Quality assurance monitoring results 2011-2012 Nursing and Midwifery Council October 2012 Page 1 of 12
Introduction We are the nursing and midwifery regulator for England, Wales, Scotland, Northern Ireland and the Islands. We exist to safeguard the health and wellbeing of the public. We set standards of education, training, conduct and performance for nurses and midwives, and hold the register of those who have qualified and meet those standards. We provide guidance to help nurses and midwives keep their skills and knowledge up to date and uphold our professional standards. We have clear and transparent processes to investigate and deal with nurses and midwives who fall short of our standards. All quality assurance of education and training operates within the requirements of the Nursing and Midwifery Order (2002) and can be found on the NMC website at www.nmc-uk.org/about-us Quality assurance of NMC approved nursing and midwifery education covers approval of new programmes, reapproval of existing programmes, programme modification, endorsement of programmes delivered offshore and the annual monitoring of programme providers. This vital role contributes to the realisation of our duty to protect the public by ensuring that nurses and midwives are educated to deliver high quality healthcare. This booklet contains an overview of the results of our annual monitoring of programme providers for 2011-2012 which was carried out by Mott MacDonald across all four countries of the United Kingdom (UK). This monitoring activity relates specifically to Article 15.5 (b) of the Nursing and Midwifery Order (2001) which states that the Council shall: take appropriate steps to satisfy itself that those standards and requirements (for education and training) are met. During the 2011 2012 monitoring cycle, we reviewed a total of 130 programmes across 54 of the 80 NMC approved education institutions (AEIs). 26 approved programme providers had earned autonomy so were not visited during this monitoring cycle. The targeted focus of a large proportion of monitoring activity focused on those programmes perceived to carry the greatest risk and included pre-registration nursing and midwifery education and independent/supplementary prescribing programmes. We use the results of monitoring and approval events to inform our future work and this is reflected in the continuous improvements made for 2012-2013 to the monitoring review plan, targeted monitoring, self-reporting and extraordinary review activity. These are available on the NMC website at www.nmc-uk.org/education Individual providers are not identified in this booklet and institutions who had earned autonomy for monitoring are not included in the statistical analysis. Summary reports of individual providers performance will be available on our website at www.nmcuk.org/education from October. Anne Trotter Standards Compliance Manager Nursing and Midwifery Council October 2012 Quality assurance monitoring results 2011-2012 Page 2 of 12
The clinical focus of programmes monitored in 2011-2012 Programme Number of programmes monitored Percentage of all programmes Pre-registration nursing Adult 15 21 Mental health 9 15 Learning disabilities 4 13 Child 6 11 Return to practice nursing 5 12* Overseas nursing 5 33* Pre-registration midwifery 19 35 Return to practice midwifery 2 8 Supervisor of midwives 3 17* Specialist Community Public Health Nursing (SCPHN) Health visiting 9 20* School nursing 7 17* Occupational health nursing 2 14* Specialist Practice Qualification (SPQ) District nursing with integrated prescribing 5 15* Adult nursing 1 10* Community children s nursing 1 9* General practice nursing 1 7* Mental health nursing 1 20* Prescribing Independent/supplementary prescribing 17 26* Community practitioner nurse prescribing 5 13* Community practitioner nurse prescribing with SPQ 1 3* Mentor/Teacher Mentor 8 12* Teacher 4 7* Total 130 *Percentage of programmes with students enrolled. Contributors to the monitoring process We monitor and review programmes to capture the views and experiences of a wide range of partners and stakeholders. This year has been no exception and we also had the opportunity to meet 99 service users in order to gain their perspective in reviewing the contribution that service user and carers made throughout the student journey. We found that many AEIs actively encouraged service user and carers participation in a range of ways including: recruitment and selection processes; service user testimonials obtained as part of the practice assessment; service user and carer participation in teaching in the AEI and during programme evaluation. Quality assurance monitoring results 2011-2012 Page 3 of 12
We routinely met with strategic education commissioners and key academic partners as part of the monitoring review visit. We also met a range of practice placement partners in order to evaluate the approaches used when meeting the standards and requirements for supporting learning and assessment in practice. 1179 students also played an important role in annual monitoring in order that we were able to accurately capture their experiences and feedback on the programmes that they are currently studying. Results of grading The chart below shows the percentage of grades across all themes in 2011-2012 compared with previous years. The picture across the five years reflects continuing growth of consistently good grades. Outstanding grades are awarded for exceptional and consistently high performance which are worthy of dissemination and emulation by other AEIs. The chart reflects the small number of AEIs who achieved outstanding grades through innovation within their programmes. Overall, the percentage of outstanding and unsatisfactory grades has fluctuated slightly whilst the percentage of good grades has improved indicating that AEIs have good control measures in place in order to comply with NMC standards. A small number of unsatisfactory grades have been awarded during this five year period, and have been followed up with appropriate action plans that were achieved within an agreed timeframe. Percentage of grades across all themes 100% 90% 80% Percentage 70% 60% 50% 40% 30% 20% 10% Outstanding Good Satisfactory Unsatisfactory 0% 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 Year The chart overleaf shows the number of grades awarded for each theme in 2011-2012 compared with previous years, with the total number of providers graded on the right. The tables on page 7 illustrate the overall five year trend. Quality assurance monitoring results 2011-2012 Page 4 of 12
Outstanding Good Satisfactory Unsatisfactory Total 2011-2012 Resources 0 51 2 1 54 Admissions and progression 0 45 7 2 54 Practice learning 2 34 13 5 54 Fitness for practice 3 48 3 0 54 Quality assurance 0 52 2 0 54 2010-2011 Resources 2 40 5 2 49 Admissions and progression 1 44 2 2 49 Practice learning 5 37 4 3 49 Fitness for practice 1 43 5 0 49 Quality assurance 1 45 3 0 49 2009-2010 Resources* 6 43 6 1 56 Admissions and progression 4 50 1 0 55 Practice learning* 6 39 11 1 57 Fitness for practice* 5 46 5 0 56 Quality assurance 1 50 4 0 55 2008-2009 Resources 1 38 14 0 53 Admissions and progression 2 48 3 0 53 Practice learning 8 22 18 5 53 Fitness for practice 3 42 6 2 53 Quality assurance 0 46 7 0 53 2007-2008 Resources 2 50 29 3 84 Admissions and progression 8 69 6 1 84 Practice learning 12 37 29 6 84 Fitness for practice 9 61 13 1 84 Quality assurance 3 60 19 2 84 *Grades for these themes include focused single key risk monitoring visits. Quality assurance monitoring results 2011-2012 Page 5 of 12
Outstanding 20% 18% Percentageof providers 16% 14% 12% 10% 8% 6% 4% 2% 0% Resources Admissions and Progression Practice learning Fitness for practice Quality Assurance 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 * Percentage scale of 20% Good 100% Percentageof providers 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Resources Admissions and Progression Practice learning Fitness for practice Quality Assurance 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 *Percentage scale of 100% Satisfactory 50% Percentageof providers 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Resources Admissions and Progression Practice learning Fitness for practice Quality Assurance 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 * Percentage scale of 50% Unsatisfactory 10% 9% Percentageof providers 8% 7% 6% 5% 4% 3% 2% 1% 0% Resources Admissions and Progression Practice learning Fitness for practice Quality Assurance 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 * Percentage scale of 10% Quality assurance monitoring results 2011-2012 Page 6 of 12
Brief analysis of results by theme Each of the five key risks has been scrutinised in order to establish relevant themes or trends that can inform current and future quality assurance of education. The quality and quantity of the data collected is pivotal in ensuring that all future quality assurance activity reflects our requirements to protect the public in being targeted, proportionate and timely in ensuring that the NMC standards for education are being met. The following subsections for each key risk provide a summary of our findings and exemplars. Outstanding grades are worthy of dissemination and emulation so it is important that we celebrate and share these outstanding exemplars within our quality assurance activity. Good grades indicate that appropriate risk control systems are in place without need for specific improvements. Satisfactory grades indicate that students can achieve all stated learning outcomes; however, programme providers are required to address any specific weaknesses that have been noted. Unsatisfactory grades indicate where there are weak risk control measures that require urgent improvements in order to become satisfactory. During the monitoring activity of 2011-2012 urgent improvements have been achieved through instigation and achievement of all agreed action plans. However, it is important to discuss unsatisfactory exemplars as part of an open and transparent dissemination of the lessons learned from the monitoring activity this year. Resources No providers received a grade of outstanding for resources, however, good grades were earned by the majority of providers. Examples included: Robust approaches to staff development Electronic red amber-green (RAG) alert systems for mentor updating requirements Effective approaches to student support Reasons for satisfactory grades included: Staff completing a teaching qualification but, in a small number of AEIs, no strategy was identified to encourage nurse and midwife teachers to record their teaching qualification with the NMC A small number of AEIs experienced challenges in ensuring sufficient mentors could access annual updating Impact of increased SCPHN - health visitor student commissions on practice teacher requirements and workloads Quality assurance monitoring results 2011-2012 Page 7 of 12
One unsatisfactory grade was awarded when it was found that the triennial review process for mentors, sign-off mentors and practice teachers had not been implemented. Admissions and progression No outstanding grades were awarded in this category with the majority of providers gaining a good grade rating for this risk. Examples where good grades were awarded include: Processes for early detection and dealing with students who give cause for concern All mentors able to identify processes when managing poor performance and for raising concerns Reasons for satisfactory grades included: The need for a small number of AEIs to strengthen processes for checking and recording CRB status prior to commencement of the programme, particularly for students entering post qualifying NMC programmes The need to formalise the process for escalating concerns about student progress in practice in post qualifying programmes Non-compliance with admissions processes in SCPHN school nursing in relation to V100 nurse/midwife prescribing programmes A small number of AEIs need to strengthen processes for the accreditation of prior learning Two unsatisfactory grades were awarded under this risk: Processes within the AEI were inadequate for ensuring that CRB clearance had been achieved within the last three years prior to undertaking a post qualifying programme In one AEI there was no evidence that pre-registration students had been asked to comply with Good health, good character requirements at yearly progression points Practice learning Two outstanding grades were awarded in this category within the following areas: Excellent use of system regulator reports to enhance student learning Prototype mentor register database which updates the live mentor register Good grades were awarded to the majority of AEIs with several examples of good practice highlighted and included: Quality assurance monitoring results 2011-2012 Page 8 of 12
AEIs are becoming more alert to clinical governance issues within trusts or health boards which may impact on practice learning experience. Positive examples of this include: Developing improved forums and agenda for joint communication; joint records of governance issues, actions and CQC visit outcomes; joint RAG rating of CQC outcomes and the impact on student learning, and an SHA forum for discussion of CQC visits and the impact on student learning. Revising the learning environment profile to incorporate CQC standards for quality and safety A number of AEIs have continued to develop and implement their service user and carer strategy in pre registration programmes 13 AEIs received satisfactory grades in this key risk category and examples of the reasons for a satisfactory grade include: Limited evidence of service user and carer involvement in programmes The need to enhance sign-off mentor guidance for achievement through fine grading of practice Improvements required in triennial review reporting The need to strengthen the process for updating of designated medical practitioners More unsatisfactory grades are awarded in practice learning that any other key risk area and this year is no exception with five unsatisfactory grades being awarded. Examples of unsatisfactory areas include: Failure to implement a process for mentors and practice teachers to access triennial review in preparation for supporting learning and assessment in practice Failure to accurately record participation and achievement through triennial review Lack of process to check whether there are sufficient mentors and practice teachers available to support pre registration and post qualifying students Educational audits were not undertaken every two years prior to student allocation decisions Fitness for practice This key risk area produced a robust compliance grade profile with no satisfactory grades being awarded which is very reassuring. Three outstanding grades were awarded and examples of outstanding practice which are worthy of dissemination and emulation include: Recognition of an outstanding independent/supplementary prescribing programme where many students instigate innovative clinical practice Quality assurance monitoring results 2011-2012 Page 9 of 12
Expert knowledge and research base of lecturers which inform the framework for students prescribing practice Year three student peer assessment which has encouraged acquisition of discipline specific graduate attributes, that is, the 4 Cs, Communication, Collaboration, Confidence and Critical thinking. The majority of the remaining AEIs achieved good grades in this category with only three satisfactory grades being awarded. Examples of satisfactory outcomes include: Strengthening of achievement of NMC teacher domains required Limitations in the coverage of the European Directive (2005) Some students not being able to access NMC students in both academic and practice settings when on an approved teacher programme Quality assurance Although no outstanding grades were awarded in this key risk area, equally there were no unsatisfactory grades awarded as the majority of AEIs have robust quality assurance systems that address weaknesses and deliver enhancement. With the exception of two satisfactory grades awarded all the remaining AEIs achieved good grades. Generally AEIs are very responsive to feedback and make appropriate changes to programmes and inform stakeholders of the enhancements to the programme that have been put in place. Areas where refinement may be helpful for AEIs include: Identify a mechanism for capturing themes that emerge from student evaluations or, indeed, failing to act on the feedback provided. Low response rate to evaluation opportunities by students may call into question the quality of the information available. Service providers experience problems when student feedback on practice placements is too sparse or too generalised to be helpful, or when the communication is not timely. As a result, some clinical placements have introduced their own evaluation forms to ensure they receive direct feedback. The requirement for external examiners to engage with the assessment of practice is not always well defined and the activities are not always well reported by external examiners in post qualifying programmes. Quality assurance monitoring results 2011-2012 Page 10 of 12
Main issues for future monitoring The findings of the monitoring reviews demonstrate that risk controls are less strong in the following areas: Risk theme Resources Admissions Practice Learning Fitness for Practice Quality Assurance Issue Mentors, sign-off mentors and practice teachers access to updating Ensuring students of post qualifying programmes meet all entry criteria including CRB clearance Implementation of robust systems for APL Implementation of the triennial review process Maintenance of accurate and comprehensive mentor, sign-off mentor and practice teacher registers. Means of identifying and resolving issues which may impact on students experience Governance of practice placements including the effectiveness of audit processes Triangulation of data from audits/ student placement evaluations / processes for escalating concerns/ CQC reports or other system regulator reports Involvement of service users. Routine monitoring to explore service providers confidence that poor performance is identified and addressed. Determine employers /potential employers satisfaction with students exiting from programme. Check that individual hours of theory and practice comply with EC directive. External examiners engagement with practice learning. Timely feedback from student placement evaluations to practice learning providers 2012-2013 targeted monitoring activity by provider In 2012-2013 we have introduced four main continuous improvements to annual monitoring as part of the existing QA framework: This includes: A refined annual review plan that focuses on the key aspects of risk to the standards for education Targeted monitoring visits to 16 AEIs based on risk A single self-report for all AEIs which conflates the previous annual report and earned autonomy report Quality assurance monitoring results 2011-2012 Page 11 of 12
Introduction of an extraordinary review process Risk control 2011-2012 QA monitoring Number of providers Good and outstanding Satisfactory and unsatisfactory As part of our targeted monitoring approach, AEIs with outstanding, good and satisfactory grades across all five key risk areas and who have no additional extraordinary concerns or follow up activity are eligible for completion of the annual self-report and self-declaration report. These AEIs will not receive a monitoring visit during 2012-2013. Providers with any satisfactory or unsatisfactory grades and/or have any ongoing concerns or follow up actions arising from extraordinary review activity will have a two-day annual monitoring visit during 2012-2013 and will be expected to complete the annual self-report.. 64 16 This edition of Quality assurance monitoring results 2011-2012 was published in October 2012. The information is available on our website at www.nmc-uk.org Contact us Nursing and Midwifery Council 23 Portland Place London W1B 1PZ 020 7333 9333 advice@nmc-uk.org www.nmc-uk.org This document is also available in large print, audio or Braille on request Quality assurance monitoring results 2011-2012 Page 12 of 12