Independent Midwives and the £1m Unspent Staffing Budget…
Recent statements from Gloucestershire Hospitals NHS Foundation Trust
— and echoed by some within the system
— suggest that independent midwives may present a safety concern because the Trust
“cannot verify their skills”
or
“does not know their governance arrangements.”
These claims require careful examination.
Because if true,
this would undermine not just independent midwives
— but the entire regulatory framework of midwifery in the UK.
They are not true.
The Myth: Independent Midwives Are Different
Truth: Independent midwives are not a separate category of clinician.
They are trained under the same national standards.
They are regulated by the same professional body.
They are bound by the same legal framework.
The title “midwife” is protected in law under the Nursing and Midwifery Order 2001.
Only those registered with the Nursing and Midwifery Council (NMC) may use that title.
There is no alternative qualification pathway.
No reduced standard.
No parallel governance system.
Every midwife
— whether NHS-employed or self-employed
— must:
Complete NMC-approved university training
Meet national standards of proficiency
Revalidate every three years
Evidence a minimum of 450 practice hours
Undertake at least 35 hours of continuing professional development
Provide reflective accounts and peer discussion
Remain subject to investigation and fitness-to-practise procedures
If the Trust claims it cannot assess the competence of an NMC registrant, then a broader question arises: how are external clinicians, locums, agency staff or specialist referral practitioners assessed?
The regulation is already there - it always has been.
Independent midwives are not outside of governance.
Governance is outside of the NHS Trust.
What Is Actually Different?
The Model of Care
The difference is not training.
The difference is the model.
NHS maternity systems operate within large,
standardised pathways designed for consistency across thousands of women.
The way the NHS, industrial scale system works makes individual care extremely difficult,
which is at odds with midwives NCM regulation.
Independent midwives, however practise continuity of care.
Continuity means one known midwife
— or a very small team
— caring for a woman throughout pregnancy, birth and the postnatal period.
Not a new face at every appointment.
Not strangers during labour.
Not fragmented shift-based care.
Doesn’t rely on standardisation.
Continuity allows:
Early recognition of subtle clinical change
Individualised assessment rather than pathway compliance
Informed, relational consent
Reduced anxiety and increased physiological safety
The evidence base for continuity of carer is longstanding and robust.
It is associated with reduced intervention, reduced stillbirth rate,
improved maternal satisfaction, and better outcomes overall.
In Gloucestershire, three pilot continuity teams were established and later disbanded.
One explanation offered was that if continuity could not be offered to all women, it should not be offered to any.
This logic deserves reflection.
If something demonstrably improves safety, equity is achieved by expanding it — not removing it.
The FOI Evidence: Underspend and Accountability
Recent Freedom of Information correspondence has documented delays in obtaining maternity outcome data and confirmed previous underspend within maternity budgets FOI – Maternity Birth Outcomes ….
At the same time that services have been suspended or restricted on the grounds of staffing and safety,
allocated funds have not always been fully utilised.
It is somewhat unbelievable that these two realities sit together.
If there is insufficient internal skill mix to provide certain services
— and there are experienced, regulated independent midwives available
— then commissioning collaboration is not radical.
It is pragmatic.
It is lawful.
It is a responsible use of public funds.
Other Trusts work collaboratively with independent midwives.
Governance agreements can be formalised.
Referral pathways can be clearly defined.
Escalation processes can be agreed.
The infrastructure for safe collaboration already exists.
The question is whether there is willingness to use it.
The Real Question: Why Are These Experienced Midwives Not Working Within an NHS Trust?
This is where the conversation becomes more uncomfortable - not just for those at the top, but for the midwives themselves.
If the Trust lacks the correct skills mix internally,
that suggests a retention issue.
Why are these outstanding and experienced midwives choosing to work outside the system?
Not because they lack competence.
Many midwives leave precisely because they understand physiology deeply.
They understand the importance of relational care.
They understand when intervention is necessary — and when it is not.
Fragmented, industrialised maternity systems reduce autonomy,
increase moral distress, and move further from the midwifery model defined in statute.
Midwives are described in NMC standards as autonomous practitioners, lead carers for women experiencing normal childbirth, responsible for recognising complications and escalating appropriately.
When professional autonomy is constrained,
and continuity dismantled, morale declines.
This is not a skills deficit.
It is a culture issue.
Safety Is Not Synonymous With Centralisation
There is a growing conflation between “safety” and “obstetric control.”
Safety in maternity care is built through trust,
continuity, early recognition of deviation from normal,
and timely escalation when required.
Independent midwives do not operate in isolation from the wider system.
They refer into NHS services when specialist care is needed.
They collaborate.
They document.
They escalate.
The idea that self-employed status inherently equates to reduced safety has no factual foundation.
In fact, one could reasonably argue that enabling autonomous midwives to practise continuity — while maintaining clear referral pathways — strengthens the overall safety net.
Rebuilding Trust
At its heart, this debate is about trust.
Trust in women.
Trust in midwives.
Trust in the NMC regulatory framework.
Trust in evidence.
To imply that independent midwives are inherently unsafe risks undermining the profession as a whole.
The safeguards are already in place.
The NMC regulates.
The law protects the title.
Revalidation enforces standards.
Accountability mechanisms exist.
If Gloucestershire wishes to restore service provision while addressing workforce gaps,
collaboration with independent midwives is not a threat to governance.
It is a solution grounded in professional regulation and public accountability.
All need not be lost.
But rebuilding trust — between women, midwives and the system — will require honesty about workforce retention, transparency about funding, and courage to welcome collaboration rather than resist it.
Because safety is not created by excluding regulated professionals.
Safety is created by strengthening relationships
— and using every lawful, competent resource available to support women well.
If you would like to support the work of Gloucestershire Maternity Action Group you can become a member for £2 / £5 or £10 per month