My Lords, I am grateful to the noble Lord, Lord Hunt, for his interest in this matter, and although naturally I am disappointed by his amendment to the Motion, I will use the opportunity afforded by it to aim to reassure him and all noble Lords that the proposed changes in this order are consistent with the Government’s commitment to strengthening the midwifery profession while also ensuring public protection. In addition, I am aware that the Secondary Legislation Scrutiny Committee has brought this order to the special attention of the House, and I will address the concerns of the committee in my remarks.
I know that the House will agree that it is vital for all women to be able to give birth in a safe, high-quality environment. This Government are committed to ensuring maternity services are the best and safest they can be. However, it is also true that things can and do go wrong, often with devastating impacts on mothers and babies but also on husbands, partners, parents, siblings and extended family members. Any good system of policy and regulation must promote best practice while also preparing to respond to mistakes when they happen.
In October 2016, Safer Maternity Care was published. It set out an action plan for the Government’s vision to make NHS maternity services some of the safest in the world and to achieve our national ambition to halve, by 2030, the rates of stillbirths, neonatal deaths and brain injuries that occur during or soon after birth and maternal deaths, with an interim aim of a reduction of 20% by 2020. Midwives are key to achieving this ambition. Because of this Government’s actions, there are more than 2,100 additional full-time equivalent midwives on our maternity units since 2010, and a further 6,300 are in training.
Midwives do a critically important job caring for mothers and babies and I pay tribute to the work that they do, which my family has been privileged to benefit from. However, when mistakes are made, it is right that they must be properly investigated. This order is before noble Lords partly in response to concerns raised during investigations into systematic failures in the care of mothers and babies at Morecambe Bay NHS Foundation Trust. As noble Lords know, following the completion of a number of investigations into complaints from families of those affected by the tragic events at Morecambe Bay, the Parliamentary and Health Service Ombudsman highlighted that,
“the midwifery supervision and regulatory arrangements at the local level failed to identify poor midwifery practice”.
A subsequent report by the King’s Fund described the system of local investigations as a “sub-FTP”—fitness-to-practise—“investigatory process”, which,
“causes confusion … and can result in a lack of clarity for providers over their responsibility”.
Similar concerns were raised in Dr Bill Kirkup’s Morecambe Bay investigation report, which referenced the,
“remarkable conflicts of interest inherent in a single individual combining the roles of risk manager, supervisor of midwives, senior midwife and staff-side representative”.
The report also stated that,
“the supervisory system as applied in Morecambe Bay … lacked objectivity and failed repeatedly to identify the evident problems in the unit or alert others to them”.
All three reports that I have just quoted from recommended that urgent change was needed to ensure a clear separation between regulation and supervision of midwives.
7.15 pm
In large part to respond to the importance of improving safety and maternity services, this order makes a number of changes to the Nursing and Midwifery Council’s governing legislation as the independent regulator for nurses and midwives across the UK. Specifically, the order will: remove the statutory system of supervision and local investigation that is unique to midwifery;
remove the statutory requirement for the NMC to have a midwifery committee; and make changes to improve the efficiency, effectiveness and proportionality of the NMC’s fitness-to-practise processes for both nurses and midwives.
My department publicly consulted on the measures set out in the order, receiving over 1,400 responses. Although the consultation highlighted concerns, in particular from within the midwifery profession, around the removal of both statutory supervision and the statutory requirement for a midwifery committee, this legislation is required to enhance patient safety, modernise the regulation of midwifery and improve fitness-to-practise processes for both nursing and midwifery. I will take each change in turn.
First, the principles of midwifery regulation are based on a model established in 1902, when midwives were working as independent practitioners. As part of the current statutory provisions, supervisors of midwives have a role in investigating and resolving fitness-to-practise concerns at a local level. This system of supervision and local investigation is unique to midwifery and there is a lack of evidence to suggest that the risks posed by contemporary midwifery practice require this additional tier of regulation. More significantly, given the findings of the reports I have referenced, I am confident that the separation of regulatory investigations from the supervision of midwives will be a positive step in enhancing public protection and will bring the regulation of midwifery into line with other regulatory practices.
To ensure that midwives continue to have access to support and development, the four UK countries, through their Chief Nursing Officers, have collaborated to develop new, non-statutory models of supervision that will deliver these elements. While taking account of the requirements in their own country, each of the four countries has been working within UK-agreed principles to develop employer-led models of supervision. These models will have no role in fitness-to-practise matters concerning midwives. The new models of midwifery supervision will be introduced following the removal of the current statutory requirements and will build on the systems and processes for good governance and professional performance already in place through employers.
The second change that the order makes is to remove the statutory requirement for the NMC to have a midwifery committee. The role of the midwifery committee is to advise the NMC’s council on matters affecting midwifery. This statutory requirement for a regulator to have a committee for a specific profession is unique to the NMC. The removal of this requirement does not prevent the NMC from establishing committees or groups in relation to midwifery, but simply removes the statutory requirement to do so—again aligning the regulation of midwives with that of other medical professions.
The NMC is working to ensure that appropriate, non-statutory routes are put in place so that the council continues to obtain expert advice on midwifery matters. To that end it has established a strategic midwifery panel to advise on key midwifery issues and develop
strategic thinking on the future approach to midwifery regulation. This panel has four-country representation and includes the Royal College of Midwives. The NMC has also appointed a senior midwifery adviser to provide expert advice on midwifery issues. It is important to note that the NMC still has a statutory duty to consult persons likely to be affected by any proposed rules changes, and when establishing standards and guidance, including midwives and those with an interest in midwifery.
This Government value the important role of midwives and believe that they provide one of the most fundamental services in our health system—enabling babies to be brought into the world in a safe environment. I hope that noble Lords will be reassured that these changes will support the profession in ensuring the best outcomes for mothers and their babies.
The NMC sets standards of conduct, performance and behaviour for over 657,000 nurses and almost 35,000 midwives, and the third set of changes concerns the fitness-to-practise processes that the NMC follows when a registrant does not meet these standards. In 2015-16, the cost of these processes was over £58 million —around 76% of the NMC’s budget. The changes in this order will enable the NMC to take proportionate action to address less serious concerns more efficiently and effectively while maintaining public protection.
The department believes that the principles of better regulation centre on giving greater autonomy and flexibility to the regulatory bodies to enable them to more effectively deal with fitness-to-practise cases. The changes we are introducing include new powers for the investigating committee to agree undertakings with a registrant or issue a warning or advice to a registrant. They also include the replacement of the Conduct and Competence Committee and the Health Committee with a single fitness-to-practise committee where both conduct and health issues can be considered. These changes will ensure that the NMC is able to respond to fitness-to-practise allegations in a more efficient and proportionate way, benefiting patients, registrants and employers.
The NMC is working with stakeholders to draft guidance for its investigating committee and case examiners in relation to the new powers. We would expect the NMC to exercise its powers in a fair, reasonable and proportionate manner, balancing the need for public protection and upholding standards and confidence in the profession with the interests of the nurse or midwife. The NMC has assured the department that it will keep the operation of its new powers under review. The NMC is also subject to accountability hearings with the Health Committee and to annual performance reviews by the Professional Standards Authority. The NMC will need to amend its fitness-to-practise rules before some of the changes come into effect. An Order in Council with these proposed amendments will be laid in Parliament for consideration.
The changes that this order makes to the NMC’s governing legislation will ensure that the regulation of nurses and midwives continues to be fit for purpose and will have patient safety at its heart. I beg to move.
Amendment to the Motion