LOCAL SUPERVISING AUTHORITY WEST OF SCOTLAND WORK PLAN 2007-2010 Introduction In August 2006 there has been a restructuring of the post of LSA MO in Scotland. Prior to this date there were fifteen Local Supervising Authorities which were merged in August 2006 into three regions, the West of Scotland, the South East and the North of Scotland. The Nursing and Midwifery Order (2001) sets out the statutory function for Local Supervising Authorities. There are four Local Supervising Authorities in the West of Scotland, Ayrshire and Arran, Dumfries and Galloway, Greater Glasgow and Clyde and Lanarkshire. The LSA is responsible for ensuring that the statutory supervision of all Midwives practising in its area is undertaken to a satisfactory standard by: Providing a framework of support for supervisory and midwifery practice Receiving Intention to practice notifications from all midwives practising within the LSA boundary Ensuring each midwife meets the statutory requirements for practice Accessing initial and continuing education and training for supervisors of midwives Leading the development of standards and audit of supervision Determining whether to suspend a midwife from practice, in accordance with Rule 5 of the midwives rules and standards NMC(2004) Investigating cases of alleged impairment of fitness to practice The LSA MO post has been established in the West of Scotland eight months. The post holder has spent the first six months in post reviewing the existing mechanism for statutory supervision of midwifery practice across the region by:- Under taking a comparison of the LSA reports carried out in 2005-2006 Attending local supervisors of midwives meetings Meeting with key stakeholders, Heads of Midwifery, Chief Executives, Directors of Nursing, NHS NES, NHS QIS, User Groups, HEI s, etc 1
Reviewing current policies / guidance for supervisors of midwives Engagement with LSA MO s in Scotland Engagement with LSA MO England forum which is now LSA MO UK Forum Reviewing any practice issues that were reported to the LSA MO Working Together The LSA MO S from the countries throughout the UK have combined with the LSA Midwifery Officers in England to ensure information is shared and that the supervision of midwifery practice is developed countrywide ensuring an equitable and consistent approach across the four countries. Therefore in the future national guidelines will be adopted and developed through this forum to provide consistent guidance and a framework for the supervision of midwifery practice across the UK. The four countries will have a united strategic direction to ensure a cohesive force working collaboratively through the UK forum to progress and enhance protection of the public through the statutory supervision of midwives. Baseline Assessment A baseline assessment was made across the region based on a comparison of the LSA reports of 2005-2006. This comparison highlighted that Supervision has a high profile across the region Supervisors appear to be proactive There appears to be good involvement with HEI s A LSA audit was not conducted in every area No supervisory investigations undertaken although each NHS Board described effective risk management systems There is a ratio of over 1 Supervisor to 15 Midwives in some areas of the region A variation in practice in how to access a supervisor of midwives across the region Some areas reported difficulty in enlisting service users to help develop and audit services There was understandably different approaches in report writing 2
As issues have been raised in the region over the past few months these issues have also been used to inform on what strengths there are in practice and what other areas require strengthening. For instance A) it is becoming apparent that there is a need to establish processes to complement some of the standards set out in the document Statutory Supervision of Midwives in Scotland e.g. the process and mechanism; B) It is evident that there is much enthusiasm amongst the supervisors generally Local Supervising Authority links and relationships Communicating and forming good working relationships is a key part of the role of the LSA MO and the first six months has been pivotal in establishing relationships across the LSA, all of Scotland, NMC and also the LSA MO UK forum. Key links made:- Chief Executives Directors of Nursing Heads of Midwifery Supervisors of Midwives Contact Supervisors of Midwives Royal College of Midwives HEI S Scottish Executive Self Employed Midwives NHS NES NHS QIS LSA MO English Forum WORK PLAN 2007-2010 1. Unification of practice of the four LSA S in the West of Scotland The West of Scotland has four LSA S sitting within the four NHS Boards, Ayrshire and Arran, Dumfries and Galloway, Greater Glasgow and Clyde and Lanarkshire. As there is now a regional post for the LSA it can be considered good practice to establish unified policies and 3
guidance for supervisors of midwives and ensure that the mechanism of supervision of midwifery practice is consistent across the region and indeed in line with statutory mechanisms across the UK. Currently there are link supervisors of midwives in each area of practice. To establish sharing of good practice and consistency across the region a bi- monthly forum with the LSA MO and link supervisors of midwives has been set up. The links will take issues back to their individual area and act as a conduit between the LSA MO and other supervisors and vice versa over the next year. Six monthly skills based workshops will be held for all supervisors in the region. Eventually as firm structures across the region are embedded in practice the LSA MO will hold quarterly forums for all supervisors of midwives. Sub groups will be formed across the LSA s in the first instance to formulate structures across the region. These will be:- Reporting mechanisms to the LSA MO and guidance on investigations through the mechanism of supervision of midwifery practice. A procedures and/ or guidance group for supervisors of midwives. Developing user public involvement Recruitment and retention of supervisors of midwives 2. Establish LSA audit across the Region Not all areas in the region have had an audit of the supervision of midwifery practice in the past year therefore the depth and quality of supervision of midwifery practice cannot be evidenced across the region. On the face of it the standard of supervision appears to be satisfactory, however there is a requirement from the NMC to audit the standards of supervision of midwifery practice. England and Wales use the same audit tool to audit the mechanism of supervision therefore it would appear appropriate for the same tool to be used across the three regions in Scotland to ensure consistency across all the countries. A programme has been established for undertaking an audit of the mechanism of supervision across the region this year and will be used as a guideline for future practice and action planning. Peer review will be the method used to enable the sharing of information and good practice. An audit team will visit each LSA and will verify the evidence required as set out in the audit tool. The audit team will hold breakout sessions with supervisors of midwives, midwives and service users. In the first year the link supervisors of midwives will be the peers and will work with the LSA MO to evaluate the process and build and improve on the process for forthcoming years. In subsequent years all supervisors will have the opportunity to be part of the audit team. 4
2. Ensure an Inter-relationship with Clinical Governance and the NHS Boards The LSA Midwifery Officer should provide support and information to assist supervisors of midwives to develop systems for risk management and the sharing of good practice. The LSA MO should ensure that supervisors of midwives support midwives across the LSA to enhance the quality of the service and to manage poor performance. A key strategic aim for the next year will be to put firm mechanisms in place for the reporting and investigating of incidents and to give guidance on supervised practice programmes, including the provision of training for supervisors of midwives to equip them with appropriate skills. A rapid task and finish sub group is being formed of supervisors of midwives across the LSA to draw up guidance and reporting mechanisms. ACTION JP May 2007 3. Establish Structures and processes to support LSA in its function Establish a sub group to review all guidance across the region in conjunction with the document Statutory Supervision of Midwives in Scotland document and the LSA MO UK guidance, ensuring procedures or guidance are in place are consistent across the Region and in line with UK guidance. ACTION JP MAY 2007 4. High Supervisor of Midwife to Midwife ratio In some areas the ratio of midwives to supervisor is above 1:15. There have also been a number of resignations in this year. It also appears difficult to recruit in certain areas of the LSA. A sub group will be formed across the LSA for recruitment and retention of supervisors of midwives. ACTION JP and links set up group by May 2007 5. Develop a Web Site for LSA Set up meetings in Ayrshire and Arran to set up a web site across LSA. ACTION JP 5
6. Engagement with users Promote opportunities to identify women who wish to participate in audit visits and who want to influence commissioning of services. Motivate local maternity services to ensure users take part in local meetings or implementation of policy drivers at local levels. Set up sub group to develop a strategy for super vision. Action JP 7. Raise the profile of the LSA Engage with key stakeholders. Be available to give professional advice to supervisors of midwives, midwifery and NHS Boards managers, educators on a wide range of subjects. Over the next two years work with LSA MO UK Forum to raise national profile bringing drivers back to The West of Scotland. Set up an effective LSA website and news letters and ensure invited on national working groups through effective networking. JOY PAYNE LSA MO WEST OF SCOTLAND March 2007 6