Intro

All content of this blog is my own opinion only. It does not represent the views of any organisation or association I may work for, or be associated with. Nothing within this blog should be considered as medical advice and you should always consult your Doctor.

What Channel 4 Dispatches Didn't Expose About the Infant Formula Industry

Many watched with interest last night as Channel 4 Dispatches exposed infant formula manufacturers and the insidious marketing tactics used.  Top quotes from the programme included this, this, this, this and this.

What Dispatches didn't cover though, is the further problem of retailers, consistently repeatedly flouting the law with seemingly little consequence. Week after week after week offences are repeatedly highlighted and reported on social media - despite retailers claiming their systems won't even allow illegal discounting on first milks...

I scanned Baby Milk Action's Twitter feed.  Here are a sample of the breaches reported in the last month - it is by no means all as several report numerous violations:

Waitrose:


Amazon:

Sainsburys:


 Asda:
 Boots:
Tesco:


Booths:

Co-op:

Wilkos


The law came into force over TWENTY years ago so retailers can hardly claim ignorance. When questioned all claim they adequately train staff, yet day after day new violations come to light.  

Clearly the law is not rigorously enforced, to the point retailers clearly don't give a stuff about adhering to it.


Speaking to MailOnline, Mike Brady from Baby Milk Action, said: 
'The law prohibits the promotion of baby formula milk. But we have seen Tesco do this time and time again, year after year.
'They claim it was a mistake and that it won't happen again, but then it does. They are treating the law as a joke.
'We have been saying Tesco should be prosecuted for repeatedly breaking the law.
'Trading Standards Officers will sometimes visit stores but their numbers have been cut back drastically, so there are just a couple of officers trying to hold these massive companies to account which means no prosecutions are being brought.
'Tesco do seem to be the worst offenders when it comes to this.'  
What this means is that virtually all safe-guards to protect the consumer (in this case babies) are being blatantly ignored.  Companies are marketing to healthcare professionals, regulating themselves, providing the research and "evidence" and then ignoring laws regarding how it's sold.

How many documentaries and news reports do we need before something changes?

New Initiative - Colour Coded Hats on Newborns - No Thanks!

I felt a bit like I'd stepped back in time this morning, when I read the following Tweet from King's in London:



I really thought we were well and truly over the idea of "hatting up" term newborn babies? It seems not:



To be honest I'm even more confused, and the plan sounds more than a little flawed...

Why do term, typical, healthy newborns need a cap?  Could hats actually HINDER important newborn behaviours?

Historically hats were used as way back in the 70s as they were thought to prevent a dip in newborn body temperature. Then we learnt about skin to skin.

"Skin Contact is a powerful vagal stimulant, through sensory stimuli such as touch, warmth, and odor, which among other effects releases maternal oxytocin (Uvnas-Moberg 1998; Winberg 2005). Oxytocin causes the skin temperature of the mother’s breast to rise, providing warmth to the infant (Uvnas-Moberg 1996). In a study of infrared thermography of the whole body during the first hour post birth, Christidis 2003 found that SSC was as effective as radiant warmers in preventing heat loss in healthy full-term infants."


Another 2018 paper "The effect of mother and newborn early skin-to-skin contact on initiation of breastfeeding, newborn temperature and duration of third stage of labor" - found separation hindered all areas and those kept close breastfed sooner, were warmer and their mothers had a more rapid third stage.

Focus shifted to "the undisturbed hour" after which babies don't need a hat. Even back in 2003 and the birth of my first, the midwives took the dinky hat I'd taken and placed it neatly back in my bag. Instead they tucked baby down my nightie and said after that, the ward was quite warm enough.

This seems logical right?  If newborns needed a hat to survive those first few hours, surely they would pop out with their own built in hoodie?  


But alas no - I made a few calls and it seems hats are indeed back in fashion; in fact mums are expected to have early skin to
skin WITH a hat, and the colour coded initiative may be rolled out on a wider scale.



As a mum and an IBCLC, I have to say this is horrifying to me.


The claim is the coloured hat enables them to identifying babies at risk of hypoglycemia (low blood sugars). All term babies apparently wear a hat for the first few hours to help maintain their temperature, including during skin to skin. This intervention it is proposed, reduces risks of separation of the dyad.

The reality is somewhat different.


First, the scent of her baby's head is extremely important to mum during skin to skin and continuing into the early days for early bondingI'm going to bet anyone who has sniffed their newly born baby's head knows exactly what I'm talking about - mothers often describe the scent as "addictive", which in turn encourages her to plant lots of kisses, colonising her with any microbes on her baby, enabling the tailor made production of antibodies, which are passed back via colostrum.


The scent also prompts mum to release oxytocin (often called the bonding hormone), which in turn causes uterine contractions, forcing an instant constriction of the blood vessels that were running to the placenta. (Odent, 2013). Oxytocin is also important when it comes to breastfeeding, and as outlined above it generates heat for the baby - and so it all neatly comes full circle. 



What's more, Dr Kajsa Brimdyr, researcher and expert in the field, covered at the UNICEF Baby Friendly Conference 2018, how hats can impede baby's "breast-crawling" reflexes after birth.

So, you'd think that if we're going to implement an intervention that has the potential to impact on all the above, plus hello, can you imagine skin to skin, half chewing on a pom pom instead of inhaling that delicious newborn scent? There must be some stonking evidence it helps.  A lot.  Right?


Nup, not at all.


There's a paucity of studies on hat wearing at all, there's differences in terms of which hats are used (plastic, stockinette etc) and almost none in conjunction with skin to skin.

However a super amazing midwife, IBCLC friend of mine (thanks Marilyn!) sent me a 2018 study, exploring the preterm baby and knits - in a rural setting where low cost interventions can be hugely beneficial:

"Thermal Effect of a Woolen Cap in Low Birth Weight Infants During Kangaroo Care."
"The use of a woolen cap was safe but provided no advantages in maintaining LBWI in the normal thermal range while being in a KMC ward."
Again these babies are low birthweight and so far more challenged in terms of maintaining their own body temperature - even for them, there was no advantage to a hat.

Going back to the cochrane review above, we can see what did make a difference to hypoglycemia?  Yep, skin to skin.

  • "Blood glucose mg/ dL at 75 to 180 minutes post birth Thresholds for low glucose vary from 40 mgto 50 mg/ dL 
  • The control group mean blood glucose at 75 to 180 minutes post birth was 49.8 mg/ dL
  • The mean blood glucose mg/ dL at 75 to 180 minutes post birth in the intervention group was 10.49 mg/ dL more (8.39 more to 12.59 more) 
  • The mean difference (MD) of 10.49 mg/ dL is clinically significant"
When not in use the hat is kept "near the cot".

Now I love the NHS, I think midwives do a sterling job in the face of ridiculous demands - with most having developed the bladder capacity of a Shire horse. But seriously, now they have to ensure colour coded hats, that are likely to be rarely atop a head, stay with the right baby too?  


Even under normal circumstances the hats wouldn't be needed, but anyone who has spent any time in summer in a typical NHS ward, knows colour coded fans may have been more appropriate. The air-con sucks, the windows barely open and the thought of a chunky knit hat becomes preposterous.


It's important to understand, I'm not questioning the the need to identify at risk infants - I'm questioning the implementation.


Surely a large acrylic colour coded magnetic disk that sticks to the side of the cot would be a far more reliable and environmentally friendly indicator, one that doesn't interfere with mums and babies?


9000 babies are born in King's hospitals each year - imagine if all hospitals roll this out, acrylic yarn isn't sustainable nor is the production of hats via volunteers.


The hat may in fact never even be worn - each baby gets a new hat for infection control reasons, (which must be a minefield in itself, w
ere all knitters healthy and in clean environments? and so on). It also surely raises the question from vegans (or anyone else who chooses to avoid animals based products) of - is that hat real wool or acrylic?  (I asked and they think mainly synthetic, but they're donated so don't really know). 


An alternative option which I think is at least worthy of consideration, is colour coded kangaroo care carriers.  

These are carriers designed to protect baby's airways during skin to skin (if mum falls asleep) and hold baby close when mum wants to be mobile.  


This facilitates best practice and could provide a mobile visual indicator. 


The other benefit of carriers is they could further protect against newborn falls.


Paediatrics 2019 published "
In-hospital Neonatal Falls: An Unintended Consequence of Efforts to Improve Breastfeeding".  The study claimed that in an effort to improve breastfeeding rates, rooming in rather than newborns in a nursery was putting babies at risk of falls.  

Therefore surely the appropriate response is to identify and minimise risks?

When newborn nurseries were introduced, the problem of increased infection risk, mixing up babies or them being stolen, would all be higher than when babies weren't separated from their caregivers. As a result, tags and improved security systems followed. Hospitals have evaluated and adapted to visible risks based on separating babies from their primary caregivers.   

Of course they didn't know then that separation was a bad idea for mothers and babies.

A 2011 paper however highlighed:

"The profound impact of maternal separation on the infant. We knew that this was stressful, but the current study suggests that this is major physiologic stressor for the infant."
They didn't know then that separating mother and infants who need intensive care support and were sent to different units, forcing increased separation - resulted in increased mortality.

They didn't know then that Mother-Child Separation Causes Neurobiological Vulnerability Into Adulthood or that 
scores and incidence of SAD were increased among children who were cared in the NICU and both were correlated with the duration of stay in the NICU.


These risks, whilst not as visible as dropping an infant, are far more common and wider reaching.
Now hospitals know more - they need to re-evaluate and react according. Dr Nils Bergman (a prominent expert and kangaroo care proponont) has long-said mothers shouldn't be left alone. 

The Paediatrics study noted:
All events were associated with mothers falling asleep while feeding their infant, and all occurred between midnight and 6 am
A UK hospital explored their fall rate even further. There they noticed:
"similarities in many of the circumstances in which the falls occurred. These were that the mother had:
  • Had a Caesarean section;
  • A low haemoglobin level [anaemic];
  • Restricted mobility, such as epidural or spinal anaesthesia.

The most common scenario was that the mother had restricted mobility, due to having had a Caesarean section, felt sleepy, and fell asleep with the baby in her arms. The baby then fell from her arms and onto the floor.
  • Simple interventions like open curtains and using bedside cots can reduce baby falls"
These strategies brought about a marked reduction of baby falls and are now being established across all the maternity units across the trust.

Bedside cots were so in demand they had to source more!


Kangaroo Carriers could reduce falls, protect airways and provided the additional colour coding re hypoglycemia.  Either way - ditch the wooly pom poms and let mothers smell their babies.

Edited to add: A midwife friend raised an interesting theory this morning, that newborns (she felt) were at risk of becoming colder with a hat, particularly the babies with hair. Although wiped, their heads are still damp and a hat on a damp head can reduce temperature.  Another interesting theory to throw into the mix!

Infant Feeding - Massive Straw Men with Ambivalence & Gaslights

"A straw man is a common form of argument and is an informal fallacy based on giving the impression of refuting an opponent's argument, while actually refuting an argument that was not presented by that opponent. One who engages in this fallacy is said to be "attacking a straw man."
When it comes to discussing infant feeding, we cover bodily autonomy a lot; mothers and their families have the right to decide how to feed their babies. Nobody should be pressurised into breastfeeding and similarly no mother should be pressurised into not breastfeeding.  It sounds pretty simple and yet it's not.

Infant feeding and discussion of, is fuelled by sleep-deprivation, hormones and significant cognitive dissonance - tangled up with complex emotions and a healthcare system that has now lost valuable skills.

Ultimately we know that many fail to receive adequate support when it comes to feeding their baby, leaving a wake of mothers failed by the system, society or both.

The perhaps most vocal response to this recently, is to claim that it doesn't really matter how we feed our babies anyway.

You can see how this happens - a mum wanted to breastfeed, couldn't and thus relays her story of the difficulties she's faced.  Human nature to many when it comes to hearing pain/distress in others, is to attempt to "fix" it.  To provide a solution which will relieve, however temporarily, the discomfort another is feeling.

To hear, acknowledge, to agree that not everyone can or wants to breastfeed or to help her unpick what happened may not feel enough - particularly when so many lack the skills to enable the latter.

So follows the response is that she shouldn't worry - as it doesn't really matter anyway...

The mum's words often read as though it mattered to her. Whether expressed as anger, guilt, sadness or in any other form, the one emotion that doesn't provoke a heated response is ambivalence.  Thus we can safely say mum is feeling something. To dismiss her desires or needs as unimportant seems the ultimate act of anti-feminism.

If a mum is telling you she wants to breastfeed, trying to convince her she's wrong and that it doesn't matter, or that she probably can't do it, that she's selfish and just doing it for herself, would really not be OK in any other discussion than how we feed our babies.

This is also when we typically see the Straw Man rear his head.

When it comes to infant feeding, the biggest clue is that the writer will often use made up terms to address imaginary groups of people - for example "lactivists".

Strangely enough this term doesn't appear in the recognised dictionaries, but we can turn to the urban dictionary for this definition:
"A lactivist is a lactation activist: someone who considers him/herself an advocate for breastfeeding, whether or not s/he's nursed. Lactivism comes in many forms: choosing to breastfeed, choosing to breastfeed for an extended period of time, choosing to breastfeed in public, choosing to smile at a breastfeeding woman, encouraging other women to breastfeed, educating the public on the benefits of breastfeeding, lobbying for pro-breastfeeding legislation, etc. Maybe you're already a lactivist, and didn't know it."
That would seem to cover rather a large demographic - anyone who considers
himself an advocate, anyone who has breastfed, anyone who smiles at someone breastfeeding?

One article someone screenshot recently stated that "lactivists promote inadequate weight gain in babies by saying it's acceptable".

This is the classic straw-man, a technique to derail discussion by refuting an argument that has never been made.  

There is no statement from the "world leader of lactivists", representing all lactivists worldwide making any such statement - they didn't ask me, did they ask you?  Who exactly are the "lactivists" referenced?

If  specific people are making the claim babies don't need food, addressing them directly would seem more effective than an open letter to a fictional collective.

"Lactation consultants" are another group readily attacked in a similar way. 

Recently I read suggestion that "lactation consultants claim a single bottle of formula can destroy supply."

I'm an International Board Certified Lactation Consultant (IBCLC) and I don't claim this, so is my colleague Debs and neither does she.  My friend Helen in Canada is also an IBCLC and similarly makes no such claims, neither does Jo in the US.  Our regulatory body didn't make this statement - so perhaps what is actually meant is one person, somewhere, calling themselves a lactation consultant, said it?

We often see similar tactics employed by far-right groups, but they're often much more easily identified than when it comes to infant feeding.

Instead this anti-breastfeeding agenda is promoted as merely a reasonable middle ground - a place where no infant feeding method is considered superior to another, because this is really what many want to hear right?  Pat pat women on the head, don't fret dear...

Imagine this in any other area of health - does what adults eat matter or will my GP be promoting beige ready meals and chips next?  If so at what age does it shift from not mattering to being the cornerstone of health?
What about an active lifestyle, is there really enough consistently convincing evidence we need to move?

The next time someone tells you how a mother feeds her baby doesn't matter, blow out the gaslight and listen to the mothers telling you it does.

All Tongue Tie Providers Now Need to Register with the CQC - Outcome & Implications for Parents

Many people still don't truly understand the whole hoo-ha with the CQC.  The confusion I think is the result of a number of factors; the embellishment of whispers, passed along morphing into a "ban" and resulting in a rather bizarrely worded petition to "reinstate providers" - so I've tried to form an analogy that might help give a better understanding.

In your local area is a private road that connects a housing estate to a busy working area. Nobody really knows who the road belongs to, only that some have permission to use the road and some don't need permission. There's a list of prohibited activities that can't be undertaken on the road - for example dancing and shouting, but walking isn't mentioned.

The police don't do anything about people walking on the road, since it isn't causing anybody any problems. The risks to the public of people walking down the road are minimal, because only people who work at the end of the road are carefully walking down it, and in 20 years, there's been no problem; all "walkers" are trained in road safety and their regulatory body ensures they follow standards, to use roads in a safe and responsible manner. A local group check on two occasions if they can use the road and the police reply that they can.

One day, a member of aforementioned local group contacts the police call centre independently to ask if he needs permission to use the road. The call handler (who has no idea about the road in question as they haven't heard of it before), gives the standard response which is to have a look at the local maps, ownership deeds and decide for themselves.

The person takes this back to the local group - concerned they now don't have permission to use the road. The local group contacts the police again, asking for confirmation they legally have express permission to use the road. The call handlers again say it's up to them to decide - there isn't a blanket rule as when it comes to roads, some need permission and some don't..

The group hires a barrister to ask the police for a definite yes or no answer - can we walk down this road without permission?  Who owns this road? Is it technically illegal to trespass? If so can you give us permission to trespass until we've planned an alternate route?  If we are acting illegally, will you, the police take action to stop any of us?

The police state that the road is privately owned, which can be in no doubt if we look at the deeds. The law states most need permission to walk down it - and no they can't give permission without application, because they don't own the road and can't break the law themselves.

They state if someone is acting illegally, of course they may take action to stop them, however if those who have always walked that way, choose to continue walking that way until they find an alternate route, they can consider each person passing on their own merits. For example, if they're from the area and are in the process of applying for permission to pass, are governed by the road safety regulatory body, following the rules and are insured to be in the area - the police can choose not to take any further action.

Frenulotomy has been undertaken by midwives and nurses in the UK for 20 years. Ironically the only fatality reported is at a CQC regulated hospital.  There seems to be confusion that registering with the CQC makes practices safer - and there are some areas of healthcare where this is true.  However tongue tie has historically always been performed by sole registered, insured, healthcare professionals, with an absence of significant adverse effects. If you have a complaint, you contact the healthcare provider's regulatory body (NMC, GMC etc) - this is still the case when CQC registered.

The CQC is designed to regulate hospitals, GPs, Care homes and suchlike - "to monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety".  The OFSTED of healthcare, they are body bound to act in the interest of the public.

Hospitals, clinics etc employ a lot of staff, not all are HCP, they need to know places are following safety protocols and have ways of monitoring satisfaction in the setting.  If we look at their fundamental standards - how many even apply to a self-employed midwife treating 3 tongue ties per week in someone's home? 

When it's one or two people working alone as registered healthcare professionals, their own training and insurance ensures fundamental standards of quality and safety are met -they're not bloody Bupa!

As soon as the ATP started pinning down the CQC, some members (including the chair herself) started completing their CQC applications. - knowing they would have little choice but to deem tongue tie a surgical procedure. By virtue of the law and their own guidance, when backed into a corner, they had little choice but to require registration.

The question is, what happens next?

The costs of preparing and maintaining CQC registration are huge (the application form alone takes weeks to complete, in part again because it's really designed for larger organisations with "staff policies", not a "one-man band").  No doubt some who just did a few here and there will decide not to continue in practice - and for those who do register, these costs will likely be passed on to parents.  Many who ceased practicing before Christmas as advised by the ATP, may have already had such an impact to their business and earnings from which it could be difficult for them to recover.

This is likely to make tongue treatment less attainable to those least able to afford it, leading the way for larger clinics and hospital treatments over the personal one to one service many have valued for so long.
------------------------------------
I spoke with the CQC 18.2.19 and clarified the following (posted initially on the Infant UK tongue tie group)

1) Since pressed legally, the CQC now really have little choice but to regulate frenulotomy. They recognise that it's low risk, has been practiced for years and so on, and as such wasn't an area of interest to them; however, legally it's impossible for them to argue that scissors, a frenulum and blood isn't surgical. Therefore, when asked to define the legal position - they've had to concede pin holding HCPs need to register. The CQC don't write the laws (parliament do), they interpret and enforce them.
.2) The only exemptions in terms of "practicing privileges" apply to doctors with GMC registration (as outlined in numerous pieces of legislation). Petitioning parliament would be the only way to potentially extend this exemption to other HCPs. Similarly if people wanted to propose frenulotomy should be on the list of exempt procedures (like toenails for example), they'd need to do the same.
3) They didn't/don't automatically expect midwives/nurses who are certified/insured and co-operating with the CQC, to stop practicing privately whilst applications are completed/processed. Under the law they cannot give permission for a "grace period", however they do decide who they do/don't prosecute and any action has to be in the public interest. Note - THERE IS NOT A BAN as some have claimed.
4) The CQC ONLY regulate registered healthcare professionals. In this RA osteopaths will require registration, however they do not regulate lay healthcare professionals eg IBCLCs, thus they will not be required to register.
5) If contacting the CQC, please remember those that answer are call handlers. Please ask to speak to the registration team for detailed information.
6) ETA: For the avoidance of doubt, frenulotomy does not fall under the regulated activity ‘maternity and midwifery services’, even where it is carried out by a midwife. Tongue-tie is a condition that is usually picked up in infancy, as a difficulty to breast feed and attach to the breast. Older children or adults may require the treatment related to speech difficulties and, where this is the case, the condition is treated by other healthcare professionals. Treating it is not part of midwifery care. It is post-natal care (see NICE interventional procedures https://www.nice.org.uk/guidance/IPG149).
Click here for Letter ATP received from the CQC and sent to ATP members


The UK, Frenulotomy, Private Services & the CQC - Separating Fact from Fiction

The UK "tongue tie world" was thrown into chaos just before Christmas, when the Association of Tongue Tie Practitioners (ATP) sent an email to all their members in private practice.

They reported that confusion had arisen over whether the Care Quality Commission (CQC - regulators of health and social care in England), considered tongue tie a surgical procedure that required CQC registration.

The ATP states that in both 2011 and 2013, the CQC had reassured them registration wasn't required. However recently, they've received reports that practitioners who contacted the CQC independently, have been advised it’s up to them to establish whether they need to register using the framework published.  

Further communications between at ATP and CQC, have so far not resulted in obtaining the blanket guidance for all practitioners that the ATP seek.

As a result the ATP sought legal advice. Whilst this was under investigation over Christmas, the ATP warned if practitioners were not registered, yet it turned out they needed to be - they could face a hefty fine and even prison.  

The ATP of course would be neglectful not to share the legal information gleaned with their members. Since they formally provide guidance regarding registration, they're quite rightly likely to be concerned about potential litigation issues that could arise as a result of any advice they give. They recommended this course of action for all healthcare practitioners that were not CQC registered.

Since it may take months for applications to the CQC to be processed, they also provided a suggested letter members could use to inform others why their frenulotomy services had temporarily ceased.  

This information was disseminated to members, some of whom ceased practice.

As updated guidance from the CQC has been published since 2013, this could mean, as the ATP highlighted in their email, that a good chunk of practitioners have potentially been misadvised - resulting in them practicing without the appropriate registration for years. Concern was also raised the CQC could take retrospective legal action if and when members applied.

What hasn't happened:


I've heard all sorts of rumours over the last couple of weeks - that the ATP had forced suspension of services, that the government?! had decided nobody was regulating frenulotomy and so had banned private practice, through to claims anyone practicing without CQC registration was acting illegally!


Clearly some forgot that all healthcare providers with a pin are already really rather regulated - so unless your friend's non-registered uncle is having a bash down the pub, we were always far from the worryingly unsafe situation some are now suddenly purporting.

Who are the ATP?

We should clarify as there has been some confusion recently online, the ATP is not a governing body or regulatory in nature. The ATP was formed by a group of tongue tie practitioners and is a committee run, member organisation. They're perhaps best known for the UK directory, or list of their members who provide tongue tie services - although their scope is larger than this as they state they aim to increase tongue tie awareness, support parents to obtain safe, effective care and so on.  All practitioner members of the ATP must submit evidence of training and insurance. 


Tongue tie providers can therefore choose to become a member, but there is no requirement to do so.  Similarly of course, both members and non-members can choose to follow guidance from the ATP, or seek their own legal counsel.

Several providers I know (including ours), had already made contact with the CQC independently, typically when setting up their practice or moving to a clinic base. All seem to have been advised (as per recent reports), that the onus was on them to read the guidance and establish whether registration was required.

Because the framework is complex and different exemption pathways exist, for example here and here (with further details and caveats in other sections and sub-sections), some providers have already separately sought legal advice long before this recent news from the ATP.

Some practitioners have already faced investigation and answered to the CQC.  

I was notified early in 2018 that IFS (Milk Matters) were under investigation for unlawfully undertaking "Treatment of disease, disorder or injury" and "Surgical Procedure".

We probably shouldn't have been surprised as after I made THIS Facebook post here, I received this (ironically a year ago to the day!):
After providing all the required information/evidence about our setup, practitioner and so on (including offering to register ASAP if required) - the complaint was dismissed with no further action needed.  

Our legal guidance received since the ATP email therefore, is that we have already satisfactorily addressed this issue direct with the CQC.  

The latest legal advice the ATP shared with members, in response to some continuing to practice, can be found in the form of an email from their barrister:
"I am afraid it (frenulotomy) is registerable as far as independent practitioners are concerned and an offence to carry it out without registration (subject to the medical practitioner exemption, explained in the advice)."[sic]
Their opinion is frenulotomy is registrable and if you don't meet the required exemptions, to not do so would be an offence.  Logical.  This however is not the same as saying all providers need to register.

It also makes the next move by the ATP yesterday incredibly confusing.

The chair Sarah Oakley writes:


Why, I wonder, do parents need to ensure a provider is CQC registered? 

The onus is not on patients to ensure their healthcare professional holds appropriate CQC registration, because they can't be expected to be aware of exemptions or the laws surrounding registration.  Despite what has been suggested recently - parents visiting a non-registered CQC provider are NOT "colluding in an illegal act".  Providers who fail to register when they need to however, can face prosecution.

What are the benefits of using a practitioner that is CQC registered rather than exempt from needing to register?  

The ATP may need to expand further and provide evidence supporting their rationale, should they be challenged legally regarding this recommendation. I can't imagine paying members (who have been advised by their own solicitor they are exempt from needing to register) will be massively impressed at this point.

It's even harder to understand the recommendations in terms of benefits to parents, as this leaves us for the most part with surgeons and dentists - the very group from which parents on the UK Infant Tongue Tie Group report the lowest satisfaction levels, when it comes to frenulotomy and infant feeding.

More about the CQC

Given what I've read in recent days, I think there is much confusion about what the CQC actually does - Here you can see what CQC fundamental standards are.

Despite what many seem to think, the CQC won't undertake complaints from those dissatisfied with their private care (as outlined here).  
"We cannot make these complaints for you or take them up on your behalf. That may seem confusing but it’s because we don’t have powers to investigate or resolve them."
The CQC inspect and ensure the provider is qualified, that general clinical standards are met and so on, but should someone be unhappy with a treatment received - whether CQC registered or not, complaints would be addressed to the relevant governing body eg the General Medical Council, Nursing and Midwifery Council or General Dental Council.

One might argue - why doesn't everyone just register with the CQC anyway, even if they don't need to, surely this is win win all round?

The problem with this is the vast majority of tongue tie providers work alone or with a colleague - yet the CQC is setup to regulate large hospitals, care homes and suchlike.

If a provider has 2 bases (working say half a day from each), the annual cost for registration to the CQC is in the region of £4000

In addition to this, sources quote anywhere between forty and hundreds of staff hours are needed to apply for and prepare for an inspection (rather like when Ofsted at inspecting schools).  If we pitch that even at forty hours (which would likely be unrealistically low for someone with no experience of the process), that's around a further £2500.

If we then consider the insurance to undertake tongue tie independently is already expensive (as you might imagine), plus other "hidden costs" like accountancy fees, ongoing CPD hours to keep up to date with current practice, conferences and re-certification costs for IBCLCs and so on) - many may soon find it's not financially viable to practice.

It would also be very difficult to argue any benefits in terms of safety, of everyone blindly registering with the CQC even if they're eligible for exemption.  

Frenulotomy has been performed extensively in the UK since the 1990s and is considered an extremely safe procedure which can be performed in the home (like a heel prick/neonatal blood-spot or blood test) - complications are considered very rare (NICE: Division of ankyloglossia (tongue-tie) for breastfeeding). 

Independent nurses and private health visitors in any great number are relatively new in terms of private UK services, from the perspective of member interests - an urgent dialogue regarding clarifying current and possible further exemptions with the CQC would seem prudent before issuing guidance.  

Assistance for different types of provider in navigating the exemptions seems necessary - yet instead we're seeing recommendation every private practitioner in the UK should race to register or be deemed "legally unsafe" and avoided by parents.  

This seems both reactionary and unnecessary to many I've discussed this with, leaving both practitioners and parents stuck.  One health professional I spoke with who is CQC registered for other activities, said they'd expect practitioners to explore all routes thoroughly for CQC exemption, offering yourself up for regulation unnecessarily they felt was madness.  Whilst unfortunately nobody was prepared to speak "on the record", this is clearly a large can of worms lacking a lid.