Reform Local Supervising Authority for midwives

83. We accept this recommendation. We will therefore modernise the regulatory regime for midwifery. 84. The statutory supervision of midwives was designed in 1902 to protect the public. It no longer meets the needs of current midwifery practice. Reports and recommendations by the Parliamentary and Health Service Ombudsman and Kings Fund found that midwifery regulation was structurally flawed as a framework for public protection, and highlighted that statutory supervisory structures encourage confidentiality in a way that does not always contribute to improving practice or systems and can be perceived as protecting the midwife rather than women or babies. This is borne out by the findings of the Morecambe Bay Investigation where the process of statutory supervision was ineffective at identifying the root causes for the many distressing incidents; at identifying and addressing poor practice amongst midwifery staff; and most importantly in addressing the families concerns. 85. In addition, the Government committed in March to the removal of the Nursing and Midwifery Council's oversight of midwifery supervision, and will work with the UK chief nursing officers to design a new system of supervision that is proportionate and recognises the importance of managing risks and promoting safety, as well as the professional development of midwives. Our intention is to act as swiftly as possible to legislate, and we intend to do this by introducing an Order in Council made under s60 of the 1999 Health Act. 86. Midwifery supervision is important for providing clinical supervision and professional development for midwives resulting in high standards of safe care for mothers and babies. Removing midwifery supervision from statute provides an opportunity to design a new system that enables a clear separation between the regulation of midwives (the role of the Nursing and Midwifery Council) and the supervision of midwives. England, Scotland, Wales and Northern Ireland are already working together to design this new system, which will include how the system will operate in future and where responsibility for its oversight will go. However, statutory supervision must continue until the law changes and a new system is in place and so as the Nursing and Midwifery Council and Government nurse leaders in the four countries have made clear, Trusts must not disestablish supervisor posts or other structures until that time.

The Thirlwall Inquiry has noted action taken in response to this recommendation.

The Nursing and Midwifery (Amendment) Order 2017 separated the function of midwifery supervision, which is the responsibility of the employer, from regulatory activity, which is the responsibility of the NMC. This brought the regulation of midwives into line with the arrangements for other regulated professions and means that supervisors are no longer involved in regulatory investigations and sanctions.

Subsequently, A-EQUIP a new, non-statutory model of supervision for midwives was developed and rolled out in each of the four countries of the UK with NHS England leading this work in England. The new model focuses on the professional and developmental aspects of the role.

The Nursing and Midwifery (Amendment) Order 2017 separated the function of midwifery supervision, which is the responsibility of the employer, from regulatory activity, which is the responsibility of the Nursing and Midwifery Council. This brought the regulation of midwives into line with the arrangements for other regulated professions and means that supervisors are no longer involved in regulatory investigations and sanctions.

Subsequently, A-EQUIP, a new, non-statutory model of supervision for midwives was developed and rolled out in each of the four countries of the UK with NHS England leading this work in England. The new model focuses on the professional and developmental aspects of the role.

Both the Parliamentary and Health Service Ombudsman’s and Dr Bill Kirkup’s reports following Morecambe Bay were critical of the Local Supervising Authority system provided for in legislation for midwives.
The Nursing and Midwifery (Amendment) Order 2017 separated the function of midwifery supervision, which is the responsibility of the employer, from regulatory activity, which is the responsibility of the Nursing and Midwifery Council. This brought the regulation of midwives into line with the arrangements for other regulated professions and means that supervisors are no longer involved in regulatory investigations and sanctions.
Subsequently, a new non-statutory model of supervision for midwives has been developed and rolled out in each of the four countries of the United Kingdom with NHS England leading this work in England. The new model focuses on the professional and developmental aspects of the role.

Department of Health response (July 2015):

We will therefore modernise the regulatory regime for midwifery.

“Government committed in March to the removal of the Nursing and Midwifery Council’s oversight of midwifery supervision, and will work with the UK chief nursing officers to design a new system of supervision that is proportionate and recognises the importance of managing risks and promoting safety” (p. 86)