role of LSA Inspection of midwives notifying intention to practice
Investigate malpractice, negligence or misconduct
Report midwives guilty of above to CMB

6. Role of the Local Supervising Authority Midwifery Officer
Responsible for the Statutory Supervision of Midwives and Midwifery Practice
Carries no management responsibility to Trusts
Does not represent the interests of providers or commissioners of maternity services
Focus on midwifery practice
Appoints Supervisors of Midwives who remain accountable to the LSA

7. Health Service Ombudsman's Report 2013
Report into three cases arising from failures in maternity care at Morecambe Bay .
Midwifery supervision and regulation should be separate
The NMC should be in direct control of regulatory activity
NMC accepted that: ‘Supervision structurally flawed’

8. Kings Fund Review of Statutory Supervision 2014
The NMC as the health care professional regulator should have direct responsibility and accountability solely for the core functions of regulation. The legislation pertaining to the NMC revised to reflect this. This means that the additional layer of regulation currently in place for midwives and the extended role for the NMC over statutory supervision should end.

9. Continued….
The LSA structure should be removed from statute as it pertains to the NMC
The sub-FtP process involving additional investigations and sanctions should be removed from statute

10. What will change ? Midwives Rules and standards
Notification of Intention to Practise
Suspension from practice
Supervisory Investigations
Referrals to the NMC
Employers responsibilities in approach to professional regulation
Women and complex care needs

11. Potential Impact
Increased risk of “conflict of interest” as midwifery practice investigations are undertaken within Trust Governance frameworks by peers and in the absence of an independent review process.
No further analysis of practice themes from supervisory investigations will result in a lack of proactive, preventative measures being implemented to provide assurance of good public protection methods
Increased referrals of midwives to FTP department at the NMC 

12. Potential Impact
Increased appeals following investigations based on perception of process being undertaken despite “structural flaw” being accepted
No local provision for the support of ‘Conditions of Practice’ when applied to registrants during the FTP process, especially those who are self-employed leading to loss of midwives from the profession
 There will be inadequate data protection policies for the retention of midwifery records.
Midwifery records holding personal information and data will not be securely and adequately retained

13. Potential Impact
Loss of expertise and professional leadership exercised within the LSA Midwifery Officer role
Loss of strategic oversight of maternity services and midwifery practice and also innovative means by which to address regional issues.
Loss of professional midwifery advice provided regionally / Country wide
Loss of organisational information and data held within the LSA including midwifery workforce data / Maternal Deaths / themes arising from practice investigations / Suspensions of services etc

14. Potential Impact
Loss of ITP submissions will result in loss of data regarding current numbers of practicing midwives in the UK on an annual basis.
There will be an inability to assure the public that each practicing midwife has verified their PREP and is fit to practice on an annual basis.
There will no longer be a process in place to ascertain where midwives with highlighted development needs are practicing which could increase risk to the public this is particularly relevant to agency midwives and self-employed midwives

15. Future Professional Implications
Professional Midwifery leadership
Advocacy for women
Support for midwives –
outside of NHS
where practice puts women at risk
Independent view of services

16. Conclusion
The dismantling of Statutory Supervision will leave a void that will impact on midwives, women and maternity services.
The NMC have a ‘moral obligation’ to ensure that the supporting elements of supervision are carried forward - will require innovative thinking
The LSAMO’s will work with the SOMs and other stakeholders to try to minimise the inherent risks to mothers and babies during the transition period