Misconduct is the kind of conduct you would not expect of a registered midwife. There is no definition of misconduct so the Panel of the Conduct and Competence Committee have to use their own judgement.

An incompetent midwife is one who’s standard of performance is unacceptably low. Again there is no definition of incompetence so the Panel of the Conduct and Competence Committee would use their own judgement.

A criminal conviction does not have to be one committed within the United Kingdom, it can be one committed outside the UK so long as it would amount to a criminal offence in this country. it can also be a conviction from another jurisdiction like a court marshal.

If a midwife has a medical condition, mental or physical, that may impair her/his fitness to practise the Health Committee will determine this in a private hearing.

There may be an issue of impairment if a midwife has been before another relevant body for example the Care Standards Tribunal for a decision on barring under the Safeguarding Vulnerable Groups Act 2006.

Before the final hearing, at whilst the investigation is ongoing, a Panel of the Investigating Committee (Interim Orders Panel) may decide whether to make an Interim Order restricting the midwife’s registration. The main reason for making such an order is to protect the public or even the midwife.The interim order will be made after hearing representations from the midwife. If it is felt that an interim order is necessary then either a conditions of practise order or a suspension order will be made. A suspension order will prohibit the midwife from practising midwifery. It will be made for 18 months but can be extended at the High Court if necessary. This will be reviewed within 6 months of the order being made and thereafter every 3 months.

The Conduct and Competence Committee will hear allegations as to a midwife’s misconduct or lack of competence. Generally the case is decided in in four parts. However if the allegations relate to a criminal conviction the Panel will usually find misconduct and move to the impairment stage.

(a)  The facts stage.

The Panel will firstly decide whether the facts of the allegations are proved. The burden of proving the allegations is on the NMC. They have to show on the ‘balance of probabilities’ that the midwife acted as alleged.

(b) The misconduct/incompetence stage.

The Panel will decide if the midwife’s conduct has fallen below the standard of that of which is expected of a midwife. This Panel will use their judgement to decide whether there is misconduct and /or incompetence.

(c)  The impairment stage.

The Panel will decide whether the midwife’s fitness to practise is impaired. The Panel use their own judgement as to whether there is impairment.

In health cases the Health Committee will decide whether the midwife’s ill health is proved and  whether the condition will cause impairment.

(d) The sanction stage.

The NMC Panel has a number of options when imposing a sanction. The Panel will consider all sanctions in turn, deciding on the appropriate sanction starting with the least severe sanction first.

THE SANCTIONS

The sanctions that are available to the Panels can be found in the ‘NMC’s Indicative Sanctions Guidance’ (published on the NMC’s website).  The sanctions that can be imposed are as follows:

Caution order (one to five years)

A caution order can be imposed by the Conduct and Competence Committee or Health Committee.

For this sanction to be imposed the Panel will consider that there is:

• no evidence that the midwife’s behaviour would have directly or indirectly harmed a patient,
• the midwife admits to the allegations and/or:
• shows insight into their failings,
• the incident was isolated and not deliberate,
• shows genuine expression of regret/apology,
• was acting under duress,
• has a previous good history,
• there’s been no repetition of behaviour since the incident,
• has taken or is taking appropriate rehabilitative/corrective steps, and
• has relevant and appropriate references and testimonials.

A midwife with a caution order can still practise however future employers MUST BE INFORMED of the caution.

Conditions of practice order

Conditions of practice can be imposed by the Conduct and Competence Committee and the Health Committee

For this sanction to be imposed the Panel will be satisfied that:

• the midwife only needs retraining on specific areas of practice, and there is no evidence of general incompetence,
• the midwife is willing to retrain if necessary,
• the midwife is willing to have their health supervised if necessary, and
• the public will be protected whilst the order is in force.

 

The panel will only impose this order if the conditions are workable and the midwife agrees a set of conditions.

Suspension order

A midwife can be suspended from practise by the Conduct and Competence Committee and the Health Committee

To be suspended the Panel will be satisfied that there has been:

• misconduct but not fundamentally incompatible with continued NMC registration,
• apparently irremediable lack of competence but where striking-off is not available, and
• serious ill health but where striking-off is not available.

The panel can impose a suspension order for up to one year. A midwife is not able to practise during this period.

Striking off order

A midwife can be erased from the register by the Conduct and Competence Committee and the Health Committee

For this sanction the Panel will be satisfied that:

• the midwife’s behaviour is fundamentally incompatible with being on the NMC register.
• serious departure from the relevant standards as set out in the code and/or where there is continuing risk to the public,
• confidence in the Council would be undermined if the person is not struck off,
• serious lack of competence where there is no evidence of improvement following two years of continuous suspension or conditions of practice, and
• serious ill health where there is no evidence of improvement following two years of continuous suspension or conditions of practice.

The midwife’s name is removed  from the register for an indefinite period.

Midwives with a striking off order may not apply for restoration to the register for five years.

Note: if there is incompetence, the midwife has to  have already undergone a period of supervision or conditions of practice before she can be suspended.

INTERIM ORDERS AFTER SANCTION IS IMPOSED

In all cases a Panel may, where necessary, impose an interim suspension or interim conditions of practice order. This order is made to cover the 28 day appeal period. It will last up to 18 months.If there is an appeal the interim order will be remain. If there is no appeal, the order will commence from the date it was imposed.

Removal or amendment to the register – incorrect or fraudulent entry

The Investigating Committee deals with issues of registration.

The Panel can order the Registrar to remove or amend a fraudulent or incorrect  entry on the register.

Appeal

An appeal of the decision of the Panel of the Conduct and Competence Committee or Health Committee is to the High Court in England and Wales.

 

 

 

THE CODE OF CONDUCT

Treat people as individuals

1 You must treat people as individuals and respect their dignity.

2 You must not discriminate in any way against those in your care.

3 You must treat people kindly and considerately.

4 You must act as an advocate for those in your care, helping them to access relevant health and social  care, information and support

Respect people’s confidentiality

5 You must respect people’s right to confidentiality.

6 You must ensure people are informed about how and why information is shared by those who will be providing their care.

7 You must disclose information if you believe someone may be at risk of harm, in line with the law of the country in which you are practising.

Collaborate with those in your care

8 You must listen to the people in your care and respond to their concerns and preferences.

9 You must support people in caring for themselves to improve and maintain their health.

10 You must recognise and respect the contribution that people make to their own care and wellbeing.

11 You must make arrangements to meet people’s language and communication needs.

12 You must share with people, in a way they can understand, the information they want or need to know about their health.

Ensure you gain consent

13 You must ensure that you gain consent before you begin any treatment or care.

14 You must respect and support people’s rights to accept or decline treatment and care.

15 You must uphold people’s rights to be fully involved in decisions about their care

16 You must be aware of the legislation regarding mental capacity, ensuring that people who lack capacity remain at the centre of decision making and are fully safeguarded.

17 You must be able to demonstrate that you have acted in someone’s best interests if you have provided care in an emergency.

Maintain clear professional boundaries

18 You must refuse any gifts, favours or hospitality that might be interpreted as an attempt to gain preferential treatment.

19 You must not ask for or accept loans from anyone in your care or anyone close to them.

20 You must establish and actively maintain clear sexual boundaries at all times with people in your care, their families and carers.

23 You must facilitate students and others to develop their competence.

Work effectively as part of a team

24 You must work cooperatively within teams and respect the skills, expertise and contributions of your colleagues.

25 You must be willing to share your skills and experience for the benefit of your colleagues.

26 You must consult and take advice from colleagues when appropriate.

27 You must treat your colleagues fairly and without discrimination.

28 You must make a referral to another practitioner when it is in the best interests of someone in your care.

Delegate effectively

29 You must establish that anyone you delegate to is able to carry out your instructions.

30 You must confirm that the outcome of any delegated task meets required standards.

31 You must make sure that everyone you are responsible for is supervised and supported.

Manage risk

32 You must act without delay if you believe that you, a colleague or anyone else may be putting someone at risk.

33 You must inform someone in authority if you experience problems that prevent you working within this code or other nationally agreed standards.

34 You must report your concerns in writing if problems in the environment of care are putting people at risk.

Keep your skills and knowledge up to date

38 You must have the knowledge and skills for safe and effective practice when working without direct supervision.

39 You must recognise and work within the limits of your competence.

40 You must keep your knowledge and skills up to date throughout your working life.

41 You must take part in appropriate learning and practice activities that maintain and develop your competence and performance.

Keep clear and accurate records

42 You must keep clear and accurate records of the discussions you have, the assessments you make, the treatment and medicines you give, and how effective these have been.

43 You must complete records as soon as possible after an event has occurred.

44 You must not tamper with original records in any way.

45 You must ensure any entries you make in someone’s paper records are clearly and legibly signed, dated and timed.

46 You must ensure any entries you make in someone’s electronic records are clearly attributable to you.

47 You must ensure all records are kept securely.

Act with integrity

48 You must demonstrate a personal and professional commitment to equality and diversity.

49 You must adhere to the laws of the country in which you are practising.

50 You must inform the NMC if you have been cautioned, charged or found guilty of a criminal offence.

51 You must inform any employers you work for if your fitness to practise is called into question.

Deal with problems

52 You must give a constructive and honest response to anyone who complains about the care they have received.

53 You must not allow someone’s complaint to prejudice the care you provide for them.

54 You must act immediately to put matters right if someone in your care has suffered harm for any reason.

55 You must explain fully and promptly to the person affected what has happened and the likely effects.

56 You must cooperate with internal and external investigations.

Be impartial

57 You must not abuse your privileged position for your own ends.

58 You must ensure that your professional judgement is not influenced by any commercial considerations.

Uphold the reputation of your profession

59 You must not use your professional status to promote causes that are not related to health.

60 You must cooperate with the media only when you can confidently protect the confidential information and dignity of those in your care.

61 You must uphold the reputation of your profession at all times.

Indemnity Insurance

62 The NMC recommends that a registered nurse, midwife or specialist community public health nurse, in advising, treating and caring for patients or clients, has professional indemnity insurance. This is in the interests of clients, patients and registrants in the event of claims of professional negligence.

63 Whilst employers have vicarious liability for the negligent acts and/or omissions of their employees, such cover does not normally extend to activities undertaken outside the registrant’s employment. Independent practice would not be covered by vicarious liability. It is the individual registrant’s responsibility to establish their insurance status and take appropriate action.

64 In situations where an employer does not have vicarious liability, the NMC recommends that registrants obtain adequate professional indemnity insurance. If unable to secure professional indemnity insurance, a registrant will need to demonstrate that all their clients and patients are fully informed of this fact and the implications this might have in the event of a claim for professional negligence.

 

 

THE MIDWIVES RULES

Rule 1

Citation and commencement

These Rules may be cited as the Nursing and Midwifery Council (Midwives) Rules 2004 and shall come into force on 1 August 2004.

Rule 2

Interpretation

“attendance upon” means providing care or advice to a woman or care to a baby

whether or not the midwife is physically present.

emergency” means a sudden, unexpected event relating to the health or condition of a woman or baby which requires immediate attention.

local supervising authority midwifery officer” means the midwifery officer appointed by a local supervising authority in accordance with rule 13(1).

postnatal period” means the period after the end of labour during which the attendance of a midwife upon a woman and baby is required, being not less than 10 days and for such longer period as the midwife considers necessary.

“practising midwife” means a registered midwife who notifies her intention to practise to a local supervising authority and who has updated her practice in accordance with the standards published by the Council, and who:

a) is in attendance upon a woman and baby during the antenatal, intranatal or postnatal period; or

b) holds a post for which a midwifery qualification is required.

“woman and baby” means any woman, regardless of her age, and where reference is made to “baby” in conjunction with “woman”, it shall be taken as including reference to the woman’s unborn baby during the antenatal and intranatal periods.

approved educational institution” means an institution or part of an institution or a combination of institutions approved by the Council under article 15(6) of the Order for conducting the whole or part of a midwifery programme of education.

“childbirth” includes the antenatal, intranatal and postnatal periods.

main area of practice” means the geographical location where the midwife has, or will be, practising most oft en in the 12-month period related to the most recent

notification of

“midwifery programme of education” means an integrated theoretical and clinical practice programme that meets the standards established by the Council under article 15(1)(a) of the Order.

supervisor of midwives” means a person appointed by a local supervising authority to exercise supervision over midwives practising in its area in accordance with rule 11(1).

Rule 3

Notification of intention to practise

1 If a midwife intends either to be in attendance upon a woman or baby during the antenatal, intranatal or postnatal period, or to hold a post for which a midwifery   qualification is required, she shall give notice in accordance with paragraph 2.

2 A midwife shall give notice under paragraph 1 to each local supervising authority in whose area she intends to practise or continue to practise:

a)  before commencing to practise there, and thereafter

b) in respect of each period of 12 months beginning on a date which the Council shall specify from time to time.

3 Notwithstanding the provisions of paragraph 2, the notice to be given under paragraph 1 may, in an emergency, be given after the time when she commences to practise provided that it is given within 48 hours of that time. A notice to be given under this rule shall contain such particulars and be in such form as the Council may from time to time specify.

4 A notice to be given under this rule shall contain such particulars and be in such form as the Council may from time to time specify.

Rule4

Notifications by local supervising authority

1 A local supervising authority shall publish:

a) the name and address of its midwifery officer for the submission of a notice under rule 3(1)

b) the date by which a midwife must give notice under rule 3(1) in accordance with rule 3(2)(b).

2 Each local supervising authority shall inform the Council, in such form and at such frequency as requested by the Council, of any notice given to it under rule 3.

Rule 5

Suspension from practice by a local supervising authority

Subject to the provisions of this rule a local supervising authority may, following an appropriate investigation (which is to include, where appropriate, seeking the views of the midwife concerned), suspend from practice:

a)  a midwife against whom it has reported a case for investigation to the Council, pending the outcome of the Council’s investigation, or

b)  a midwife who has been referred to a Practice Committee

of the Council, pending the outcome of that referral.

2 Where it exercises its power to suspend a midwife from practice, a local supervising authority shall:

a)  immediately notify the midwife concerned in writing of the decision to suspend her and the reason for the suspension, and supply her with a copy of the documentation which it intends to submit to the Council in accordance with sub-paragraph b, and thereafter

b)  immediately report to the Council in writing any such suspension, the reason for that suspension and details of the investigation carried out by the local supervising authority that led to that suspension.

3 The Practice Committee to which the midwife concerned is referred by the Council must consider whether or not to make an interim suspension order or interim conditions of practice order in respect of the midwife concerned.

4 Unless that Practice Committee makes an interim suspension order the local supervising authority must revoke the suspension once the Committee has determined whether or not to make an interim suspension order.

5 If the Practice Committee does make an interim suspension order but that order is subsequently revoked, the local supervising authority must revoke their suspension.

Rule 6

Responsibility and sphere of practice

1 A practising midwife is responsible for providing midwifery care, in accordance with such standards as the Council may specify from time to time, to a woman and baby during the antenatal, intranatal and postnatal periods.

2 Except in an emergency, a practising midwife shall not provide any care, or undertake any treatment, which she has not been trained to give.

3 In an emergency, or where a deviation from the norm which is outside her current sphere of practice becomes apparent in a woman or baby during the antenatal, intranatal or postnatal periods, a practising midwife shall call such qualified health

professional as may reasonably be expected to have the necessary skills and experience to assist her in the provision of care.

Rule 7

Administration of medicines

A practising midwife shall only supply and administer those medicines, including analgesics, in respect of which she has received the appropriate training as to use, dosage and methods of administration.

Rule 8

Clinical trials

1 A practising midwife may only participate in clinical trials if there is a protocol approved by a relevant ethics committee.

2 For the purposes of this rule:

“ethics committee” means an ethics committee established or recognised by the United Kingdom Ethics Committees Authority, or established or recognised for the purposes of advising on the ethics of research investigations on human beings prior to 1 May 2004 by the Secretary of State, the Scottish Ministers, the National Assembly for Wales, the Department of Health, Social Services and Public Safety, a Strategic Health Authority, a Health Board, or a Health and Social Services Board.

Rule 9

Records

1 A practising midwife shall keep, as contemporaneously as is reasonable, continuous and detailed records of observations made, care given, and medicine and any form of pain relief administered by her to a woman or baby.

2 The records referred to in paragraph 1 shall be kept:

a) in the case of a midwife employed by an NHS authority, in accordance with any directions given by her employer

b) in any other case, in a form approved by the local supervising authority covering her main area of practice.

3 A midwife must not destroy or permit the destruction of records which have been made while she is in attendance upon a woman or baby.

4 Immediately before ceasing to practise or if she finds it impossible or inconvenient to preserve her records safely, a midwife shall transfer them:

a)   if she is employed by an NHS authority, to that authority

b)   if she is employed by a private sector employer, to that employer

c)   if she is not covered by paragraph a or b, to the local supervising authority in whose area the care took place.

5 Any transfer under paragraph 4 must be duly recorded by each party to the transfer.

6 For the purposes of this rule: “NHS authority” means:

a)  in relation to England and Wales, any body established under the National Health Service Act 1977 or the National Health Service and Community Care Act 1990 which employs midwives

b) in relation to Scotland, any body constituted under the National Health Service (Scotland) Act 1978 which employs midwives

c)  in relation to Northern Ireland, any body established under the Health and Personal Social Services (Northern Ireland) Order 1972 which employs midwives.

“private sector employer” means an organisation other than an NHS authority or a limited company or partnership in which the midwife or any member of her family has or has had a substantial interest.

Rule 10

Inspection of premises and equipment

1 A practising midwife shall give to a supervisor of midwives, a local supervising authority and the Council, every reasonable facility to monitor her standards and methods of practice, and to inspect her records, her equipment and any premises

that she is entitled to permit them to enter, which may include such part of the midwife’s residence as may be used for professional purposes.

2 A practising midwife shall use her best endeavours to permit inspection from time to time of all places of work in which she practises, other than the private residence of a woman and baby she is attending, by persons nominated by the Council

for this purpose, one of whom shall be a practising midwife

Rule 11

Eligibility for appointment as a supervisor of midwives

1 A local supervising authority shall appoint an adequate number of supervisors of midwives to exercise supervision over practising midwives in its area.

2 To be appointed for the f rst time as a supervisor of midwives, in accordance with article 43(2) of the Order, a person shall be a practising midwife and:

a)   have three years’ experience as a practising midwife of which at least one shall have been in the two-year period immediately preceding the first date of appointment, and

b)  either:

i have successfully completed a programme of education of the type mentioned in paragraph 5 within the three year period immediately preceding the first date of appointment, or

i where it is more than three but less than five years since she successfully completed a programme of education of the type mentioned in paragraph 5 (calculating that period by reference to the first date of appointment), have also successfully complied with the Council’s updating requirements as set out in the guidance issued to local supervising authorities in accordance with article 43(3) of the Order.

3 For any subsequent appointment as a supervisor of midwives, a person shall be a practising midwife and:

a) have practised as a supervisor of midwives within the three-year period immediately preceding the subsequent date of appointment, or

b) where she has only practised as a supervisor of midwives within a period which is more than three years but less than five years immediately preceding the subsequent date of appointment, have also successfully complied with the Council’s updating requirements as set out in the guidance issued to local supervising authorities in accordance with article 43(3) of the Order.

4 In the case of a national of an EEA state (or other person entitled to be treated for the purpose of appointment as a supervisor of midwives no less favourably than a national of such a state by virtue of an enforceable Community law right or any enactment giving effect to a Community obligation), the conditions in paragraph 2 or 3 shall be satisfied if, in the opinion of the Council, a person has had comparable training or experience within or outside the EEA.

5 The provider, content and duration of a programme of education referred to in paragraph 2(b) shall be such as the Council shall from time to time specify for the purposes of this rule.

6 Following her appointment, a supervisor of midwives shall complete such periods of study relating to the supervision of midwives as the Council shall from time to time require.

7 In this rule, “date of appointment” means the date identified in the letter of appointment sent by a local supervising authority as the date upon which she will commence her duties as a supervisor of midwives.

Rule 12

The supervision of midwives

1 Each practising midwife shall have a named supervisor of midwives from among the supervisors of midwives appointed by the local supervising authority covering her main area of practice.

2 A local supervising authority shall ensure that:

a) each practising midwife within its area has a named supervisor of midwives

b) at least once a year, each supervisor of midwives meets each midwife for whom she is the named supervisor of midwives to review the midwife’s practice and to identify her training needs

c) all supervisors of midwives within its area maintain records of their supervisory activities, including any meeting with a midwife, and

d) all practising midwives within its area have 24-houraccess to a supervisor of midwives.

Rule 13

The local supervising authority midwifery officer

1 Each local supervising authority shall appoint a local supervising authority midwifery officer who shall be responsible for exercising its functions in relation to the supervision of midwives including in relation to the appointment of supervisors of midwives under rule 11(1).

2 A local supervising authority shall not appoint a person to the post of local supervising authority midwifery officer unless:

a)   she is a practising midwife

b)   she meets the standards of experience and education set by the Council from time to time.

Rule 14

Exercise by a local supervising authority of its functions

Where a local supervising authority (in relation to the exercise of its functions as to the supervision of midwives) has concerns about whether a local supervising authority midwifery officer or a supervisor of midwives meets the

Council’s standards, it shall discuss those concerns with the Council.

Rule 15

Exercise by a local supervising authority of its functions

Each local supervising authority shall publish:

a)  the name and address of its midwifery officer, together with the procedure or reporting all   adverse incidents relating to midwifery practice or allegations of impaired fitness to practise of practising midwives within its area, and the procedure by which it will investigate any such reports

b) the procedure by which it will deal with complaints or allegations against its midwifery officer or supervisor of midwives within its area.

Rule 16

Annual report

Each year every local supervising authority shall submit a written report to the Council by such date and containing such information as the Council may specify.