Midwives - epetition reply
14 November 2007
We received a petition asking:
"We the undersigned petition the Prime Minister to ensure the survival of independent midwifery in the UK and thereby offer real choice to pregnant women."
Details of Petition:
"All Independent Midwives have been informed that the government is intending to make professional indemnity insurance (PII) a compulsory requirement for registration within 12-18 months. There is currently no PII available to independent midwives so they will no longer be able to practice legally. Independent midwives practice outside the NHS but within the regulatory framework of the Nursing and Midwifery Council and bound by it's 'Code of Professional Conduct' and 'Midwives Rules'. Independent midwives are specialists in normal birth caring mostly for women planning home birth. The care they give has been shown to have good outcomes for women including those who are usually classified as 'high risk', with more normal births, reduced caesarean section rates and increased breast feeding rates. The government must ensure that either professional indemnity insurance is available to all midwives however they choose to work or exempt independent midwives from the requirement for PII."
Read the Government's response
The Government introduced compulsory professional indemnity insurance in 2005 for all healthcare professionals as a way to ensure that all users of health services would be protected should they need to pursue a legal claim for negligence against a professional. All practitioners employed in the NHS are indemnified through their employment contracts. Self-employed practitioners need to seek indemnity insurance through an independent insurer.
This is currently not possible for independent midwives because of the high costs associated with potential claims against them. The Government are committed to supporting independent midwives to find a method to access indemnity cover, as this is clearly in the public's best interests. The Government have therefore encouraged members of the Independent Midwives Association (IMA) to explore forms of sub-contracting with Primary Care Trusts (PCTs) and NHS Trusts or social enterprise.
The options available include setting up individual contracts with NHS Trusts, developing contracts with NHS employers, and pursuing a social enterprise model. The Government have outlined these options below:
Individual contracts with NHS Trusts
An independent midwife would hold a contract to work for a Trust to support a specified number of women or deliveries over a specified period of time. The midwives would maintain their independence in as much as they would be free to take up contracts with Trusts of their choice, and would not be direct employees of the Trust. However, the contract would include an accountability clause that tied the midwives into the existing management and accountability structure of the Trust. In other words, the midwives may be accountable to the Head of Midwifery for any work undertaken on behalf of that Trust.
Sub-contracting model
The Albany Practice in south London has held a contract with King's College Hospital for a number of years. It provides all midwifery care to the women from one GP practice on a block contract basis. This means that the midwives are indemnified by the Trust, and abide by their policies and guidelines.
Social enterprise model
The IMA has developed a model of NHS community midwifery care to enable any woman to choose one-to-one care throughout her pregnancy, labour and the postnatal period from a midwife of her choice. The proposed model would sit alongside the current midwifery service, and it would be for each woman to make her own choice. The Government understand that the IMA has identified a group of midwives as well as a Primary Care Trust willing to test this model and develop an outline contract.
While we may support these options, we are not in a position to ensure that any one model of practice is implemented in preference to another within the NHS. It is for the local commissioners of maternity services, in conjunction with providers, to decide what model of care provision is best for their local community.
The Government are also exploring the possibility of making changes to the Clinical Negligence Scheme for Trusts (CNST) system and extending cover to midwives contracted to PCTs. However, the Government remain committed to ensuring that women and their babies are protected.
Currently, NHS organisations obtain indemnity through the CNST for the NHS care that they provide. This indemnity broadly covers clinical acts of employees carried out in the course of their employment that result in negligent harm to patients. It is the Government's intention to widen membership of CNST to allow non-NHS providers of NHS care to become eligible for membership of the scheme. This change will require amendments to primary legislation and is therefore subject to Parliamentary approval. Members will be covered only for the NHS care that they provide. The size of a member's contribution to the scheme is broadly based upon the volume of work that is carried out, the specialties covered and an appropriate risk assessment. Obstetrics and maternity are considered the highest risk specialties and therefore attract the largest contributions.
Of course, independent midwives that wish to work under contract to the NHS will benefit by being eligible to apply for CNST cover for the NHS care that they provide. However, they will need to ensure that they have their own professional indemnity insurance in place to cover their non-NHS work.
Whilst independent midwives are able to provide an excellent service for a small minority of women, the focus of our policy, as outlined in the Maternity Standard of the National Service Framework (NSF) for Children, Young People and Maternity Services and the recently published Maternity Matters is on providing flexible, high quality, community-based and largely midwifery-led services for all women and their partners. More details of the NSF and Maternity Matters are available on the Department of Health's website at: www.dh.gov.uk (by typing 'NSF children' and 'maternity matters' respectively in the search bar).
The Chief Medical Officer has also considered the possibility of a no-fault compensation scheme in Making Amends: A consultation paper setting out proposals for reforming the approach to clinical negligence in the NHS (2003). The Government are not aware of any consideration that may have been given to this in the independent sector.
As part of our ongoing commitment to this matter, the Chief Nursing Officer (CNO) has met representatives of the Association of British Insurers to explore what options could be made available for independent midwives.
In May, the CNO again met representatives from the independent midwife community to listen to their views and to update them on progress in developing options to help them obtain professional indemnity insurance. The Government understand that this was a useful and constructive meeting and that further meetings are planned.
Further Information
Take a tour of Number 10