Background

The purpose of statutory supervision of midwives is the protection of the public from malpractice by actively promoting a high standard of midwifery care. The statutory function of supervision of midwives and local supervising authorities (LSA) was first laid down in the Nurses, Midwives and Health Visitors Act of 1902 (HoC) and has continued to be detailed in successive Acts until the present day (HoC 1997). Changes have taken place over time and the focus of supervision has moved away from a punitive and controlling system to the supporting and enabling activity of peer review (ENB 1999 a & b).

The United Kingdom Central Council (UKCC) is currently the regulatory body for midwifery that produces the statutory Midwives Rules and Code of Practice (UKCC 1998) that set out the personal accountability of midwives to be competent practitioners.

The English National Board (ENB) is accountable for ensuring that the standards for midwifery practice are met and provides guidance to LSA and supervisors of midwives. Following wide consultation, the Government has proposed that the UKCC and National Boards will be replaced by one new council, accountable to parliament, that “will have ultimate control of the regulatory process and ownership of setting and monitoring standards” (Health Service Circular 1999). The role of the LSA will continue.

Local Authorities undertook the LSA function until 1974 when responsibility for the function was transferred to Regional Health Authorities. Regional Nurses, who were not necessarily midwives, became responsible for maintaining the standard of midwifery supervision as specified in statute. From April 1996 the LSA function was delegated to Health Authorities that formed into consortia. Each consortium identified a lead Health Authority to take responsibility for the appointment of a Responsible Midwifery Officer (RMO) and funding of the LSA function. In England, all LSA midwifery officers are practising midwives.

The UKCC and ENB established a framework for the operation of LSA (1996). The focus is on a proactive approach to statutory supervision of midwifery and RMO are required to be practising midwives and experienced supervisors of midwives. Peer nomination of local supervisors demonstrates a commitment to the process of appointment and so empowers midwives. Prior to appointment to the role, an academic course and assessment must be completed. There is a policy for the deselection of appointed supervisors who fail to meet the standard of performance deemed acceptable by the LSA.

Over the last two years, the government has set a clear agenda for quality in the NHS (DoH 1997, 1999) in which consumers should have a voice. The LSA has an important role in ensuring that commissioning of services meets the changing expectations of the public and requirements of the national agenda offering value for money. Statutory supervision of midwives is primarily concerned with the protection of the public by maintaining high standards of midwifery care providing an objective voice independent of employment issues. With its focus on fitness to practise and authority to suspend midwives from practice, statutory supervision is an integral part of maternity service quality programmes and strengthens the Clinical Governance agenda. Midwives value the leadership role of supervisors (Stapleton et al 1998) and this is an important area to address to enable supervisors to maximise their contribution to change programmes.