NMC: Not for Midwives, Not for the Public – Not Fit for Purpose!

By Ruth Weston

It is the fifth of May, we are having a protest outside the Nursing and Midwifery Council (NMC) headquarters, and 5 of us get to meet the NMC’s CEO inside (although we did not know until the day that this would happen).

Their response to the outrage pouring out from midwives and mothers regarding the banning of IMUK midwives is revealing, as is their response to the many midwives countrywide upset at the loss of independent supervision, the midwifery code and the attendance of family and friends ban.

The NMC’s clear message was – “We are not here for midwives, it is not about what you want.  Our role is to protect the public.”  And this was the attitude to all of the Midwives’ complaints made during the meeting.

However, when I asked what their public engagement programme was and how people got involved, and how and where the public could hold the NMC account, they were equally clear that they had no programme and no mechanisms for doing so.  They are, they say, just building them now!  So – they ignore Midwives because they say they are not there for midwives’ benefit, but they do not listen to or engage with the public who the NMC say they speak for and protect!

There are two pieces of twisted logic entwined in the NMC’s aims and focus:

On the NMC’s website, under the “about us” section, they say, (link)

“We regulate nurses and midwives in England, Wales, Scotland and Northern Ireland. We exist to protect the public”.  Later in the page, “We are not responsible for representing or campaigning on behalf of nurses and midwives”

The NMC want everyone to know, including midwives, that they do not represent midwives. They are extraordinarily clear about this on their public statements, and they also repeatedly remind midwives of this in communications where midwives are asking for support and guidance.

So here we have what I would term a false dichotomy pitting the safety of the public against the welfare of midwifery as if they are in competition.  Those of us who use the midwifery service (the public which the NMC claim to be protecting) know that our safety and autonomy as women and birthing mothers depends a great deal on the wellbeing and good practice of the midwifery profession and the midwives within it.  They are not competing priorities.  They are the same thing, our interests are entwined: the NMC cannot support safety in maternity without supporting midwives.

But here we have the organisation that midwives are obliged by law to be registered with stating that it ‘is not there for the midwives’.  To make it explicit: the organisation set up to regulate midwifery, set up to ensure good safe midwifery practice, to ensure midwives are good midwives  is clearly  and publically stating that ‘it is not there for midwives’ . How can a profession’s regulatory body NOT be interested in the health and well being of the profession it is regulating and the individuals it regulates?  Surely the point of safety and protection of the public is ensuring that the people you are regulating are fully supported and in the best position to practice in the best interests of the public, the state of midwifery is very much the NMC’s concern because it impacts on their stated public protection obligation.  Only when it comes to the rare conviction of malpractice in midwifery is it a penalising body and by this time harm has possibly already been done to the public. Surely, most of the public protection work is working out what safety means for the public and working with midwives to ensure the profession is in best fit to deliver that safe practice.  It beggars belief that a regulatory body full of highly qualified professionals that are not midwives have not worked this out for themselves – or checked best practice with other regulators.

The second part of their faulty logic and policy is their understanding of what it means to be an organisation that protects the public.  If you make strong statements that you are not there for midwifery, but instead to protect the public, then you would assume that the NMC is an organisation with a strong public engagement ethos or else how can they speak for the public or know what and how the public are protected.  No way!  The NMC is there to protect the public but is only now beginning to set up an engagement programme. At the meeting they admitted to only one consultation meeting with one user organisation – NCT.  No attempt has been made to engage with the wide range of service user organisations in maternity to find out what is important to them in terms of public protection.

To make it explicit, the regulatory organisation which says it is there for the public – does not actually engage with that public, consult and listen to them, nor does it enable us to hold them to account for their decisions.

As one insider said to us of the NMC terms ‘it is dog’s breakfast’.  And this is why the IMUK decision came about as it did and is causing such a problem to the NMC. The NMC did not talk to the women who use the service about what was important to them, they did not listen to the public and consumer organisations, and they did not do an impact assessment on the safety of withdrawing a service at short notice over the Christmas holidays.

And that is why I say #nmcnotfitforpurpose  – because it says it is not there for the midwives but for the public – but it is not even there for the public.  It has set up a false dichotomy between midwives and mothers showing how little it understands the evidence of its own appointee Mary Renfrew in the Lancet Series on Midwifery (link)  Women need a strong, autonomous midwifery profession as this protects women and their babies.  Until the NMC ‘gets’ that it is not fit for purpose as it is, the midwifery profession is not safe. #savethemidwfe

The NMC has its back against the wall –  Now nurses are also angry at the behaviour of NMC – the same grumbles.  And without the support of the public it will have lost all credence.  Time to act! Stay in touch with the campaigns:

  1. Save Independent Midwifery Facebook Group – ask to join – a good place for all kinds of information, and ideas for action and planning to do more
  2. Association of Radical Midwives (ARM) are leading the charge in setting up a new regulator – join this wonderful organisation whether you are a midwife or not and watch out for campaign meetings on this issue
  3. Join AIMS, helping to support their work in ensuring that women have a strong and united voice with the NMC.

Airedale NHS Trust – Leading the Way!

On almost the same day that Airedale NHS Trust, Yorkshire, announced that it is welcoming independent midwives onto their midwifery bank, a study into The Albany, one of the finest examples of midwifery caseloading in the UK, has yet again shown how the outcomes of caseloading and continuity are outstanding, for women, families, midwives and indeed the NHS. (Click for full Albany document)
Airedale NHS has joined a number of NHS Trusts who have recognised that independent midwives and NHS health professionals are a team who can work together to improve care for women, and to improve NHS services. They have welcomed independent midwives onto their bank contract system, ensuring that women who were left without their known and trusted midwife following the NMC’s decision can now obtain antenatal, labour and postnatal care from the midwife that they have chosen. This applies to existing and to new clients, and is not limited to the Airedale geographical area.
A Yorkshire independent midwife who is part of the new arrangement explained the workings of the IM’s holding bank contracts & what that means for them & the women.

‘Under these new arrangements we will use a bank contract from AGH [Airedale] when attending our clients in labour to ensure that we have indemnity insurance in place as required by the NMC for registration. This situation is fully discussed with our clients during the antenatal period. We use NICE as a starting point for our care discussion already and most guidance from AGH is the same. If there are any differences between NICE and AGH’s guidelines, we will discuss them. AGH understand that many women opting for IM care do so because they want care which is different to hospital/NICE guidelines, and they respect that. If women choose to have us care for them under AGH bank contract for birth (some may choose alternatives) we have to acknowledge their guidance, discuss this with the woman and document the choices then made. We will be being supported in this by Sarah at AGH who will complete the hospital ‘risk assessment’ process for us by offering women a phone or meeting consultation where their choices can be documented so correct procedures are being followed internally. Women remain completely able to make the choices they wish and we will support them fully in their decisions’.

In return, the local IMs will work with Airedale Trust on joint training projects, sharing knowledge and experience and improving the maternity care offered by all. The IMs will also act as back up to the Trust’s homebirth service, especially to support women with more complex needs for which specific IMs have extensive experience in the context of home birth.

NOT a solution to the IMUK/NMC Crisis
It is essential to understand that this does not resolve the fact that the NMC have refused to allow midwives using the IMUK’s indemnity solution, despite the NMC’s statement to IMUK that, “We (the NMC) are unable to advise you about the level of cover that you need. We consider that you are in the best position to determine, with your indemnity provider, what level of cover is appropriate for your practice”
While this offers independent midwives the ability to be able to work and support women and families, and while we are hugely grateful for the support and understanding of Airedale Trust, this is still not midwives being truly independent. The fight continues!
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