Case study 24: Midwife’s No Case To Answer incurs massive hearing costs

Aug 1, 2024 | Case Studies | 0 comments

An independent midwife was referred to the NMC five years ago. She had worked with a client who was expecting twins in 2019 and was planning a home birth. The system frowns on this hugely, and sets out to coerce women to change their minds.

This mother was an intelligent and strong woman and did her own research to make the right choices for her and her family. She went into labour at 32 weeks and went into hospital where the midwife supported and advocated for her but gave no clinical care.
She continued to make her own choices but was bullied numerous times, especially about having continuous monitoring. One of the hospital midwives reported the independent midwife to the Nursing & Midwifery Council (NMC) and 5 years later her hearing was scheduled for an 8 day hearing.

The mother and twins are all in good health and the parents have made no complaints in regards to this midwife’s care.

The allegations were as follows:

That you, a registered midwife, between 7 July 2019 and 10 July 2019, having been instructed by Patient A as an independent midwife:

1. Provided advice that was not in line with national guidelines in that you advised Patient A that to request intermittent auscultation despite knowing that Patient A was a high-risk pregnancy that required continuous fetal monitoring;

2. Provided advice that was not in line with safe practice in that you suggested:

a. that Patient A’s babies could be resuscitated on Patient A’s chest or stomach despite being aware that the babies would be premature and/or that this would not be normal practice for the Trust;

b. that delayed cord clamping could occur, against the Trust’s policy in relation to premature babies;

c. that the neonatal team are not present in the room at the time of delivery contrary to the Trust’s normal practice for high-risk pregnancies;

3. Failed to manage a high-risk pregnancy in that you did not inform Frimley Park Hospital that you had been instructed by Patient A to act as an independent midwife and/or that you were managing Patient A’s care.

The hearing

The midwife, as was her responsibility, gave lots of information to the NMC about the case so as to show her experience and that she had not failed in her duty of care. The case continued to hearing.

The hearing started on June 17-19 this year and adjourned before it was resumed again on July 15th 2024.

On Day 3 of the hearing at the close of the NMC’s case the panel made of its own volition the unusual step of asking both parties to prepare submissions on no case to answer on all charges. This is where it is proposed that the NMC have not provided enough evidence to prove the facts of the case. The registrant’s barrister presented a Galbraith application and the panel agreed that there was insufficient evidence and the case was closed with no case to answer.

On Day 4 of the hearing, both sides presented their summations for proceeding (the NMC conceded one charge could be dropped in regards to cord clamping and the panel heard both sides as to why the others should or should not remain). At this point the NMC had concluded the presentation of their case and it was to be decided if this was sufficient for there to be a case to answer. Said above.

On Day 5 the panel deliberated before handing down No Case to Answer on all Charges.

 

For one charge, 2b, the panel stated that “the only relevant evidence, in fact, goes against the charge”.

The panel only had one registrant member, the other two being lay including the chair. For such a case we would expect at least 2 midwives to be on the panel.

 

We have previously posted about the costs of hearings.

We calculated that a previous hearing, for a case against a nurse who was always going to retire and whose case collapsed, cost nearly £40,000.

Another had 60 charges against him with 59 dismissed – hearing costs were over £23,000.

Another midwife whose case closed with no misconduct and no necessity to sanction had high costs for the hearing alone. This midwife had a previous hearing which lasted 10 weeks, 2 years previously. It was decided there was no clinical misconduct – we calculated the total cost of the hearing to be £193,750.

 

This case hearing costs.

Since our independent midwife’s previous case, panel costs have increased but, based on an updated FOI, we know the costs for panels, as well as additional staff members from the NMC, to attend the hearing this week.

We estimate that this hearing cost £36,896, equivalent to 307 registrant’s annual fees.
This is without the costs associated with the five years of case management and the costs to the registrant of representative fees and loss of earnings.

Breakdown:

Role Daily charge Additional notes
HEARING PART ONE
Cost of panel Chair £367/day Refund travel and out of pocket expenses
Cost of registrant panel member 1 £320/day
Cost of registrant panel member 2 £320/day
Cost of legal assessor £500
Cost of case presenter (externally sourced for this hearing) Based on Grade C £196/hour x 7.5 hrs/day
Cost of hearing coordinator

£26,805 – £33,909/annum = approx. £150/day

Cost of transcriber

Attendance remotely – £135+VAT per day

Transcription £1.65 per folio:

A folio being 72 words – estimate 120 folio’s per hour of proceedings.

** Grade C barrister costs based on disclosure of costs at a 2017 appeal hearing – likely to have increased **
** Panel costs based on FOI in 2023 **
** Panel members rate increased in June 2024 – prior to then Chair = £350/day and reg/lay member = £310/day **

We ask the NMC:

  • Why was there only one registrant panel member?
  • Who was responsible for signing off that this case should go to hearing?
  • What was the NMC doing over the past 5 years to be unable to prove facts at hearing? Why was the case pursued?
  • Why was this case not closed earlier without the added expense of a hearing and trauma of long drawn-out case management?
  • Why were charges not drafted in line with up-to-date practice eg around cord clamping?
  • How many other midwives have had similar charges and not had the same outcome?

As an independent midwife this lady is at high risk of referral. Her overarching aim is to advocate for woman and child. This can sometimes cause conflict with hospital based teams where professional jealousy can occur, or a teams fail to allow the woman to make her own birth choices.

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