The Draft Nursing and Midwifery (Amendment) Order 2017 – a move towards a more modern and efficient regulator

1 March 2017

The Nursing and Midwifery Council (NMC) is the healthcare regulator for nursing and midwifery in the UK. It exists to safeguard the health and wellbeing of the public by setting the standards of education, training, conduct and performance for nurses and midwives.

On 22 February 2017, the House of Commons Legislation Committee considered the draft Nursing, and Midwifery (Amendment) Order 2017. It was considered by the House of Lords yesterday (28 February 2017). The draft order looked to make three changes, namely to:

  • Remove the additional tier of regulation relating specifically to midwives by removing provisions in the statutory supervision of midwives;
  • Remove the midwifery committee as a statutory committee of the NMC; and
  • Make a number of changes to improve the efficiency and effectiveness of the NMC’s fitness to practise processes.

Statutory supervision of midwives

Under the NMC’s current legislation, midwives are subject to an additional tier of local regulation through the supervision of midwives statutory provisions. This allows for investigations into the fitness to practise of midwives to be resolved locally by other midwives without the involvement of the NMC. The supervision system dates back to 1902 when midwifery was outside of the health sector and additional safeguarding measures were required. This is a unique system for midwives and is not seen in the regulation of other health care professionals.

The changes look to bring the regulation of midwifery in line with other regulated professionals and provide more clarity to midwives in relation to their accountability to the NMC, ensuring that there is a clear separation between local supervision and regulatory investigations and sanctions and removing the potential conflict of interest inherent in midwives investigating other midwives.

In consultation, concerns were raised regarding the safety of patients and quality assurance if this supervision is removed; however, it was noted in the Government response that there was no additional evidence found that the additional tier of regulation protects patients. The consultation also highlighted concerns that this change will remove additional support for midwives and that the specialised nature of midwives will be marginalised within the NMC. The Government’s response was these concerns can be alleviated by new models of support being developed and this was reiterated by the Minister of State on 22 February.

Statutory requirement for a Midwifery Committee

The NMC is required by legislation to have a statutory midwifery committee. This committee advises the NMC on various topics including policy issues affecting midwives and the education and statutory supervision of midwives. No other health care regulator, irrespective of the number of professions it regulates, has a specific committee for a particular profession and abolishing the committee would bring midwives in line with other regulated health care professionals.

The consultation highlighted a concern that this will lead to a loss of representation of midwives, who only represent a small percentage of the NMC’s register; however, the Government response made it clear that the removal of the committee does not affect the NMC’s statutory duty to consult midwives. The NMC already has a strategic Midwifery Panel and has appointed a Senior Midwifery Advisor and it is hoped that this this will ensure the continued support and representation of midwives on the register.

Changes to the NMC’s fitness to practise processes

A number of changes to the NMC’s fitness to practise processes have been proposed, including but not limited to, giving the Investigating Committee and Case Examiners additional powers to make decisions in relation to issuing warnings, agreeing undertakings and giving advice.  Another proposal is to establish a single Fitness to Practise Committee which would replace the Conduct and Competence Committee and Health Committee.

The NMC spent approximately 76% of its budget on fitness to practise cases in 2015-16. It is believed that these changes will lead to a more efficient fitness to practise process and bring the NMC in line with other regulators such as the General Medical Council (GMC) and the General Dental Council (GDC). 

It is hoped that, the greater powers to be given to the Investigating Committee and Case Examiners will provide the NMC with more proportionate, effective and efficient methods of dealing with fitness to practise concerns, whilst still maintaining public protection. 

The current process of two separate committees for Health and Conduct and Competence matters is said to lead to increased costs and delays when a case needs to be transferred between the two. Such delays and costs implications are likely to reduce as the new Fitness to Practise Committee would be able to consider all allegations on all statutory grounds.

The proposed changes will clearly bring the NMC in line with other statutory regulators, with promises of a more efficient, proportionate and effective process. The concerns in relation to changes for midwives look to have been addressed.  It is yet to be seen however what impact these changes will have. 

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