Written Evidence submitted by Professional Standards Authority (MID0001)

1.                 Introduction

1.1             The Professional Standards Authority for Health and Social Care promotes the health, safety and wellbeing of patients, service users and the public by raising standards of regulation and voluntary registration of people working in health and care. We are an independent body, accountable to the UK Parliament.

1.2             We are pleased to provide the Committee with written evidence on the topic of midwifery regulation and supervision.  Our evidence is based on our work which includes:

• Overseeing nine health and care professional regulators – including the Nursing and Midwifery Council  (NMC) - and reporting annually to Parliament on their performance
• Conducting research and advising the four UK governments on improvements in regulation
• Promoting our concept of right-touch regulation and publishing papers on regulatory policy and practice.

1.3             For the reasons detailed in section 2 below we support the PHSO’s recommendations for separating midwifery supervision from midwifery regulation.  We are monitoring progress by the NMC in achieving the necessary improvements and have met with The King’s Fund whom the NMC has commissioned to review potential models for the future of midwifery regulation.

1.4             As a UK body we will also discuss the issue with officials in Scotland, Wales and Northern Ireland as well as in the Department of Health in England.  The regulation of midwives is a non-devolved matter and as such this issue requires a co-ordinated UK wide response.

2.                 What can be learnt from other professions?

2.1             We see few parallels or similarities to the supervisory arrangements for midwifery in the regulation of other professions. Perhaps the closest example is the role of the Responsible Officer within medical regulation. However there are important differences between the Responsible Officer role, which was introduced to help deliver revalidation for doctors, and the Supervisor of Midwives, not least that the Responsible Officer does not have a role in investigating untoward incidents on behalf of the General Medical Council (GMC).

2.2             We have raised concerns about the role of the Responsible Officer in revalidating doctors and the challenges this role presents to meeting our expectations of good regulation, for example:

• Introduces a conflict of interest – as Medical Directors, Responsible Officers might be considered to have a vested interest in having their doctors deemed fit for revalidation
• Lack of independence from the profession– whilst the decision whether to revalidate rests with the GMC, this is based on the Responsible Officer’s assessment. The role of assessing whether a doctor is fit to practise essentially remains with the profession
• Opportunity for inconsistency – There is scope for considerable variation in the type, amount and strength of evidence submitted and subjectivity in its interpretation. In addition, the number of Responsible Officers, periods over which assessments are made and the resources required, added to potential weaknesses in the evidence presents a challenge to obtaining accurate and consistent judgments.

2.3             As has already been noted, these difficulties also arise in the Supervisor of Midwives role, although to a greater extent given the wider regulatory function that the Supervisor of Midwives role is intended to fulfil.

2.4             Other regulated professions do not have this confusion of roles and the potential for a conflict of interests with respect to investigating incidents on behalf of the regulator. The absence of clear comparators from other professions suggests that there may be difficulties in sustaining the Supervisors of Midwives role in its current form in the future. This position is supported if we examine the rationale for the regulatory reforms that arose following the Shipman Inquiry. These sought to change the balance of power and influence that professionals and non-professionals had in regulation. The White Paper, Trust, Assurance and Safety (2007) described the reason for these reforms:

 ‘…patients, the public and health professionals need to be able to take it for granted that the councils act dispassionately and without undue regard to any one particular interest, pressure or influence. This will ensure that the regulators are not only independent in their actions, but, just as critically, that they are seen to be independent in their actions. Doubts based on perceived partiality have threatened to undermine patient, public and professional trust in a number of regulators over a many decades.’ (Para 1.3)

2.5             The most significant change in this respect was to create the General Pharmaceutical Council and establish a clear separation between the regulatory and professional leadership roles previously fulfilled by a single organisation (the Royal Pharmaceutical Society of Great Britain). Across other regulators, including the NMC, elections of professional representatives to regulatory councils were abolished and replaced by appointment of members based on evidence of merit and competence. Councils were reconstituted to given parity of lay and professional membership. These two steps removed the direct influence of the profession over their regulation, moving away from self-regulation to a shared approach that clearly prioritised the interests of patients and the public.

2.6             Seen in this context the Supervisor of Midwives role is a clear candidate for reform as it demonstrates a local manifestation of an older model of professional regulation – one that uneasily combines important regulatory and professional leadership roles. This combination of functions in one role creates circumstances that undermine confidence in regulation. It would be far more appropriate, and it would better reflect the realities of current midwifery practice and the role of professional regulation if the Supervisor of Midwives did not have such regulatory responsibilities. In essence, the regulatory responsibilities of an employer-based supervisory role should be adequately captured by the core standards for the profession issued by the regulator.

2.7             If it is decided that a local professional leadership role in midwifery remains important, the new role could be developed by learning from supervision and clinical leadership in other professional groups such as social workers and psychotherapists.

3.                 Conclusion

3.1             We welcome the Committee’s attention to this important issue and hope the information we have provided assists. We would be happy to provide further information or clarification if that would be helpful. 

4 September 2014