Freelance midwives to work uninsured as health officials put off clampdown

Lawyers and patient groups attack 'near criminal' move they say puts nurses' needs above safety of mothers and babies

A government move to allow independent nurses and midwives to continue working without insurance and to delay plans for a clampdown was condemned this weekend as "near criminal".

Health officials confirmed last night that they are now "reviewing" plans to make it compulsory for midwives and other health staff to have liability insurance. The review will take until next May and, in effect, flies in the face of a government promise to make it compulsory for all health professionals working privately to buy compensation cover.

Senior lawyers and patient safety campaigners have now accused the Department of Health and the Nursing and Midwifery Council (NMC) of choosing to protect the interest of professionals over the needs of mothers and babies, who, until the issue is resolved, cannot get compensation for negligent care.

Campaigners reacted angrily to the delay just days after the NMC ruled that an independent midwife must face a disciplinary hearing this autumn over her conduct during a home delivery in 2004.

The midwife was referred to the NMC in February 2007 by the lawyer acting for the Anderson family, whose baby was left with a disability because of complications during the birth. The family's claim for £300,000 damages was dropped after it emerged the midwife was uninsured.

Tim Dyde, head of clinical negligence at Tozers Solicitors, wrote to the Department of Health in February 2008 after representing baby Daisy. He said: "The Government told me they would put in place a system of compulsory insurance for midwives. One-and-a-half years later, after talking with the midwifery unions, they have decided to review their policy to require insurance because of 'complex issues relating to administration'.

"I find it incredible, near criminal, that they see 'administration' problems as more important than the problems of children injured at birth, who are left without any compensation. Independent midwives, politicians and the NMC all have a choice in this matter, but the people most affected, the injured children, do not."

Prior to 1993, all midwives enjoyed insurance cover provided by the Royal College of Midwives, but this ended when the scheme was withdrawn. Some turned to commercial insurance, but many began practising without insurance in the face of annual premiums of up to £20,000.

When the last commercial policy was withdrawn from the market in 2005, all 150 independents, who charge £3,000-£5,000 for home births and individualised care, were left uninsured. The number of uninsured nurses is uncertain. All health professionals working for the NHS or a private hospital are insured by their employer.

In the face of strong lobbying by independent midwives, the NMC took a controversial step in 2002 to recommend rather than require indemnity. According to several former NMC members contacted by the IoS, the decision followed strong lobbying by some professional members of the voting council, while patient safety concerns were played down. The NMC says midwives must inform prospective clients of what lack of liability insurance might mean, but the IoS has found huge variations in the accuracy of the information they provide to mothers.

Despite repeated calls for standardised, easy-to-read information for women, the NMC has failed to produce it, even though it has acknowledged that "uninsured midwives could not necessarily be relied on to tell clients that they were not insured".

Tina Funnell, a former NMC lay member, said: "The NMC is not a trade union, but it acted like one. The views of consumer and patient safety groups were never fully presented and people like me were chastised for bringing up these concerns."

The NMC said: "We do not have the legal power to impose indemnity insurance on nurses and midwives. It is extremely difficult to obtain indemnity insurance on the open market. Imposing such a requirement could place an unreasonable expectation on nurses and midwives because they may not be able to find the insurance. For these reasons we have reinforced the need for them to be honest with their clients about this situation."

'We paid £3,000 ... insurance was not mentioned, we assumed we were covered'

Daisy Anderson is five next month. She was born at home in rural West Sussex, under the care of an independent midwife. Things went horribly wrong during the delivery, leaving Daisy with permanent nerve damage to her right arm. The midwife who delivered her will face a disciplinary hearing next month, but Daisy will never be compensated – the midwife was not insured.

Victoria Anderson (pictured with husband Matthew and Daisy) describes the horror of her daughter's birth: "Daisy was my third child and we decided on an independent midwife because we lived so far from hospital and I wanted more continuity of care. We found an experienced midwife we liked and so we paid her £3,000. I was in the water pool, no pain, but then suddenly it went wrong really fast. Daisy's head was out but her shoulder was stuck and all I can remember is the sound of scissors snipping, cutting me and Daisy's neck, trying to pull her out. An ambulance was called, she had to be resuscitated; we both needed plastic surgery. We're grateful that Daisy survived, but she's been left with terrible balance and only one arm really. She's just had a major operation but she'll never be 100 per cent.

"Looking back, I was gi-normous; I was induced and I'd developed diabetes while pregnant, which wasn't picked up. All of these make shoulder dystocia more likely. If we'd known that I would have gone to hospital. And she never mentioned insurance, not once, so we assumed that we were covered. I know it wouldn't make up for her arm, but I just wish I had something to give Daisy when she's older."