REVALIDATION. Portfolio of Evidence to Vinny Ness. SRN SCM MSc DAM

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1 MOCK PORTFOILO Nursing & Midwifery Council REVALIDATION Portfolio of Evidence 2013 to 2016 Vinny Ness SRN SCM MSc DAM Project Manager Powys Local Health Board

2 Each registrant must demonstrate how they meet the requirements of reregistration and have their evidence confirmed. The easiest way to present the evidence for Revalidation is by maintaining a Portfolio this can be in a paper or electronic format If you already have a professional portfolio, it is not expected that you need a separate portfolio for revalidation, but please ensure that in building upon an existing portfolio you include the exact requirements of revalidation. Although not a requirement of Revalidation it is suggested as good practice, that you include the following information: An up to date overview of your CV Your Job Description(s) Your IPR/ PDR It may also been helpful to divide your portfolio into sections as follows; Example: Section 1: Personal Details and CV Section 2: Job Description and IPR/ PDR evidence (this could be amalgamated into section 7) Section 3: Continuing Professional Development (Revalidation requirement) Section 4: Practice Hours log (Revalidation requirement) Section 5: Reflective Practice (Revalidation requirement) Section 6: Feedback (Revalidation requirement) Section 7: Reflective Discussion and Plan (Revalidation requirement) Section 8: Confirmation (Revalidation requirement) Section 9: Professional Indemnity (Revalidation requirement) Section 10:Health and Character (Revalidation requirement) All Templates produced by the NMC can be found on their website The templates used within this mock portfolio (Aug 2015) were provisional but are now published by the NMC as final. Where a template is produced it MUST be used with the exception of the log for practice and CPD hours.

3 Revalidation requirement Evidence of 35hrs in 3years Continuing Professional Development 20hrs Participatory and 15hrs self directed (what you have attended/learnt in theory) The NMC have produced a template for recording this information. It is also advised that, where possible, you include in your portfolio evidence of your CPD e.g. certificates of attendance, conference agendas, copies of publication(s) etc. as this may be required for submission if your portfolio is called for audit.

4 Vinny Ness - Continuing Professional Development (CPD) record log Please provide the following information for each learning activity. You may be required to upload additional evidence in relation to your record of CPD. For examples of the types of CPD activities you could undertake and the types of evidence you could keep in your portfolio please refer to Annex 2 of How to revalidate with the NMC. Dates Method Please describe the methods you used for the activity. For example: Online learning Course attendance Independent learning May 2013 Course attendance Topic(s) Please give a brief outline of the key points of the learning activity, how they are linked to your scope of practice, what you learnt, and how you have applied what you learnt to your practice Aneurin Bevan SoM away day Clinical leadership in the workplace and the Francis Report Link to Code Prioritise people Practise effectively Preserve safety Promote professionalism and trust Practice Effectively 6.1 make sure that any information or advice given is evidence-based, including any information relating to using healthcare products or services 6.2 maintain knowledge and skills you need for safe and effective practice Preserve safety 14.1 act immediately to put right the situation if someone has suffered actual harm for any reason or an incident has happened which had the potential for harm 14.3 document al these events formally and take further action if appropriate so they can be dealt with quickly 17.2 share information if you believe someone may be at risk of harm, in line with the laws relating to the disclosure of information Number of independe nt hours Number of participatory hours 7hrs

5 Sept 2013 Course attendance Welsh Government Equality impact Assessment Making a Difference Prioritise People 1.3 avoid making assumptions and recognise diversity and individual choice 1.5 respect and uphold people s human rights Practice Effectively 7.3 use a range of verbal and non-verbal communication methods, and consider cultural sensitivities, to better understand and respond to people s personal and health needs Promote professionalism and trust 20.1 keep to and uphold the standards and values set out in the Code 6.5hrs Jan 2014 Course attendance/panel member Abertawe Bro Morgannwg Health Board SoMs What makes a difference to birth? Midwives do Practice Effectively 6.1 make sure that any information or advice given is evidence-based, including any information relating to using healthcare products or services 6.2 maintain knowledge and skills you need for safe and effective practice 9 Share your skills, knowledge and experience for the benefit of people receiving care and your colleagues 6hrs June 14 Policy forum Policy Forum for Wales Safe and compassionate health and social care in Wales: next steps for policy on standards, governance, regulation and the workforce Prioritise people 1.1 treat people with kindness, respect and compassion Practice Effectively 6.1 make sure that any information or advice given is evidence-based, including any information relating to using healthcare products or services 6.2 maintain knowledge and skills you need for safe and effective practice Total 0hrs 4.5hrs Total 24hrs

6 Nov 14 Mandatory clinical update March 15 Observation Hywel Dda Health Board Obstetric emergency study day Advisory panel on substance Misuse Evidence gathering on substance misuse in an ageing population April 15 Independent Royal College of Midwives i-learn A review of the NMC Code Practice Effectively 6.1 make sure that any information or advice given is evidence-based, including any information relating to using healthcare products or services 6.2 maintain knowledge and skills you need for safe and effective practice Practice Effectively 6.1 make sure that any information or advice given is evidence-based, including any information relating to using healthcare products or services 6.2 maintain knowledge and skills you need for safe and effective practice Practice Effectively 6.1 make sure that any information or advice given is evidence-based, including any information relating to using healthcare products or services 6.2 maintain knowledge and skills you need for safe and effective practice 9 Share your skills, knowledge and experience for the benefit of people receiving care and your colleagues Promote professionalism and trust 20.1 keep to and uphold the standards and values set out in the Code 7hrs 5hrs 2hrs Total 2hrs Total 36hrs

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8 Revalidation Requirement Evidence of 450 Practice Hours in 3years (examples of what you have done in your role) The NMC have produced a template for recording this information.

9 Confirmation of Practice Hours 450 To confirm your hours of practice as a registered nurse and/or midwife, please fill in a page for each of your periods of practice, in line with How to revalidate with the NMC. Please enter your most recent practice first. You may need to print additional pages to add more periods of practice until you reach 450 hours. If you are both a nurse and midwife you will need to provide information to cover 450 hours of practice for each of these registration. Dates Jan 2015 to April 2015 Name & Address of Organisation Powys t Health Board HQ Neuadd Brycheiniog Cambrian Way Brecon Powys LD3 7HR Type of Organisation Scope of Practice No of Hours Registration Secondary healthcare provider Project management Regulation/ Revalidation Education 15hrs/wk Midwife May 2015 ongoing Clinical Governance Patient Safety Substance Misuse (SM) and Fatal & Non Fatal Poisoning Reviews Plus 22.5hrs/wk 37.5hrs/wk Dates May 2011 to Dec 2014 Jan 2015 to April 2015 Name and Address of Organisation Healthcare Inspectorate Wales Rhydacar Business Park Merthyr Tydfil Cardiff CF48 1UZ Input to the wider Powys SM agenda Type of Organisation Sphere of Practice Number of Hours Registration Inspection and Regulation Local Supervising Authority Midwifery Officer (LSAMO) 37.5hrs 22.5hrs Midwife

10 Brief Description of Work I was seconded to Welsh Government, Healthcare Inspectorate Wales, the body which holds responsibility for the Local Supervising Authority (LSA) in Wales on behalf of Welsh Ministers, to carry out the role of LSA Midwifery Officer. This was a four year secondment from my substantive role in Powys Health Board. The role of the LSA is to put in place and monitor the delivery of a framework for statutory supervision of midwives in line with the Nursing and Midwifery Order The requirements of the framework are set out in the Midwifery rules and standards (NMC 2012). The LSA discharges its function through the appointment of Midwifery Officers. I worked with a colleague and between us we covered a geographical patch in Wales. I was responsible for overseeing supervision in Hywel Dda, ABMU and Aneurin Bevan Health Boards. Very soon after being in post it was apparent that supervision did not work well, in part as it was impossible to oversee something that you have no direct responsibility for managing, but also because of the three way structure between the LSA, the Health Board and the NMC which confused the lines of accountability and responsibility. As a result the LSA team, myself and another LSA MO, re designed and implementing a new model of supervision unique to Wales which was known as Future Proofing. This was a very challenging change management process which took approximately 18months to two years to complete. It was a great example of collaborative working which involved a significant number of interested stakeholders and has been held up as an exemplar across the UK. My main tasks will be set out under day to day responsibilities of the LSAMO first, followed by the work I led on in the implementation of the FPS model. Day to day responsibilities as an LSAMO I was responsible for overseeing the provision and performance of supervision in three Health Boards, Hywel Dda, ABMU and Aneurin Bevan. I covered the other Health Boards when my colleague was on leave or off sick. To fulfil this requirement I did the following activities; Met quarterly with the Head of Midwifery and the contact SoM (later the SoMs working in the FPS) to go through the LSA dashboard which set out the performance targets set by the NMC and were mandatory Met bi annually and on an ad hoc basis with the Director of Nursing to report back on any concerns that had not been resolved at a lower level and to provide her, and subsequently the Board with assurance that statutory supervision was working well or where it needed to improve. Attended monthly or bi monthly (each organisation had a different arrangement initially) SoM meetings to share the work of the LSA, to feedback on information from the NMC, to observe their activity in terms of SoM investigations and feedback on lessons learnt and for them to seek assurance from me on any matters to do with supervision. To meet with all SoMs in my patch at least annually to monitor their progress against the SoM competency tool and their indicative CPD plan. To agree the need for and monitor the progress of all SoM investigations, this included reading draft reports, making comments for improvement and agreeing the final draft with the recommended sanction. Agreeing action plans as a result of a SoM investigation and in the case of Supervised Practice (SPP) meeting with the midwife at the start of the programme, as many times as required as the programme progressed and then giving the final sign off when the programme was complete. In the case of a failed SPP or any other matter where a midwife s fitness to practice (FtP) was called to question I would need to make a referral to the NMC which included submitting all relevant evidence the LSA held on file about the midwife including local attempts to support her restoration. In some case it would be necessary to suspend a midwife from practice to ensure public safety which was always agreed with my line manager as it is a very stringent action which impacts on an individual s right to work. I would be required to attend any interim orders hearings where the NMC FtP department would decide whether to uphold the suspension through an interim order or to close the case if there was insufficient evidence that a case could be proved against the midwife. We both met bi annually with the RCM and the CNO to update on supervision progress We attended alternative bi monthly HoM meetings on an alternate basis and also attended quarterly meetings with the LMEs We both took part in the selection of and teaching to student SoMs I led on the development of a competency tool for all SoMs and devised the means of auditing progress with same I also led on developing the self assessment audit tool for supervision standards We both met with the NMC on a quarterly basis to complete the quarterly quality monitoring assessment. Future Proofing Supervision I wrote the Case for Change paper, an options appraisal for moving away from the existing model to the proposed and finally adopted model across Wales. I led on all legal documentation such as service specification, job description, collaboration agreement, MOU I negotiated with lawyers to develop and hone the necessary documentation and then collaborated with WG/HIW lawyers and NHS lawyers to agree final versions in readiness to implement the model

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12 Revalidation requirement Evidence of Five Pieces of Reflective Practice in 3years Relating to CPD, feedback, incident/event or all three and How this subject relates to the NMC Code The NMC have produced a template for this which you MUST use

13 Template: Reflective accounts record log You are required to record a minimum of five written reflections on the Code, your CPD and practicerelated feedback, as outlined in How to revalidate with the NMC. Please fill in a page for each of your reflections, ensuring you do not include any information that might identify a specific patient or service user. You must also discuss these reflections as part of a reflective discussion with another NMC registrant and get the appropriate form signed by the registrant that you have the discussion with. What was the nature of the CPD activity/ practice-related feedback? Reflective account: This reflection relates to CPD I attended a Policy Forum for Wales Keynote Seminar Prudent Healthcare in Wales: challenges, practicalities and progress. This forum brings together policy makers from Welsh Government and government agencies with key stakeholders to discuss and debate policy issues that are devolved to Wales and or affect the people of Wales. This particular seminar about Prudent Healthcare attracted me as I had heard this new buzz phrase being used quite a lot but had no idea what it was about and how it was to be translated into healthcare provision. The literal translation of Prudent is seeing ahead and therefore prudent healthcare would translate into acting with or showing care and thought for the future. What did you learn from the CPD activity and/or feedback? I was both excited and disappointed about what I heard at this seminar where there were some very eminent speakers who are very influential on Welsh policy. In essence this new model is about improving efficacy of healthcare provision whilst driving up quality of care. There are some key principles to be addressed in providing prudent healthcare which are; Avoid wasteful care Treat clinical need first Do no harm but more importantly actually do measurable good Minimum intervention Most effective prudent healthcare is when planned with strong patient partnership The do no harm must extend into also achieve tangible and measurable outcomes It was quite a sobering fact to hear that 43% of all Wales expenditure goes on the NHS so it is easy to see why it is imperative that the NHS makes best use of the public purse. I think most nurse and midwives are wedded to the principle of evidence based healthcare but sometime it is our medical colleagues who chose which evidence they wish to apply preferring, in some cases, to hang on to what they know and consider to be best practice. However it behoves us all to work towards embedding the evidence in to what we do to ensure the longevity of the NHS in the UK. Ultimately it may be that in the long run successive governments will need to impose serious sanctions upon NHS managers and medical staff if they fail to achieve measurable outcomes, reduce waste and avoid duplication and only provide care and interventions that have been proven to be effective. How did you change or improve your work as a result? Attending this forum and hearing the strong evidence for why all health care providers should be working towards prudent healthcare made me resolve to ensure I play my part as a senior manager in the NHS. I will continue to strive to ensure public money is spent to the best effect. I will also be looking to see that all services have strong action plans based on best evidence and are able to demonstrate robust high quality continuous improvements and outcomes. I am also now a strong proponent for involving service users in planning the delivery of services that they feel are important for them, so long as they understand they have to be chosen from a menu that is evidenced based.

14 How is this relevant to the Code? Select a theme: Prioritise people - Practice effectively - Preserve safety - Promote professionalism and trust Prioritise people - this means putting people first, involving them in their care listening to their preferences and acting in their best interest 2.1 work in partnership with people to make sure you deliver care effectively 2.2 recognise and respect the contribution that people can make to their own health and wellbeing 2.3 encourage and empower people to share decisions about their treatment and care 4 - act in the best interest of people at all times Practice effectively means working to the best of your ability using the best available evidence and bet practice. 6.1 make sure that any information or advice given is evidence based, including information relating to using any healthcare products or services and 6.2 maintain the knowledge and skills you need for safe and effective care Preserve safety this means practicing safely, avoiding harm, raising concerns and being candid with people when things go wrong. 19 Be aware of, and reduce as far as possible, any potential for harm associated with your practice

15 Template: Reflective accounts record log You are required to record a minimum of five written reflections on the Code, your CPD and practice-related feedback, as outlined in How to revalidate with the NMC. Please fill in a page for each of your reflections, ensuring you do not include any information that might identify a specific patient or service user. You must also discuss these reflections as part of a reflective discussion with another NMC registrant and get the appropriate form signed by the registrant that you have the discussion with. Reflective account: What was the nature of the CPD activity/ practice-related feedback? This reflection relates to CPD I did a review of the NMC Code on the RCM website i-learn. The purpose of this exercise was two fold 1) I wanted to see if there was anything new I have not identified myself from reading the Code and sharing the learning with others and 2) I wanted to demonstrate to colleagues an example of easy ways to do self directed learning that contributes to your 20hrs of non participatory CPD to comply with the NMC revalidation process What did you learn from the CPD activity and/or feedback? I was pleased to see I had identified the key issues to raise with colleagues and have been doing so since April 2015 as part of the raising awareness of revalidation. Whilst I did not learn anything new about the Coded per se I did learn about using the RCMi-learn service, which was excellent, easy to use and very informative. There were several very useful prompts in and exercises in the module which helped me to consider both current and potential future action I made nee to consider in practice How did you change or improve your work as a result? I will now continue to use i-learn to enhance my midwifery CPD especially whilst I am in the project lead role as I will need to demonstrate going forward that I have sufficient hours to maintain my midwifery registration after this period of revalidation. I will also complete the actions I was unable to do at the present time as I am not in direct clinical practice but again this will be useful for my portfolio going forward How is this relevant to the Code? Select a theme: Prioritise people - Practice effectively - Preserve safety - Promote professionalism and trust Having completed the whole exercise in relation to the Code, the four themes, its purpose, what s new and what s changed I think I have covered off the total relevance of the Code and how it aims t enhance patient centred care, embed it in every day practice all with the overarching aim of enhancing public protection and making sure the public can have trust and confidence in NMC registrants who provide their care Template: Reflective accounts record log You are required to record a minimum of five written reflections on the Code, your CPD and practicerelated feedback, as outlined in How to revalidate with the NMC. Please fill in a page for each of your reflections, ensuring you do not include any information that might identify a specific patient or service user. You must also discuss these reflections as part of a reflective discussion with another

16 NMC registrant and get the appropriate form signed by the registrant that you have the discussion with. Reflective account: Practice Related Feedback What was the nature of the CPD activity/ practice-related feedback? I became embroiled in an argument with a subordinate member of staff and I did not handle the situation well. The telephone conversation and the meeting we had subsequently did not go well and on reflection, as a senior manager with in depth experience of conflict management, I did not handle the situation appropriately for which I am sorry. I was asked if I would like to apologise to the individual which is what she was hoping for but I declined as I did not feel I had anything to apologise for other than the way in which I handled the situation which I openly acknowledged to the individual during our meeting. What did you learn from the CPD activity and/or feedback? I learnt several things from this process such as; Do not have telephone conversations with staff when you know there are already relationship difficulties and an obvious avoidance of instruction If a telephone conversation becomes difficult and protracted avoid being drawn in and seek to close down the discussion early but as politely as possible. I believe I am a firm but fair manager and am usually able to recognise if I have not handled a situation well and will always apologise if I can see I am wrong How did you change or improve your work as a result? In future I would arrange a meeting as soon as possible ensuring there is someone else present to witness the conversation. I will make formal notes of the meeting to share with interested parties as a record of the discussion. If there are relationship difficulties with an individual I will seek an alternative way of managing the situation asking a colleague to address the performance issue rather than potentially inflame the situation further. How is this relevant to the Code? Select a theme: Prioritise people - Practice effectively - Preserve safety - Promote professionalism and trust Prioritise People whilst this is mainly about patients receiving care there are elements in this theme that could apply to this situation; 2.6 recognise when people are anxious or in distress and respond compassionately and politely. I may not have been fully cognisant of this person s anxiety about not being able to comply with the agreed action owing to her own inaccurate assessment of local issues which she felt prevented her for achieving what was asked of her. Whilst I did try to seek a potential solution to her concerns I failed to get my message across. Practice Effectively communicate effectively and keep clear, accurate records, reflect and act on feedback; 7.4 check people s understanding from time to time to keep misunderstanding or mistakes to a minimum and 7.5 communicate clearly and effectively.. I believe I tried to comply with both of the above themes of the Code by checking the individual s understanding of both the previous instruction and her flawed assessment of other pressures that did not exist. I did try to communicate clearly and effectively both by and then by telephone but again failed to share my message appropriately. Template: Reflective accounts record log You are required to record a minimum of five written reflections on the Code, your CPD and practicerelated feedback, as outlined in How to revalidate with the NMC. Please fill in a page for each of your reflections, ensuring you do not include any information that might identify a specific patient or

17 service user. You must also discuss these reflections as part of a reflective discussion with another NMC registrant and get the appropriate form signed by the registrant that you have the discussion with. Reflective account: CPD activity/ practice-related feedback? Practice-related feedback I received a thank you from a group of senior nurses after I had presented to their group on the revalidation process thanking me for my presentation. This was a large group of senior nurses who had invited me to talk to them about what needed to be done for compliance with the forthcoming NMC revalidation process. They were keen to begin the process if needed but wanted to be on the right track before doing so. What did you learn from the CPD activity and/or feedback? This was a very senior group who have a wide range of knowledge and understanding of revalidation and possibly a variant range of compliance with PREP. This made me realise that what ever level you are at in an organisation or however senior an individual might be I should not take it for granted that the audience are all fully aware of what needs to be done. This led me to reconsider what information I had prepared for the wider road shows to be delivered to all registrants across Powys to make sure I had covered every detail so as not to miss anything out. It also helped me to understand how challenging this new process may be for less senior staff and possibly for others at the far end of their career who have not been familiar with feedback and reflective practice. How did you change or improve your work as a result? I re checked all resources prepared to date both to ensure those who will be using the resources to support them in meeting the revalidation requirements are able to follow them effectively; but also to support other colleagues who are to deliver the presentations, in supporting their staff, have sufficient information added to them to enable a consistent and complete message to be delivered. How is this relevant to the Code? Select a theme: Prioritise people - Practice effectively - Preserve safety - Promote professionalism and trust Practice effectively This theme is about making sure your practice is evidence based; 6.2 Maintaining appropriate skills and knowledge for safe practice; 7.1 and 7.2 Make sure the language you use and the range of communication tools are effective to help others to understand; 8.1 Work co-operatively with colleagues respecting their skills and expertise; 9 Sharing your skills and knowledge effectively with others Also Promote professionalism and trust This theme is about maintaining your own registration and supporting others to do the same 22 Fulfil all registration requirements; 24.2 Using complaints and other feedback to inform and improve your practice or that of other colleagues. Therefore I feel that in developing my skills and knowledge about revalidation and making sure I have devised clear and unambiguous tools to share with others I am upholding both of the above themes in the Code.

18 Evidence of Five Pieces of Feedback In 3years from Patients, families, peers, manager, complaints, compliments etc. (NO PATIENT IDENTIFIABLE INFORMATION)

19 Practice Related Feedback Annual Performance Review I had my annual performance review with my line manager just as I was finishing my secondment with Healthcare Inspectorate Wales. The Welsh Government process also requires you to have a mid point review when any areas for development are identified so that they can be addressed. My mid point review had not raised any concerns. The end of year/end of tenure review was a very positive meeting and I felt very proud of my achievements which my line manager recognised thanked me for. All comments were positive and in particular about how I had contributed to the Future Proofing of supervision. My manager also thanked me for sharing my expertise with him as he felt he had learned a lot about supervision and indeed midwifery as a result. He stressed how he always felt comfortable accepting my advice in relation to difficult cases such as referrals to the NMC or suspensions from practice as he trusted my judgement which was always supported by a clear rationale and in depth written reports so providing a clear audit trail of what had been done to get to that point. Whilst as a secondee I cannot be graded as a civil servant we still discussed the Welsh Government's box marking system which is a predictor of where you would be on the promotion scale. I was very encouraged to hear that I would be assessed as in box 2 which indicates that I would be ready for promotion when a suitable position came up had I have been a WG employee. In terms of development he was again very positive but suggested my IPR document should have made more explicit the many things I had actually achieved during the past year rather than just a description of what actions I had taken during the year. I also had a glowing testimonial from the Chief Executive during my leaving presentation. She was very complimentary of my communication skills which she said had helped her to make appropriate decisions. She also spoke of my strong work ethic which to her mind meant the LSA had achieved so much. It was lovely to hear her say that every team needed a Vinny and that I would be greatly missed in HIW. As a result of my feedback I will make sure that in future my IPR is much more outcome focused and I will strive to maintain my passion and strong work ethic for as long as I remain in work. My overarching driver is also to be the best that I can and in that way make such patients and service users received the very best care that can be given. How is this relevant to the Code Practice Effectively Always practice in line with best evidence and communicate effectively 6.1 make sure that any information or advice given is evidence-based, including information relating to using any healthcare products or services 6.2 maintain the knowledge and skills you need for safe and effective practice 7.5 be able to communicate clearly and effectively. 8.1 resect the skills, expertise and contributions of your colleagues, referring matters to them when appropriate 8.2 maintain effective communication with colleagues 8.4 work with colleagues to evaluate the quality of your work and that of the team 8.6 share information to identify and reduce risk 9.2 gather and reflect on feedback from a variety of sources, using it to improve your practice and performance

20 Written Practice Related Feedback Future Proofing Supervision This feedback relates to the work of the LSA team but in particular I will reflect on my contribution to the team achievements. In 2011 I took up a secondment with the WG as the LSA Midwifery Officer having been a supervisor of midwives for many years. It was immediately apparent how different it was to seethe function of statutory supervision form the other side of the fence as it were i.e. being held to account for how the LSA oversaw the delivery of supervision. I worked with a colleague who I had worked with for many years previously and we shared the sae work ethic and values which made for a great working team. My colleague had some knowledge of the LSA function as she had been doing 1day a week with the LSA for some time but her work was limited to specific functions. With fresh eyes I was able to ask the noddy type questions why, why and more why! Having recognised the difficulties of being held to account for something we did not have direct management or oversight of we set about making a change. The project became known as Future Proofing Supervision (FPS) and took approximately 18months to 2yrs to come to fruition. In essence through convening a multi agency steering group and following express permission from all Wales Nurse Directors we were able to redesign the model of supervision so that we have a very small number of full time equivalent supervisors of midwives (SoMs) working directly to the LSA which meant the LSA was able to directly oversee and monitor the SoM activity working closely with the Head of Midwifery to comply with an accountability framework. My key inputs to the project were; to write the initial paper known as the Case for Change which was an options appraisal aimed at convincing stakeholders of the need to make such a radical change to the current model. There was a serious degree of resistance from Health Boards as they too have a statutory responsibility so give this up and in essence has external reviewers coming in was very challenging. I also led on all the legal requirements such as service specification, JD, MOU, Collaborative Agreement and other related documents. This involved working closely with shared services lawyers, Welsh Government lawyers and then lawyers representing the NHS. I wrote the progress papers to the CNO and the Nurse Director group and negotiated with the NMC to ensure all relevant stakeholders were keep involved and updated. Since the projects inception we have had nothing but positive feedback on how we worked so well together ad in partnership with all stakeholders demonstrating a very high commitment to achieving the final goal. The FPS model has acquired national acclaim including being recognised by the UK government at a select committee debate on supervision following negative press from the Parliamentary Health Service Ombudsman in England. We were invited to present at, at least three LSA annual conferences across the UK to share the key messages from the process, had a poster presentation at the RCM conference in Nottingham and had an article published in the British Journal of Midwifery. The chief executive of HIW and our line manger were extremely grateful for all our hard work and very complimentary about the way we worked to bring about what our CEO called the best example of collaborative working she had seen in her working career. T The ultimate accolade came when the NMC decided to carry out the Quality and safety audit of supervision in Wales in December 2014 having had concerns that we had taken longer to implement the model that at first planned. We had 12 weeks in total to prepare for the external review team to attend which was somewhat taxing but we managed. The review team were very impressed with our evidence bit that which was submitted prior to the visit and what they were shown on the day. The external visits to Health Boards, Universities and other stakeholders confirmed their findings. We were delighted to receive feedback that we had met all 9 standards set my the NMC in the Midwives rules and standards and there were no areas for development. The team were explicitly complimentary about the collaborative change management process completed largely but the LSAMOs.

21 The lay reviewers also completed an audit of provision from the lay perspective and again provided some very positive feedback on how well new elements of the model were working to enhance public protection. Overall I am extremely proud of this piece of work and feel sure it has made a difference to SoMs, the LSA and overall to the women midwives provide care for. The only regret would be that our changes were non completed a few years ago when we would have had some very strong audit findings which may have had a positive effect on the NMC s decision to disband supervision for the midwifery profession. In many ways this will be a great loss as our nursing colleagues often envied midwives having this additional layer of statutory support. It s my intention to work towards a pilot of group supervision across all NMC registrants in Powys as a means of ensuring all staff have an annual PADR and can comply with the NMC revalidation process. How is this relevant to the Code Practice Effectively Use best evidence to change practice, communicate effectively and work collaboratively. 8.1 respect the skills, expertise and contributions of your colleagues, referring to them when appropriate 8.4 work with colleagues to evaluate the quality of your work and that of the team 8.5 work with colleagues to preserve the safety of those receiving care share information to identify and reduce risk 9.3 deal with differences of opinion with colleagues by discussion and informed debate, respecting their views and opinions and behaving in a professional way at all times Preserve Safety - make sure patient and the public are protected and you take necessary action to deal with concerns 16.1 raise and, if necessary, escalate any concerns you may have about patient safety, or the level of care people are receiving in your workplace or any other healthcare setting and use the channels available to you in line with our guidance and your local working practices acknowledge and act on all concerns raise to you, investigating, escalating or dealing with those concerns where it is appropriate to do so Promote Professionalism and trust uphold the reputation of your profession at all times. You should display a personal commitment to the standards of practice d behaviour set out in the Code keep to and uphold the standards and values set out in the Code 25.1 identify priorities, manage time, staff and resources effectively and deal with risk to make sure that the quality of care or service you deliver is maintained and improved, putting the needs of those receiving care or services first

22 Written Practice Related Feedback Potential Complaint A member of staff I was working with in my LSA midwifery officer s post had failed to meet an agreed deadline. I had to follow up the incomplete action on at least two occasions and eventually managed to speak to her on the telephone as she had ed me sharing an action she had taken in direct contravention to the previously agreed action. The telephone conversation became very protracted, detailed and heated on both sides on occasions. The individual was sharing information with me that she should not have been in possession of and to my mind was therefore gossip. When I informed her of this she took offence that I said she was a gossip which is not what I actually said. Eventually I terminated the phone call and arranged to meet with the individual with another colleague so that we could explore potential solutions to get the required action back on track. She had invited another colleague to support her in the meeting. From the outset of the meeting it was apparent she was on the attack as her attitude was very de personalised and aggressive. Following her opening gambit, in which she retracted or redesigned what had been said in the telephone conversation, I had to point out the inaccuracies in her recall. She again took offence at this. The meeting broke down and she left the room. I was so concerned at how badly both the phone conversation and the meeting had gone I immediately reported to my line manager the fact that there was a potential for a complaint to be made against me. I wrote an account of the issues that had led to the scenario and how things had progressed from there. My line manager invited the individual in to speak to him and whilst she did not wish to pursue a complaint she obviously put over her side of the story which was at total odds with mine. I was given an opportunity to share further detail and to attend a meeting to arbitrate on our diverse views but I did not wish to take up this offer as I felt we would never agree. There was no further action but I have written a reflection on this to see what I learnt from it and what I would do differently should it ever happen again. How is this relevant to the Code Prioritise People 2.6 recognise when people are anxious or in distress and respond compassionately and politely Promote professionalism and trust 20.3 be aware at all times of how your behaviour can affect and influence the behaviour of other people

23 Practice Related Feedback Supervisors of Midwives Views of the LSA Midwifery Officer On leaving the LSA Midwifery Officers post at the end of April 2015 after 4years in the job the SoMs wrote a poem about the time they had spent working with me. Whilst it was written in a light hearted manner there were some very important messages for me in terms of how others perceive me, my work ethic and my professional values. I felt it was worthy of some reflection from me to see if I should change my practice going forward. The word dynamic was used about myself and my colleague as a team dynamic is defined as being characterised by force of personality, ambition, energy etc. also the forces that produce motion. There was then reference to my like of change. The SoMs noted my direct attitude and my tendency to say it as it is. However this was tempered by their recognition that I am also very kind and fair. There was a lot of hilarity and mocking about me being a pedant asking for almost perfect reports even when on draft 10! This typifies how, even at this late stage of my career, I can never stand still, in terms of professional development or in my desire to always see services and clinical care improved when needed which I do not think I would ever want to change. I feel I will only try to introduce change if change is needed as I cannot bear change for change sake as any change takes up a lot of time and energy my drive and total passion was noted in my poem again I hope I never loose these qualities. Being firm but fair are key traits of my personality both in my personal and work life and I would not like to change that. However I do sometimes think I should not be so direct on occasions as I have been accused of being strident. I think I may still need to hone the ability to be less out spoken at times but I will not compromise my integrity. The poem recognised that my striving for perfection was with the best intention aiming to support SoMs in the first instance rather than a lawyer picking up their weaknesses at a later date. Fundamentally though this is about patients and the public who deserve the best we can do at all times which is not something I would ever change. How is this relevant to the Code Promote professionalism and trust upholding the reputation of the profession at all times, demonstrating a personal commitment to the standards of practice set out in the Code, be a model of integrity and leadership for others to aspire to, leading to trust and confidence in the profession from patients, people receiving care, other healthcare professionals and the public All standards beneath this overarching aim apply I believe the perception of me held by others and as demonstrated in the poem, describe many of the attributes and behaviours set out in the body of the Promoting professionalism and trust Code theme. I recognised the elements of my skills and behaviours as described by colleagues but do not feel these reflect negatively on me. Indeed on reflection I would not wish to change who I am except maybe on occasions to be less out spoke so long as this does not compromise my integrity.

24 Written Practice Related Feedback I was invited to present to a senior group of nurses on the revalidation process. This was a large group of nurses who were obviously keen to learn about revalidation having taken the initiative to invite me to speak at one of their professional groups rather than wait until I was doing the general round of revalidation roadshows. The group was very lively and it was obvious to me on the day that they were keen to learn. There was a buzz in the room from the outset and the group looked interested in the topic. There were many questions and solutions explored throughout the presentation, and then following, which suggested to me that attendees were interacting with the topic. This was immediate feedback for me in that the group had responded well to the subject matter and were keen to explore potential solutions on how they could comply with the revalidation process. Several nurses thanked me on a personal level for coming and said how helpful the session had been to support them in taking up revalidation. A few days later I received the following thank you from three of the senior nurses. Hello Vinny, Very many thanks for your excellent presentation and update on Revalidation for the Diabetes Link Nurses last week. Kind Regards J, S and T

25 Revalidation requirement: Evidence of Reflective Discussion and Plan This must be with another NMC registrant who may or may not be your line manager. The reflective discussion will cover your CPD and Practice related feedback and how you have related this to the Code. It will also review your action plan from CPD and feedback and its influence on your practice The NMC have produced a template for recording this information which MUST be used.

26 Reflective Discussion form (please note this was the provisional form. The final version can be downloaded from the NMC website) You are required to have a reflective discussion with another NMC registrant covering your written reflections on the Code, your CPD and practice-related feedback. Please refer to How to revalidate with the NMC for further information. This form should be completed by the registrant with whom you had the discussion and stored in paper format only: Name: Vinny Ness NMC Pin:????????????? address: Professional Address (including postcode): vinny.ness@wales.nhs.uk Powys t Health Board Seminar Dinning Room Bronllys Hospital Brecon Powys LD3 0LS Name of registrant: (with whom you had a PDD discussion) NMC Pin of registrant: (with whom you had a PDD discussion) Cate Langley XXXXXXXXX Date that the discussion took place: Number of reflections discussed and short summary of discussion I confirm that I have discussed the number of reflective accounts listed above, with the above named registrant, as part of a reflective discussion and in line with the How to revalidate with the NMC. 5 reflections relating to a mixture of CPD and practice related feedback. We also reviewed the IPR and the supervisory review for evidence of a plan for CPD Signature: Cate Langley RM

27 Revalidation requirement: Confirmation (normally done by your line manager but if they are NOT an NMC registrant you MUST have evidence of your Reflective Discussion BEFORE you can get confirmation) The NMC have produced a template for recording this information which MUST be used.

28 Confirmation from a third party form (please note this was the provisional form. The final version can be downloaded from the NMC website) Name: NMC pin number: I have received confirmation from (select applicable): Vinny Ness xxxxxx A regulated health care professional To be filled in by your confirmer: Name Job Title Personal Professional Address including postcode Date of confirmation discussion Cate Langley General Manager cate.langley@gmail.com cate.langley@wales.nhs.uk The Hazels Llandrindod Wells LD30 6SZ 21 st January 2016 If you are an NMC registered nurse or midwife please provide: NMC Pin Number If you are a regulated health care professional please provide: Profession_ Physiotherapist ID of membership for regulatory body PT 1657

29 Revalidation requirement: Evidence Professional Indemnity Discussion Mainly relevant if you have another job apart from being an employee of Powys thb or you are in independent practice There is no template to complete, but a line manager may remind the registrant of the importance of Professional Indemnity. It is the registrant s responsibility to ensure this is in place/ they are appropriately covered for any work they undertake using their NMC registration. Revalidation requirement: Evidence of Health & Character Discussion There is no template for this and it is the registrant s responsibility to self declare this information. Should a line manager have any concerns, they should raise concerns with individual throughout the year not at the time of revalidation