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Professional Indemnity Insurance

IM UK Professional Indemnity Insurance update – March 2014

Independent midwives have been unable to secure Professional Indemnity Insurance (PII) since 2002. From February 2013, IMUK have been engaged in a campaign and mission to find an affordable insurance solution to the UK Government proposed implementation of the EU Directive on Cross-Border Healthcare.  IMUK have achieved this goal and have found an insurance product that will meet the requirements of EU Directive 2011/24/EU.

The product will enable self-employed midwives to retain autonomy and remain on the Nursing and Midwifery Council (NMC) Register. IMUK have worked tirelessly to separate midwifery risk from obstetric risk and highlight the incredibly low claims history against Independent Midwives. It was this low clinical risk data that had insurance brokers approaching IMUK with the idea of a “captive” insurance product.

This model of insurance requires a certain level of capital in order to offer a robust level of insurance cover and it was for this reason that IM UK were in negotiations with the Government to secure investment in the future of choice for women and choice for midwives.  IM UK have been able to demonstrate significant savings for the NHS and provide excellent outcome statistics; significantly Independent midwifery has been acknowledged by the DoH and David Cameron as “the gold standard to aspire to”.  IMUK were hugely dissapointed with the DH announcement on the 6th March that it will not financially support the proposal; IM UK continues to actively seek funding to launch the insurance, and invites midwives pursuing self-employed practice to join the organization to access and strengthen the insurance product.

A team of lawyers, insurance industry experts and midwives have written the insurance policy. This has allowed IM UK to keep women and self-employed midwives as the main focus, rather than profits for an insurance company.

Independent Midwifery could be the solution to the current maternity crisis: thousands of midwives registered but not working have indicated they would work self-employed with insurance. Thousands of newly qualified midwives could work self-employed when there are no jobs available for them within the NHS.  Women opting out of the system will relieve the pressure on the NHS.   

Thank you all for your support and rest assured, we are in this for the long haul.
 

 

THE HISTORY: 

Currently there is no professional indemnity insurance available to Independent Midwives (IMs), which means we are personally liable for any negligence claim made against us.  Midwives who are employed by the NHS are covered through their Trust which belongs to the Clinical Negligence Scheme for Trusts (CNST) run by the NHS Litigation Authority (NHSLA).

 

The Royal College of Midwives (RCM) provided insurance cover to all its members until 1994. Following a case involving an independent midwife, the commercial insurers providing RCM cover became aware that they would need to pay out, since the midwife was self employed and therefore had no vicarious liability through an employer. As a result, the insurers immediately raised their premium to half a million pounds, which the RCM felt it could not afford. The College decided to exclude those members who practised independently from PII cover, in order to keep RCM premiums at an affordable level.

 

Some commercial cover was available until 2002 but the premiums kept escalating, despite an excellent claims history, until an annual premium was around £20,000 per midwife. As this was more than many independent midwives earned, most were forced to make the difficult decision to cease practising or practise uninsured. In 2002 the last commercial insurer withdrew from the market because it was not commercially viable due to the small numbers of independent midwives in the UK.

 

Since 1993, Independent Midwives UK (formerly Independent Midwives Association) has searched globally for affordable and appropriate indemnity cover. This has been unsuccessful because midwifery risk is calculated on the same basis as obstetric risk, even though the midwifery remit and approach within maternity care is very different. Compensation payouts within obstetrics are the largest within the health care sector, because of the nature of most claims. 

 

Evidence shows that many people sue hospitals because they received inadequate communication / explanation from caregivers, their care was impersonal and / or procedures were carried out without properly informed consent. Often, patients want a full explanation and an apology for what happened, not necessarily financial compensation. Unfortunately the medical profession often “closes ranks” after a tragedy believing that an apology is an admission of responsibility. This actually makes patients more inclined to sue, as the only available option to seek redress. 

 

We aim to build close and trusting relationships with our clients, based on good communication and information exchange and respect for our clients’ rights to make their own choices and decisions about the care they want and receive. We trust that this partnership approach to care will help protect against the types of scenario above.

 

HOW THIS AFFECTS OUR CLIENTS:

 

There is no insurance available to either Independent or employed midwives that will pay out if ‘things go wrong’.  Insurance is there if medical negligence is proved against a practitioner – having or not having insurance does not mean that your care is any safer.  However, should you decide that our care has been negligent in any way; you would need to take us to court to prove this. Should you be able to prove negligence on our part, any compensation offered would be based on our personal circumstances. You may be advised against pursuing this, since the amounts involved would be relatively small and legal costs high. However, if negligence was to be proved, we would also receive disciplinary action via our professional regulatory body and if necessary, be removed from the midwifery register. Within the NHS, cases rarely get to court, because Trusts often settle before this, to save the heavy costs of a legal case. Therefore, it is hard to evaluate how easy it is to actually prove negligence in any case.

 

You need to think carefully how you would feel, should the outcome of your pregnancy not be as you desired. Unfortunately unexpected tragedies do occur and in most cases, no one is to blame. However, it is important that you only go ahead with booking an Independent Midwife once you feel you fully understand all the facts surrounding this issue. Please ask as many questions as you wish during your consultation with an IM and, if in any doubt please contact Independent Midwives UK for further clarification.

 

HOW THIS AFFECTS INDEPENDENT MIDWIVES:

 

All Independent Midwives are required to document the care they give and because of the insurance situation, IMs are usually extra careful. Our governing body, the Nursing and Midwifery Council, requires us to inform all potential clients that we do not have professional indemnity insurance and the implications of this. We expect Independent Midwives to always be conscientious, professional and responsible practitioners. 

 

However, Independent Midwives choose to work this way because our whole philosophy and attitude to care is based on our belief that our role is to offer well informed, up to date and honest midwifery expertise and advice, to enable and support you in making your own informed choices about care for yourself and your baby and that any decisions affecting your care are made jointly and with consent. Working in this way, should also help protect against negligent practice on our part.

 

However, IMUK is campaigning to ask the government to find a workable and affordable solution to the PII situation.