I fully accept my noble friend’s statement on that score. It has been said that the Government have not been sufficiently supportive of the attempt by IMUK to overcome these obstacles, and I welcome my noble friend’s recognition of those efforts.
Independent Midwives UK made an application, as my noble friend knows, for government funding for its proposal. That was considered, but the conclusion reached after independent expert advice was that the proposed insurance model was not feasible and would not provide long-term protection to pregnant women.
Alongside that, we were mindful that the creation of any government scheme specifically for Independent Midwives UK would effectively position the Government as the underwriter of the independent sector. My noble friend is as aware as anyone of the sensitivity of that. That would have undermined any private sector solution, which in turn would reduce the onus on midwifery service providers to demonstrate financial responsibility in what is undoubtedly a high-risk area of clinical practice—that is, it would reduce the onus on them to be responsible for showing an underwriter the appropriate steps being taken to mitigate risks. So, for a number of reasons, we were not able to take those proposals forward.
However, we explored a number of routes. One was that a corporate body should be formed that would be eligible to join the clinical negligence scheme for trusts, although that would not cover non-NHS work. We made funds available via our Social Enterprise Investment Fund to support the development of social enterprise solutions where the market does not offer affordable indemnity to individuals. That was not seen as a viable route either, although a new social enterprise called Neighbourhood Midwives was set up through that route and is now offering maternity care in the private sector with appropriate indemnity cover in place. Its business model is a 100% employee-owned mutual providing management and support to small, community-based neighbourhood practices.
My noble friend Lady Brinton asked about the insurance sector. From the start of the discussion in 2010, dialogue has been in progress with the Association of British Insurers, individual insurers and insurance brokers, who have indicated that insurance would be available for corporate bodies employing midwives to deliver NHS or non-NHS services. It would be necessary for corporate bodies to demonstrate the robustness of their governance systems to provide adequate assurance
to an indemnifier. Where providers can demonstrate safe outcomes as well as good risk management processes, this would affect the price that was quoted, making it more affordable. There are also other factors that can be varied, depending on the appetite for financial risk, that can reduce the price, such as excess provisions. This concurs with the independent research commissioned by the NMC and the Royal College of Midwives that suggests that independent midwives would be able to obtain insurance as employees within a corporate structure. As I say, some independent midwifery providers have secured insurance by fulfilling the above principles.
I heard my noble friend Lady Cumberlege say that the order effectively deprives certain individuals of the right to work. I do not share that view. The right of an individual to practise their profession is not an absolute right; the state may impose certain conditions provided by law that an individual must satisfy in order to practise their profession. Those conditions should be both proportionate and justifiable.
The bottom line here is that we believe it is unacceptable, as the noble Baroness, Lady Emerton emphasised, for individuals not to have access to recourse to compensation where they suffer harm through negligence on the part of a registered healthcare professional. The NHS constitution in England reinforces this by including,
“the right to compensation where you have been harmed by negligent treatment”.
In requiring all practising regulated healthcare professionals to hold an indemnity arrangement as a condition of registration, the order does not make the practice of independent midwifery illegal—far from it. Midwifery outside the NHS will still be accessible in the ways that I have already described. I note that Independent Midwives UK is advertising insurance as a benefit of its membership, so I wonder whether any self-employed midwives will in fact have to stop practising.
My noble friend Lady Brinton hit the nail on the head when she expressed her welcome for the EU directive and the principles that underlie it: that all patients across the EU should be treated by healthcare professionals who have insurance or indemnity cover.
The noble Baroness, Lady Emerton, touched on the issue of compensation. As she knows, compensation for negligence can be very high indeed. It is for this reason that the Royal College of Midwives no longer offers insurance because its scheme was stopped after an issue involving an independent midwife.
If we distil the arguments to their most basic, the implication behind a number of criticisms of this order is that choice in natal care should trump other considerations. I am afraid that the Government take a different view. Our policy is that patients should have recourse to redress if they are harmed, and the most cost-effective and proportionate way of achieving that is by requiring all practising regulated health professionals to hold appropriate cover.
Having said that, we lay great emphasis on choice, as my noble friend is aware. The policy set out in Maternity Matters: Choice, Access and Continuity of Care in a Safe Service, published in 2007 but endorsed by the current Government, aimed to introduce by the end of 2009 four main areas of choice in maternity. The choices are: how to access maternity care, whether
via a GP or directly through a local midwifery service; the type of antenatal care—depending on the circumstances, midwifery care or team care with midwives and obstetricians; the place of birth, depending on the circumstances, supported by a midwife at home or in a free-standing midwife-led unit in a hospital, or supported by a maternity team including obstetricians in a hospital; and where to access postnatal care, at home or in a community setting.
I hope my noble friend will concede that maternity has been a major focus for the current Government. We have invested heavily in training additional midwives. There is a record number in training at the moment. We have invested large sums in improving and refurbishing birthing units, as well as introducing specialist mental health midwife training so that every birthing unit will have a specially trained clinician available by 2017. This is a major part of our agenda.
I think I have said as much as I can in answer to questions. I will, however, respond in writing to the points that I have not adequately covered, including my noble friend Lady Cumberlege’s question about how many home births might be on hold or suspended as a result of this order. I beg to move.