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Date: 07 July 2014
Today's Topic: UK Independent Midwives Face Extinction
Triggers: BBC News Report
My Grump: Independent Midwives now face insurance premiums that make their job impossible
Independent midwives have had the backing of mum's for many, many years, as they offer unique one-to-one care in pregnancy, often in a home setting.
But that choice has been taken away because of changes to the way independent midwives work is insured. New E.U legislation, demands all health professionals have professional indemnity (PI) insurance (quite rightly so), but all independent midwives now face practicing illegally, leaving the majority of UK women with no alternative to an NHS birth.
UK Independent Midwives have launched a final bid to gain government support to save their profession, but the solution ultimately lies with the public demanding the reinstatement of this choice of birth.
This seems very closed mind thinking to me. The independent midwives provided a valuable service to those who could afford it, and took a massive strain off the NHS. So what's the problem?
Independent Midwives are fully trained and regulated and work outside the NHS, charging around £3,000 for a full package of antenatal and post-natal care, and attendance at birth, usually at the woman's home. Their difficulty has been simply mathematical: there are too few of them (around 200) and the potential claim in the highly unlikely event of neglectful care could be sky high for any insurer.
I heard somewhere (can't remember where), that the average insurance premium for an Independent Midwife (IM) is around £20,000 per year. IM's spend large amounts of time with their mum's and so are limited in the number of ladies they can cater for at any one time. If an IM is part-time and say takes 6 mum's a year, they are working for nothing and still out of pocket. If they can take 20 a year, 33% of their fee is taken up as insurance and the remainder at 20% income tax, means they would be financially better off sitting at a supermarket checkout or flipping burgers for the clown.
They've been forced out of business any way you look at it. As premiums were more than many independent midwives earned, most were forced to make the difficult decision to cease practising or practise uninsured. In 2002 the last commercial insurer withdrew from the market because it was not commercially viable due to the small numbers of independent midwives in the UK.
However, some clever person came up with an insurance bonded product that would ensure IM's could continue to work just as they have always done. All they need is the financial backing to launch it: a 10 million pound fund to ensure that any claim could be met. This could be hard cash, or a simple promise from the government that they would meet any potential claim, should the worst ever happen, and a claim was made.
Midwives want the government to back them, mums want the government to back them, the NHS would do well to come down on the side of IM's, but the governments response? We are not in the business of propping up the self-employed. That's what I mean by short-sighted.
Why is it short-sighted? If IM's become illegal, then the women who would have hired them will give birth instead in the NHS – immediately costing more than the money required to save them. So, there's something in it for the taxpayer too.
And another thing: Independent Midwifery offers a real opportunity to the 20% of newly qualified midwives who won't get a job because there isn't enough money in the NHS to employ them. Instead of the paltry 200 or so now, the 5000 midwives who are registered but not practicing due to burn out or lack of vacancies could return to work in a self-employed capacity.
The Royal College of Midwives puts the shortfall of midwives at about 10,000 and until 1994 the Royal College of Midwives insured independent midwives to practice, but withdrew cover when premiums soared.
The truth is this: Independent Midwives offer a different approach – they care for women on a one to one basis throughout pregnancy, birth and beyond, forging bonds of confidence and trust. IM's have often chosen to leave the NHS because they want to practice a more personal and holistic model of midwifery, and it is for this reason that many women seek them out, looking for healing births after trauma, or a more individualized assessment of their 'risk factors' in the case of birth after caesarean for example.
Independent Midwives have an incredibly low claims history against them and with proper cover, IM's could be the solution to the current maternity crisis. This could be paid for by women opting out of the system which will relieve the pressure on the NHS. Currently there is no professional indemnity insurance available to Independent Midwives, which means they are personally liable for any negligence claim made against them. Midwives who are employed by the NHS are covered through their Trust which belongs to the Clinical Negligence Scheme for Trusts (CNST) run by the NHS Litigation Authority (NHSLA).
Independent Midwives are conscientious, professional and responsible practitioners. They have to be. You, as the purchaser of their service, would very quickly make life very difficult for anyone who was discourteous, unprofessional, negligent and dangerous, and they would be out of business very, very quickly.
The quest continues: www.pelvicgirdlepain.co.uk.
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