Leading Independent Midwife Awarded 'Midwife Of The Year' Forced to Give up Practice Following Govt Legislation Change

SHEPPERTON, England, March 10, 2014 /PRNewswire/ --

Jacqui Tomkins, Independent Midwives UK Chair, has been awarded (5^th March) 'Midwife of the Year' by the prestigious British Journal of Midwifery. The award recognises and celebrates outstanding achievement and excellence in midwifery. However this is a bitter-sweet moment for Jacqui because the Government has refused to support Independent Midwives after the EU Directive comes into force.  The new EU Directive requires that all healthcare professionals, including Independent Midwives (IMs) must be insured. However, currently IMs are the only healthcare professionals in the UK who are unable to purchase insurance which would meet the Directive. Jacqui's award acknowledged her work in setting up an insurance product which would meet the requirements of the Directive but needed government support. As a result, once this legislation is in place, IMs will be unable to continue to work and will be deemed illegal.

This in turn, would result in the currently practising 180 IMs going out of business and joining more than 5,000 registered midwives who are currently unable to get a job in the NHS. An additional 3,000 mothers who currently seek the support of IMs will be forced into the NHS, at an estimated cost to the NHS of £13 million. Forcing independent midwives to cease practising will only further impact on the already over-stretched and under resourced NHS system. Many women are also saying they would rather birth alone than enter into a system they do not feel safe in. Women need a safe alternative to turn to.

The Independent Midwives UK (IMUK) is a bespoke insurance company which is a not-for-profit model to allow them to continue. It is set up to meet the requirements of the EU Directive and would allow midwives to continue to provide care to women as they have done successfully for years. Risk assessment has shown that insurance pay outs would equal £850,000, based on figures over the last 10 years, significantly less than the estimated £13 million cost to the NHS if all midwives were only able to practice within the NHS.

Despite the IMUK calling for Government backing to support the new insurance company, the Department of Health has written to the IMUK stating they will not provide backing, instead suggesting IMs either join the NHS or social enterprises - models which compromise patient care and dilute the care an independent midwife gives and a patient receives.  

Jacqui states; "At a time when approximately 5,000 midwives are unable to secure employment on the NHS IMs will struggle to find employment on the NHS. Women need to be provided with a safe alternative to the NHS. Social enterprises are not a suitable alternative as they have strict inclusion criteria, which means many women will not be able to access them. They rely on the commercial insurance market - which is profit driven - and means insurance may be withdrawn at any time.  Social enterprise models are in their infancy and have not yet proven financially stable. The Department of Health has made false assumptions about our proposed insurance package and huge inaccuracies were shown in their 'cost-effectiveness analysis' of our proposal."

"The IMUK is confident our bespoke insurance package for independent midwives delivers the EU Directive's requirements. It will allow self-employed midwives to continue to provide a full maternity care pathway which will provide the NHS and Department of Health with a viable, cost-saving alternative to social enterprises which are effectively gambling with patients' wellbeing and IMs ability to practice. It is the first product to separate midwifery risk with obstetric risk resulting in a low claims risk element. The IMUK will not allow patients to face potential harm through lack of Govt backing to insure us."

Until the legislation has passed, IMs will continue to support mothers-to-be and will continue to book new clients in a bid to provide mothers with a safe alternative to the NHS. Jacqui concludes: "I have been awarded the prestigious title of 'Midwife of the Year' yet I fear that I will not be able to continue to work as a midwife, supporting my clients, if the government does not re-review our proposed insurance package or find a viable alternative. I find the Government's actions highly irresponsible and short-sighted to allow the loss of the only maternity model independent of the NHS which meets all of their own targets and which women say is exactly the care they need.  If they don't accept our proposal they must take responsibility for finding a viable solution to this issue. The IMUK will not give up; we will continue to fight for the rights of practising IMs and our clients".

Further Resources:

Finlay Scott policy review of indemnity and insurance
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216297/dh_117457.pdf

Increase in Freebirthing predicted without independent midwives

http://www.theguardian.com/lifeandstyle/2013/sep/14/freebirthing-birth-without-medical-support-safe

Why Independent Midwives are the key to birth freedom

http://www.telegraph.co.uk/women/mother-tongue/9949281/Home-delivery-why-independent-midwives-are-key-to-the-fight-for-birth-freedom.html

Birthrights: Why independent midwifery matters http://www.birthrights.org.uk/wordpress/wp-content/uploads/2013/05/Why-Independent-Midwifery-Matters2.pdf

About Independent Midwives:
Independent midwives (IMs) are registered and regulated by the Nursing and Midwifery Council (NMC) and practice outside the NHS. They provide continuity of care during pregnancy, birth and post-natal, and attend births at home. IMs often assist women who have had poor experiences of care in previous and are an incredibly valuable repository of skills that are fast disappearing in mainstream maternity care, such as vaginal delivery of breech babies and twins. Thousands of women turn to them every year seeking to prioritise birth at home, avoid induction or caesarean sections and for the continuous care they can provide which is frequently unavailable within the NHS system.    

Additional information:

The government have put forward the solution of joining the NHS or Social Enterprises

• NHS has no jobs to accommodate
• 20% of all students will not get work. 50% of those who do will be part time. IMs cost more than newly qualified because of wealth of experience.
• 5000 midwives on register now unable to work in the NHS (NMC)
• Paramount -  SE rely on commercial insurance market, which is driven by profit. Past experience shows the commercial market can withdraw at any time.  This has happened in the UK in 2002, leaving IMs uninsured. It happened in 2013 when RCN withdrew ultra sound insurance overnight!  In Germany all midwives have commercial insurance which is now being withdrawn, making it illegal for midwives to practice.  
• If NM 121 UKBC rely on commercial market and cannot afford premiums or the product is removed, they will be unable to practice immediately despite having women in their care.
• NB. IM UK insurance is not for profit - run by midwives for midwives and women.
• Not independent care.  Some women will never birth in the NHS for a variety of reasons including past trauma.
• Women need a safe alternative outside of the NHS. Many IM clients have PTSD form previous births and cannot enter into the NHS system.
• Caseloads are not chosen by either Midwife or Client.
• Employment model results in high caseloads which negatively impacts on care.
• Not proven to be financially viable/sustainable.
• Forming such a corporate entity requires a significant amount of financial backing, in terms of both insurance and a centralised IT system (legally required to comply with existing regulations).
• Social Enterprise companies are committed to paying their midwives regardless of the allocation of the trust award. A client transferring in labour would represent a loss to the social enterprise.
• There is fear that this could lead to a reluctance to transfer, impacting on client care.
• Requires NHS Contract to operate.
• Only one provider has secured an NHS contract - through personal connection with the commissioner.
• Commissioners will not contract in social enterprise companies with no track record, or statistics to prove financial viability.
• The NHS is reluctant to commission to social enterprises because outsourcing backlogs in other simpler areas of healthcare is more financially viable with no transfer back.
• The NHS is reluctant to commission in the social enterprise because outsourcing backlogs in other, simpler areas of healthcare is more financially viable with no transfer back.
• There is only one insurer backing this model and they have confirmed that they cannot or will not provide another policy to anyone else (not commercially appealing).
• fees have to be increased to cover business costs - excluding a vast number of women from accessing a service outside of the NHS.

Despite efforts by three companies, this model has not been shown to be financially viable:

one has been told that as they have no track record and no stats to show financial viability the NHS will not commission from them. 

one is experiencing financial difficulties.

one has already been in liquidation twice, this is a third attempt.