Monday, April 10, 2017

Assessing the NMC's Defense of its Independent Midwifery Ban

After receiving much criticism for its effective ban on independent midwifery, the NMC released a document [pdf] that seeks to explain and justify their position (see especially the fourth and final page).

Their central conclusion is that they are simply following orders, and it isn't their responsibility to do anything to mitigate the harms they're thereby causing:


So what we are seeing now is an entirely foreseeable consequence of Government policy (of successive governments since 2009) and the EU Directive which introduced this mandatory requirement in the interests of public protection. As Finlay Scott advised in 2010 and remains the case today, if the UK or any of the devolved administrations consider it is necessary to enable the continued availability of the services provided by entirely independent midwives, acting outside the alternative governance structures which are available to them, then they must seek to facilitate a solution, as the solution does not lie with the NMC.

They further stress:
The NMC exists to protect the public using the statutory powers it has been given. This includes ensuring that all its registered nurses and midwives have appropriate indemnity insurance. The NMC does not have the power to remove, waive or disregard this statutory duty, nor could it be in the public interest for it to do so.

I think there are a couple of points worth noting here:

Firstly: This is non-responsive to the specific concerns that have been raised about the NMC's hasty and overzealous exercise of its statutory powers.

* The NMC did not have a statutory duty specifically to disrupt existing care arrangements (it could instead have allowed a reasonable adjustment period between reaching its final verdict and implementing the ban, preventing IMs from acquiring new clients rather than disrupting the maternity care of their existing clients).

* The NMC did not have a statutory duty to ban IMs from attending births even in a non-medical capacity.

* The NMC did not have a statutory duty to form its judgment (that IMUK's indemnity insurance was "inappropriate") in an arbitrary and ignorant fashion, without properly assessing the catastrophic risk model provided by IMUK's actuaries which explain why they believe their product to be entirely fit for purpose. [Listen to 23 - 24 mins through this radio interview, where IMUK chair Jacqui Tomkins explains that after long refusing to even meet to discuss their model, the NMC finally conceded that they hadn't even attempted to assess IMUK's catastrophic risk model because it was "very complicated and would have taken a lot of time"!!]

* The NMC did not have a statutory duty to refuse to communicate with IMs about what level of indemnity cover it would consider "sufficient". (In case their stubborn and uncooperative arrogance does not come through sufficiently strongly in the above quotes, have a listen to NMC Chief Executive Jackie Smith at 11:30 mins through this radio interview, responding to the host's query about what would constitute sufficient cover with, "That is for them to satisfy me.")

In each of these cases, far from simply faithfully executing their statutory duties, it seems clear that the NMC has behaved in a reckless, callous, and arbitrary fashion, contrary to the interests of the affected parties (including affected members of "the public" who suffered disruption to their maternity care as a result).

Secondly: While perhaps less important in practice, I think it worth flagging just how lacking in imagination one would have to be to think it impossible in principle that disregarding a regulation "could [...] be in the public interest".  After all, I think my previous posts make a reasonably strong case that requiring indemnity insurance for IMs is bad policy, and that enforcing it does more harm than good. (The costs are passed along to clients, pricing more people out of the higher standard of care provided by IMs. And the nature of indemnity insurance is merely to provide greater financial compensation in limited circumstances, not any actual medical protection, so there's no clear grounds to support paternalistically requiring patients to purchase such cover as a requirement of receiving independent care.)  That the NMC is apparently incapable of even conceiving of such arguments being successful (let alone actually taking them seriously) is I think just further evidence of their stubborn and irrational refusal to listen to criticism.

1 comment:

  1. Thank you for the clear analysis. IMUK did seek assistance from government prior to the law being passed. They not only declined to assist they also blocked our solution. The NMC appear to have taken up the role of putting an end to Independent Midwives bit it is not clear why. My suspicion is that the ultimate aim is to remove midwive's autonomy and treat us as nurses. Women don't need nursing they need empowering! Maybe empowered women look dangerous?

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