The Nursing and Midwifery Council (NMC) has withdrawn its approval of an English university’s midwifery course – a first for the regulator, which has never taken such drastic action before.
The regulator announced last night that the midwifery programme at Canterbury Christ Church University (CCCU) is now removed from its list of accredited university courses, following “very significant concerns” about safety and quality control.
“We understand this is a significant decision which will have a huge impact on the students affected and the local workforce"
Sam Foster
The move is a first for the regulator, which has never before taken the decision to revoke a nursing or midwifery course's accreditation.
A CCCU spokesperson said the decision would be “devastating” for its students, and expressed “disappointment” that the NMC went forward with removing approval of the course.
When the course was first placed at risk, earlier this year, an anonymous group of CCCU students told Nursing Times that NMC withdrawal would mean around 130 students could not complete their studies.
They said: “We’re not sure what’s going to happen to us or our programme.”
Nursing Times understands there are currently no first-year midwifery students at CCCU, as the course was paused in 2022, and the university confirmed there would no 2023 midwifery intake.
Student midwives currently enrolled on the programme would be supported to move to another education institution, said the NMC.
In its report explaining its decision, the NMC said it understood the difficult position this put students in, but that “the overarching objective of the NMC is to ensure public protection”.
The regulator found a series of failings in the way student midwives at CCCU were being trained, particularly surrounding how they were supervised when on placements at local hospitals.
Student midwives on placements are, under NMC guidance, supposed to be supernumerary, which means they are not counted in the safe staffing levels.
However, on several occasions students reported not being supernumerary in practice, not being listened to when they had concerns, and feeling unsupported both on placement and during their course.
The NMC also found that course leaders had signed off students who were not up to standard, and, overall, was not satisfied the programme could produce midwives who were able to practise at safe NMC-approved levels.
The regulator was first made aware of potential issues at CCCU in January 2020. At this point, the concerns were purely around the practice learning environment – placements – for student midwives at East Kent Hospitals University NHS Foundation Trust.
Around the same time, the Department of Health and Social Care (DHSC) commissioned a report into maternity and neonatal care at East Kent following a series of preventable infant deaths.
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The NMC’s investigation, however, then threw up concerns about the university’s management of the programme and the quality assurance for student midwives.
When CCCU applied for its September 2022 programme to be certified by NMC under the regulator's new standards, these concerns meant it was denied.
A full NMC audit of the course then began, which took evidence about the academic and practical aspects of the midwifery course from leaders, current students and the staff in charge of students at placements at East Kent.
The quality assurance (QA) board at NMC looked into five areas at a ‘listening event’:
- Effective partnership working: collaboration, culture, communication and resources;
- Selection, admission and progression;
- Practice learning;
- Assessment, fitness for practise and award;
- Education governance: management and quality assurance.
These areas were then split into 26 sub-areas and judged on a traffic light system. Of these, just two were rated as green, two as orange and the remaining 22 as red in the QA report.
The report found insufficient capacity to accommodate all students on placements, a lack of academic assessors, a lack of qualified practice supervisors, inadequate safeguards to prevent “unsuitable students” entering the profession, and that the course fell short of the NMC’s learning outcomes, among other issues.
NMC said there were “significant concerns” about the culture of not reporting safety incidents at East Kent, and expressed a worry that students’ “normalised experiences” on placement could render them unfit to practise.
The QA report further found the course was not being strict enough. A third of students tested at a moderated practice assessment day were rated as red – the lowest rating – having previously been signed off as competent in the same skills.
This report was sent to CCCU in February 2023.
CCCU was at this point told that unless it submitted evidence to the contrary, or immediately improved things, the course was to be deemed unsatisfactory and that it would be struck off the NMC's list of approved programmes.
After the university submitted its evidence, an additional two areas were then changed to 'green' by NMC and six of the 'red' risk areas were labelled as 'improvements seen', but not changed to green.
Among areas that the NMC noted improvements included the university's admission procedures, staffing numbers and the organisation of practical placements.
"We are disappointed that [the NMC] has not afforded the university the opportunity to establish and embed the changes across different practice settings."
CCCU spokesperson
However, inspectors remained worried that improvements would be too slow to avoid posing a risk to the public and the decision to strike the course off was made at the end of April, communicated to the university at the start of May.
Sam Foster, NMC executive director of professional practice, said: “After very careful consideration, and in the best interests of women, babies, and families, we’ve made a final decision to withdraw approval of the midwifery programme at Canterbury Christ Church University.
“We understand this is a significant decision which will have a huge impact on the students affected and the local workforce.
"However, as the UK’s midwifery regulator, our role is to protect the public and uphold the high standards of midwifery practice that women and families have the right to expect."
She added: “Our full attention now turns to working with the university and NHS England on plans to support the affected students to continue their education at another institution.”
A CCCU spokesperson said, following the announcement the course would no longer be NMC-accredited: “The Nursing and Midwifery Council’s decision to withdraw approval for our BSc Midwifery course has devastating consequences for our student midwives as well as the regional midwifery workforce in Kent and Medway.
“Our absolute priority is the wellbeing of our students and staff, and ensuring that our students can continue to complete their studies and begin their future careers, to be the high quality, much needed midwives that this region needs.
"We will work with our staff, students and NHS partners to achieve this.”
The spokesperson added that the decision came in spite of “significant improvements”, which the NMC had recognised.
They further said: “We are disappointed that they have not afforded the university the opportunity to establish and embed the changes across different practice settings.
“The university remains committed to providing education and training for the widest range of health and social care professions.”
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