NMC withdraws approval of midwifery programme in interest of safety

Published on 03 May 2023

A fundamental part of the NMC’s regulatory role is to assure the quality of nursing and midwifery degrees across the UK. To do this we set education standards that ensure graduates are equipped to join our register with the skills, knowledge and experience to provide safe, effective and kind care for people.

We approve courses designed to meet these standards, and we have the power to withdraw approval if we feel our standards are no longer being met. 
Following significant ongoing engagement with Canterbury Christ Church University over serious concerns we had with the delivery of its midwifery programme, and having reviewed a wide range of evidence, in February 2023 we informed the university of our initial decision to withdraw approval. 
Our process required the university to provide assurances within a month that our standards were being met. Having reviewed the university’s submission, we have now made a final decision. 
While we acknowledge that some progress has been made since February, we are not assured that the midwifery programme run by Canterbury Christ Church University is meeting the required NMC standards. We’re concerned that the university, in partnership with the NHS trusts that provide placements for its students, is not equipping midwifery students to meet our requirements. In particular we are concerned about students not gaining the skills and expertise to deliver safe, effective and kind care when they join our register. 
That means, from 10 May 2023, the midwifery programme will no longer lead to registration as a midwife in the UK. This doesn’t stop the university seeking fresh approval of a programme against our standards in the future. 
We considered whether to give the university additional time to address our concerns. While we recognise the positive progress made in some areas, we do not feel that more time would be sufficient to address the substantial number and complexity of the issues, such that we would be assured students graduating this year would meet the standards of proficiency for joining the register. 
Sam Foster, Executive Director of Professional Practice at the NMC, 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. 
“Our standards set out the proficiencies every midwife must have from the time they graduate and join our register. We work with education institutions to ensure students are appropriately supported and trained to provide high-quality care. We can withdraw approval when we’re no longer assured these standards are being met. 
“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.” 

Additional information 

The history to the NMC’s decision  

We have been working with Canterbury Christ Church University since February 2020 to address concerns around the education of midwifery students. We first had concerns about the practice learning environment for midwives given the well-documented and extremely serious concerns about the safety of maternity services at East Kent Hospitals University NHS Foundation Trust. Subsequently, wider concerns about the university’s management of the programme, and partnership working with its practice learning partners arose during the approval visit which ultimately led to our decision to refuse approval of the programme against our new standards in 2022.  
Where we originally had concerns about the learning environment for midwifery students at East Kent Hospitals University NHS Foundation Trust, we engaged with the university through our normal processes to seek regular assurance that our standards were being met.   
Separately to this process, our visitors as part of the joint approval event with the university against our new midwifery standards in June 2022 identified concerns, including from current students and practice partners, which led to refusal of the new programme.   
The university was due to seek re-approval at an event in January 2023 but has subsequently deferred.  
Since August 2022, in light of the concerns raised, we met with the university monthly to seek ongoing assurances that our standards were being met and to review their action plans and contingency plans. 
Health Education England (HEE) separately undertook its own listening event with students and the university’s practice learning partners in August 2022 which identified a number of actions, reflecting areas raised during the NMC approval visit.   
Where we identified concerns with the programme we undertook a student listening event in December 2022 ahead of the planned January approval visit. The report from that event was provided to the university who in turn submitted their observations on the report.   
Alongside the reports, our QA Board also received the exceptional reports submitted by the university and their action plans.   
In February 2023, the university also decided to pause its midwifery student placements at the William Harvey Hospital, which is part of East Kent Hospitals University NHS Foundation Trust. The CQC also announced enforcement action at the William Harvey Hospital Maternity and Midwifery Services.   
On 22 February 2023, reviewing all of the information our QA Board took the initial decision to withdraw approval of the university’s midwifery programme, because it no longer felt assured that the university was equipping midwifery students to meet NMC standards and deliver the care people have a right to expect, nor that students were learning in safe environments. This decision was communicated formally to the university on Monday 27 February.   
The university responded to our concerns, and our QA Board met again on 6 April. The Board agreed there were aspects of the university’s response that needed clarifying.   
As a result, we gave the university extra time to provide these clarifications. The QA Board then reconvened on 26 April and, after thorough deliberation of the university’s response and clarifications, made a final decision to withdraw approval of the programme.   

The specific concerns  

Fundamentally, we are concerned that students may graduate without being able to deliver safe midwifery care. We have published an explanation of our concerns in more detail.   

What happens to students now? 

We're working with Canterbury Christ Church University and NHS England as they rapidly explore options that would enable students to graduate from another institution and join the register. The university will confirm the arrangements as soon as it can. 

Our concerns are limited to CCCU’s midwifery programme  

We have no specific concerns with its nursing or nursing associate programmes, nor with the practice of recent CCCU graduates.   

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