Many people ask me to explain about private midwives, independent midwives and insurance.
There is a lot of confusion so I will aim to explain the situation, as it stands today, and as I understand it. There is currently a story doing the rounds on social media that midwifery outside the NHS will have to stop at the end of this month. That is incorrect.
In the UK, most midwives are employed by the NHS and so are regulated and have to follow the policies laid down by their employing organisation. They are paid by the NHS (aka the taxpayer). Some of us choose to work outside the NHS, and our work is paid for by the individual using our service. So far, so simple – the same principle applies to other aspects of healthcare such as dentistry or physiotherapy or in other areas such as education. If you want something which is different to what the state provides, and you are lucky enough to have the financial resources, you have the option to choose a service provider and buy directly from them. In this blog I will aim to explain the key issues regarding private midwives, independent midwives and insurance. UK legislation requires that midwives are covered by insurance. The NHS provides this for their employees, for those of us outside the NHS it is more complicated.
The terms private midwife and independent midwife are to some extent interchangeable, until the issue of insurance is discussed.
A private midwife is simply one that you pay for directly, not employed by the NHS and paid indirectly by you through taxation. Private midwives can work alone, in groups or as part of a organisation. Although clients pay directly for my work I have tended to avoid the term because I was concerned that it could be perceived as elitist or excluding, in the way that some people view private schools. Private midwives are not necessarily “posh” (some are I’m sure!) and we work for a very wide range of people. My clients have come from a wide range of circumstances and financial situations. Many people borrow money from family to pay for private midwifery care because they have found that the NHS isn’t able to offer what they need or the type of care they prefer. When you pay for something directly it can change your sense of power in the relationship. For most of my clients I think the single most important factor is the relationship we build through continuity of care.
An independent midwife to me is a midwife who works outside (independent of) the NHS. I make independent decisions, rather that being required to work in a specific way. As an independent midwife I aim to provide you with guidance and balanced information so that you can make an informed decision. If I choose to spend hours with a client as they grapple with a decision, that is my choice and I do not have to justify it. What I can suggest or talk to you about is bounded by my knowledge, not organisational policies. Our decisions can be based on our shared assessment of your unique personal situation. As an independent midwife I choose to work collaboratively with a group of other non-NHS midwives, to share knowledge and ideas, to support one another so on. I do not believe that working with a group of colleagues means that I lose my independence.
Definitions become relevant in relation to insurance. Insurance for midwifery practice has been challenging for some time. Sadly, not all pregnancies end happily and the amount of an insurance claim against midwives and obstetricians can be huge. Within the NHS there is a scheme known as the Clinicial Negligence Scheme for Trusts (CNST) which aims to manage risk and provides a form of insurance for NHS Trusts. This is why some NHS policies are as they are, to reduce the chance of a claim. For those working outside the NHS, insurance is required, but there are very few insurers willing to get involved. Those who do require evidence that the chance of claims is being minimised. The usual way to do this is to have a structure organisation which ensures regular professional updating, has some guidelines for practice which the team share and a structure to oversee and monitor members’ practice, addressing concerns about poor or unsafe practice. Lone workers are seen by the insurance industry as potential mavericks who are more likely that others to cross the line between creative personalised care into potentially unsafe practice. Group norms create a moderating influence and provide feedback to their members.
Healthcare, particularly midwifery and obstetric medicine, has to face the challenging truth that things do not always end well, even with the best possible care and professional skills. Life is a risky business and birth particularly so. We are responsible for the care of both mother and baby/babies at a risk laden time. In our society, that often leads to a financial claim against the midwife or doctor. A claim for a baby born with longterm health and support needs is likely to be huge.
I am insured to provide antenatal and postnatal care as a sole, self employed midwife, but in order to have insurance to provide care at the time of birth I work with the Private Midwives organisation, technically as an employee, and thus agreeing to work within their clinical governance framework. This week a campaign has been launched by a group of “birth activists” who are seeking to raise money to set up a fund to pay out claims from, as an alternative to holding insurance. This has been prompted by their insurance premium being raised to a completely non viable level. This has not happened to the group I work with (our policy has just been renewed). Given that the minimum acceptable insurance cover is for a £10million (per client booked for birth care) I cannot quite see the idea of establishing a fund being successful. The campaign leaders are being more than a little disingenuous when they say “there are no insurance options left for independent midwives who wish to remain self employed”. Most people have no understanding of the relevance of “self employed” in that sentence. Midwives CAN continue to work independently from the NHS, but we need to be willing to work collaboratively with colleagues and open our practice to the scrutiny of our peers. I am very happy to do that and learn a huge amount from my colleagues.
The discussion about private midwives, independent midwives and insurance will no doubt continue. I hope that this information enables those considering using a private midwife or independent midwife to understand the potential issues. We are not going to disappear. I am here, loving my work and happy to answer any questions.