Laurence Vick
Posted on 25 Sep 2013

Free, but Lonely – Independent Midwives

Michelmores Comment: after 20 years spent searching for indemnity insurance, pressure is mounting on the UK's independent midwives to secure cover.

Frei, aber Einsam - 'free, but lonely', the motto of the great Hungarian violinist Joseph Joachim, probably had little to do with insurance cover. The UK's independent Midwives, however, live with a similar compromise: the price of their independence is that no insurer will underwrite the risks of their trade.

Independent midwives (IM) are self-employed, fully qualified midwives, who counsel and assist an expectant mother through her pregnancy as well as during the birth itself. The IMs' approach is advertised as 'traditional', and does not lack supporters: David Cameron has come out in praise of IMs, declaring that they are an institution that must be preserved. So far, however, rhetoric appears to be the extent of the Government's backing.

Not currently eligible to join the NHS' Clinical Negligence Scheme for Trusts, independent midwives are seen as a risk too far by the insurance industry. Before 1994, they were included in the Royal College of Midwives' insurance package, but, following a claim against an IM, insurance premiums soared and the College was forced to exclude IMs from its cover.

With commercial indemnity unaffordable (the trade body Independent Midwives UK placed the pre-2002 premium at £20,000 annually per midwife), IMs have been practising without insurance for over a decade. What this means is that, in the event of a negligence claim against an IM where no liability attached to the NHS, a claimant will only be able to sue up to the value of the IM's assets. 'Only', of course, is a relative term; this would be no small sum to the negligent midwife. Against the NHS, on the other hand, birth injury compensation awards can extend to millions of pounds.

In a claim against an IM, it would be likely that legal costs would outweigh the final sum awarded, effectively leaving a claimant without means of redress. Maternity care remains a high-risk area; in 2012, the NHS Legal Authority released its 10 year statistics on maternity claims against the health service, showing that claims for negligent obstetric and gynaecological treatment cost the NHS more than almost every other specialty put together, and attracted the second highest number of claims. Within obstetrics, 'management of labour' had the highest rate of claims.

A change is coming

The situation of the IMs is about to reach a conclusion, for better or worse. A 2011 EU Directive is due to become implemented in UK domestic law in October 2013, stipulating that all regulated healthcare professionals will need to have Personal Injury Insurance, or be prevented from practising. This could mean that IMs, a group of professionals with significant skill, will be removed from the health market entirely. Many feel that this would be  tragedy.

Following this, there has been movement in the insurance industry, but without conclusive results. As reported in the industry publication the Insurance Post, an independent study of the IMs' options led insurers to recommend that the Government step in and provide indemnity for IMs. As yet, Whitehall have not spoken up to oblige. Time is running out, and whether IMs can retain the freedom to practice their trade as they currently do remains to be seen.

For subscribers to the Insurance Post, Callum Brodie's article on Independent Midwives' search for cover can be read here.

You can also read a recent interview with Michelmores' Laurence Vick in the Post, on NHS indemnity, here.

If you would like to discuss claim involving a midwife or obstetric/gynaecological treatment, you can contact us free for discreet, impartial advice.