Gaps In Guidance

Does this impact patient care?

All UK nurses, midwives and nursing associates will be familiar with the Nursing and Midwifery Council (NMC) Code (2023). The set of standards that encapsulate the expectations of anyone wishing to join the professional register.

To join the NMC register is to commit to uphold and embody these standards, both through our clinical practice, and in the morals and behaviours we exhibit as individuals in a trusted profession. However, in reality, as professionals, are we given the tools we need to do so, especially when working with additional needs beyond our speciality?

Healthcare inequalities

It’s no secret that inequalities exist in healthcare for individuals with disabilities, even more so for those who are disabled and pregnant as found in the Missing Billion Initiative’s March 2025 report “Disparities in maternity care for disabled women in the UK”, which highlighted in addition to poorer clinical outcomes, significant gaps in current UK guidance for healthcare professionals.

Significant gaps

The Royal College of Obstetricians and Gynaecologists only mentions disability in 2 out of its 67 published guidelines, and it has zero guidelines available specifically titled and focused towards disability or disabled women.

The National Institute for Clinical Excellence (NICE) – an important source of evidence based clinical expertise for healthcare professionals, didn’t fare much better, disability was only mentioned in 6 of the 30 available guidelines covering fertility, pregnancy and childbirth. Surprisingly, disability was not mentioned at all in the NICE report on pregnancy and complex social factors.

Professional standards of practice

How does this relate back to the NMC Code? We are instructed within it to practice effectively, and to achieve this by “always practicing in line with the best available evidence”.  Arguably, in this scenario, this is difficult to achieve when the evidence-based guidance available is minimal at best.

Preserve safety is another standard, achieved by “being aware of and reducing as far as possible, any potential for harm associated with your practice”. Awareness may be present, but the ability to reduce potential harm and mistakes is considerably more challenging, when there is not robust clinical guidance to underpin clinical practice.

It is evident that current resources can only be viewed as the beginning of guidance, and that there is a need for more specialist guidelines in order to provide tailored care. As healthcare professionals, the onus is on us to abide by the NMC professional standard of preserving safety by “recognising and working within the limits of your competency”, working within your scope and recognising when there is a gap in specialist knowledge is integral to providing the gold standard – person centred care.

References:

Nursing Midwifery Council (2023). Standards - The Code. [online] Available at: https://www.nmc.org.uk/standards/code/.

‌UK (2025). Missing Billion Initiative. [online] Missing Billion Initiative. Available at: https://www.themissingbillion.org/uk-maternity-report.