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February 5, 2015

Supervision, where next?

IMUK Chair Jacqui Tomkins on the NMC’s decision to remove supervision from legal framework.

Discussions starting with “Supervision is living on borrowed time” have been peppering my consciousness for some several years. So the announcement last week, from the Kings Fund, that the recommendation to the NMC was to remove supervision as a statutory requirement for midwives did not come as a surprise.

There have been many voices over the years that have questioned the appropriateness of this unique extra layer of regulation that has been afforded to midwives only. No other health professional group has been required to mirror this statutory condition for registration. So should we be concerned that we are now afforded the same status as all those other health professionals? Or should we be celebrating the removal of an often punitive and traumatising tool?

Clearly the recent deaths and events at Barrow and Furness that triggered this review are only the latest concerns around the appropriateness and effectiveness of the supervisory model. However the Kings fund report does acknowledge that the level of failure to deal with serious and consistent fitness to practice issues seems to be unique to this particular Trust. I am sure blurring of the lines between the two strands of supervision, one of regulation and one of support, was part of the reason why the supervisory process became flawed in this case, but I have often thought the many other hats that some supervisors wear are also suspect in an individuals ability to be objective when conducting an investigation.

Should we be concerned that we are now afforded the same status as all those other health professionals? Or should we be celebrating the removal of an often punitive and traumatising tool?

These issues could easily be overcome though if there was a will to see supervision survive. It doesn’t require a rocket scientist to conclude that if independent supervisors  external to a trust were engaged to provide the regulatory role of supervision, and named, chosen supervisors provided the supportive role, we could prevent these kinds of mistakes from happening again.

If such a will did exist and midwives truly saw a value to the review and development of supervision then I believe we should also be asking for SOMs that are fit for purpose. They need to be experienced, respected for their leadership skills, clinically based and relevant to the area of investigation in question. It’s no use whatsoever having a supervisor investigate a community based midwife if her own experience is in high dependency.

We need to demand that there is an equatable level of representation of midwives within the body of the NMC.

Supervision is also concerned with providing a voice for women who do not wish to comply with the mainstream medical model.  Where now will these women find the support that they require? If the reality is that the NMC accepts the Kings fund recommendations then we must become pragmatic. If the role of incident investigation now falls to employers what provision will the NMC make for self employed practitioners? Whatever it may be it will need careful consideration as independent midwives could face inappropriate referral to the regulator through poor understanding of independent practice and the rights of women to decline recommendations but who continue to receive support from their independent midwife.

Supervision is also concerned with providing a voice for women who do not wish to comply with the mainstream medical model. Where now will these women find the support that they require?


It goes without saying that IMUK will seek to be included in talks with politicians and the regulator to address these issues. But until that time we should all ponder the possible consequences of the Kings Fund recommendation and consider signing this petition to save supervision, or at least raise the red flag of concern.

IMUK Chair Jacqui Tomkins on the NMC’s decision to remove supervision from legal framework. Discussions starting with “Supervision is living on borrowed time” have been peppering my consciousness for some several years. So the announcement last week, from the Kings Fund, that the recommendation to the NMC was to remove supervision as a statutory requirement for midwives […]

 
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