Post supervision across the UK
On March 31, 2017 we saw the removal of statutory supervision from the Nursing and Midwifery Order 2001. This meant that midwifery roles and functions associated with Local Supervising Authorities (LSAs), Local Supervising Midwifery Officers (LSAMOs) and Supervisors of Midwives (SoMs) would no longer be a required function.
The Royal College of Midwives sent a letter to the House of Lords Scrutiny Committee, which led to the proposed changes to the Nursing and Midwifery 2001 Order being debated in the House of Lords and subsequently in the House of Commons. This resulted in a call to ensure that some form of midwifery leadership replaced the existing LSA structure.
In England a new model, Advocating for Education and Quality Improvement (A-EQUIP) has been developed. A multi-stakeholder taskforce oversaw the development of A-EQUIP and the role of the Professional Midwifery Advocate (PMA). The PMA role provides midwifery supervision and support through the use of the A-EQUIP model.
A-EQUIP and the PMA role is employer led, and it is the responsibility of NHS providers to decide how this role will be implemented in their organisation. This allows maternity providers to be more flexible in applying all or some elements of the model that best supports local needs and priorities. There is an expectation that all organisations will support and develop this role and it will become part of the Care Quality Commission (CQC) criteria when inspecting a service, ensuring the organisation has an A-EQUIP model in some form.
PMAs are qualified midwives that have undertaken further-recognised training provided by a Higher Education Institute (HEI). Once selected and trained, PMAs can then undertake a number of duties as part of their substantive midwifery role; this can be in a full-time capacity or on a sessional basis.
The PMAs act as role models, promoting safe and effective evidence-based care for women, babies and their families. This is achieved by supporting midwives to identify how personal actions can improve the quality of care provided to women and families, and by using a process known as restorative clinical supervision. This provides midwives with the time and space necessary to focus and further develop professionally in accordance with their career aspirations. This is particularly important for retaining midwives and supporting them to develop and grow.
A new model of midwifery supervision was launched in Scotland during 2018, following the changes to legislation.
All investigations are now undertaken through a model which is employer led, rather than supervisory.
This new model is on based on models of clinical supervision, designed to offer midwives a supportive environment in which they can ‘reflect, respond, restore’. More information about the process undertaken in Scotland can be found on the Scottish Government website.
During 2017, current supervisors of midwives were invited to indicate if they wished to continue in the new supervision model and new volunteers were also sought. NHS Education for Scotland devised an educational preparation programme for the new role, which included online modules and face-to-face preparation. More than 150 new supervisors of midwives completed their supervisor training. Going forward, all midwives will be asked to attend at least one group supervision session each year. The new supervisors have been trained in group facilitation and coaching techniques, to enable midwives to get the most out of their group supervision sessions. The learning materials can be viewed on the NHS Education for Scotland website.
The new model is being evaluated through a programme of research to ensure that it is achieving its goals. So far, feedback from the new supervisors about the education preparation and their first experiences of running group supervision sessions has been positive.
Currently there is an interim position is in place in NI. Full details can be found on the NIPEC website.
Work is underway to develop an overarching supervision framework for Nursing and Midwifery, which will include safeguarding, however this work is still in the very early stages. To date, a review of the three types of supervision in NI has been undertaken and an outline for a future framework is being considered. The work ahead is significantly challenging and it is agreed that the principles to be adopted within supervision should be a measurable and reportable process to the CNO.
In Wales the new clinical supervision model is employer led and supervisors have both a monitoring and evaluating role.
The Clinical Supervisors for Midwives (CSfM) are appointed by their employer and have a 20% clinical component within their role. They support midwives to learn, reflect, review and discuss practice issues through a model of coaching and mentoring.
There is a mandatory requirement for all midwives to access four hours of clinical supervision each year, two of which must be in a group session.
Supervisors obtain peer support through an All Wales CSfM Forum.
Set KPIs ensure that all Health Boards can demonstrate supervision effectiveness.