The Nursing and Midwifery Council has a consultation exercise to seek views on including a clause in the Code of Professional Conduct requiring all nurses, midwives and health visitors to have professional indemnity insurance. The following is AIMS' response:
30th September 2002
Director of Policy and Standards
Nursing and Midwifery Council
23 Portland Place
Dear Mr Reyes Hughes
The inclusion of a clause in the Nursing and Midwifery Council's Code of professional conduct relating to the requirement for all nurses, midwives and health visitors to have professional indemnity insurance
AIMS objects to the inclusion of this clause in the Code of Practice.
The Nursing and Midwifery Council is there to protect the public and ensure that professionals are competent and practice ethically. Indemnity insurance has nothing to do with the quality of practice or ethical standards and its introduction into the Code of Practice will not protect the public. Indemnity insurance will offer families the opportunity of suing a negligent practitioner and obtaining compensation. It will not prevent a practitioner from acting negligently in the first place.
When the Royal College of Midwives withdrew insurance cover for independent midwives, the numbers of these midwives were suddenly and significantly reduced because only a small number of midwives could afford their own insurance, or felt able to continue to work without it. Now indemnity insurance is simply not available for independent midwives who have tried very hard to obtain it. The effect of this clause would be to make independent midwifery unavailable to the public. Consumers will have the strongest possible objection to this since our evidence is that midwives in independent practice provide a service for which there is a substantial demand and these midwives act as the standard bearers for good midwifery care.
There is also a danger that if indemnity insurance is introduced the standards of practice will then be dictated by the insurance industry and their priorities and values will not be the same as those of the midwifery profession. We have already seen examples of the insurance industry inappropriately judging midwifery practice by medical standards.
Furthermore, we understand that even if insurance is made available it is likely to be set at £20-£32,000 a year, a rate that exceeds many midwives' salaries. If, however, indemnity insurance is introduced as a requirement for all practitioners it must be set at a level that every practitioner can afford, bearing in mind the low levels of midwifery remuneration.
In terms of safety and choice for women, many women have been so traumatised by the birth of their first baby in hospital that they refuse to go anywhere near a hospital. They then find that the NHS midwifery service is unwilling to provide a midwife to attend them anywhere other than hospital.
In other cases hospitals have refused to provide, within the hospital, the kind of care women want and have referred them to the Independent Midwives Association.
If midwives cannot practise without indemnity insurance and Trusts are not willing to offer the kind of care many women want (e.g. VBAC at home, a midwifery managed vaginal breech birth or a home birth service) it will force an increasing number of women into birthing their babies at home without any professional attendance.
At the moment some of those women at least have a choice of engaging an independent practitioner in some areas.
The consequence of this proposal would be a serious restriction in parents' choices and safety, resulting in a reduction rather than an increase in public protection.
Beverley A Lawrence Beech
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