DHSC 'in breach of law' by not offering home births

Tynwald Commissioner says current situation is 'unacceptable'

The Island’s health department has breached its legal obligations by not offering women on the Isle of Man the option to give birth at home. 

The Tynwald Commissioner for Administration has recorded a finding of maladministration over the Department of Health and Social Care’s decision not to offer home births. 

Angela Main Thompson OBE was asked to investigate by a couple who had their first child in October 2020, having initially hoped for a home birth. 

Mr S, as he’s been called in the report, is from the Island, and met Mrs S in the UK while attending university. 

They decided to relocate to the Island when Mrs S became pregnant in 2020, but had to stay in the UK until August of that year due to Covid border restrictions, so the expectant mum’s birth plan was put in place while she was still resident in the UK. 

The couple found the DHSC’s website listed home births as an option, but it was only when they relocated that they learned this wouldn’t be available to them. 

The 2001 National Health Service Act states the DHSC shall secure adequate number of midwives for attendance on women in their home during childbirth, and at least 10 days afterwards. 

Initially there was confusion over who would carry out the investigation, with Ms Main Thompson advising then-DHSC CEO Kathryn Magson that an internal review should be carried out by the department before it’s reviewed to the commissioner, but this didn’t happen. 

Legal guidance sought from the Attorney General’s Chambers by the DHSC after its decision not to allow Mrs S to have a home birth suggested that the department was only obligated to have the midwives, not to deploy them - a position that was rejected by the commissioner. 

The investigation also looked at previous legal advice relating to a case in 2017, which told the department it ‘had to deploy resources so as to meet its service obligations’. 

The commissioner also found that Miss Magson’s statement to her investigation was ‘intended to mask the reality’ that home births are not routinely available on the Island. 

In the five-year period from 2017 to 2021, 3,478 babies were born on the Isle of Man, with just four of these being planned home births – a situation the commissioner described as “pretty stark”. 

Current interim CEO Dr Stuart Quayle told Ms Main Thompson in August this year that home births are accessed on a case by case basis, but Mrs S – who’s now expecting her second child – was told by Manx Care that it doesn’t offer choices on birth planning. After Ms Main Thompson questioned this position, Manx Care responded that there appeared to have been a communication error. 

Former DHSC CEO Karen Malone told the investigation that resourcing was a challenge, with a shortage of midwives globally, not just on the Island. 

The commissioner said she had great sympathy with the department’s approach, given the resourcing issues, but that this approach does not comply with legislation. 

With reforms due to health legislation in the current administration, Ms Main Thompson added that removing the mandatory requirement for home births may be the only solution, but it would be unfortunate. 

In her conclusion, Ms Main Thompson found that the DHSC breached its statutory obligations, resulting in a finding of maladministration, adding that the continuing failure by Manx Care to discuss home births on a case by case basis is ‘unacceptable’.

Manx Radio has contacted Manx Care and the Department of Health and Social Care for a response.