Executive summary

Overall, the feedback received varied between the different professional groups that we spoke with. Throughout the review there was good representation from the various professions in each session. 

Nursing students and SNAs spoke positively about their experiences with allocated supervisors and felt most supervisors were friendly, welcoming, and very supportive. They added that if they were not allocated a supervisor, or their supervisor was away, then their placement often lacked direction and structure. Nursing students and SNAs advised us that their supervisors lacked protected time to teach which has had a negative impact on the opportunities available to them. Experience of induction varied for nursing students and SNAs with some learners reporting a good induction and others reporting having not received one. Most learners felt well supervised and that there were robust processes in place for achieving proficiencies. 

We found nursing and SNA educators to be very passionate about education and they enjoyed supporting learners. They did however advise that at times they felt overwhelmed with competing priorities and felt that the vacancy controls currently in place were negatively impacting the support they could offer learners. As a result, they felt that the support they have been able to give has been diluted.

Feedback from AHP learners was very positive, and they reported a wealth of learning opportunities available to them. They praised the level of support from their supervisors and the flexibility that their placement provided. There was positive feedback about the induction process, and they highlighted the usefulness of induction resources they received ahead of their placement. Learners spoke about receiving tailored support from their supervisors and felt very much part of the team. 

Although feedback from AHP learners was positive and educators reported feeling valued by them, they were less confident that the leadership team were aware of what an AHP placement entails. AHP educators also raised that the the value of AHPs in an inpatient Mental Health setting was not always recognised by the wider multidisciplinary team. 

All AHP learners and the majority of student nurses and SNAs would recommend the organisation as a place to work/study and a place to receive treatment. 

Based on the review findings, we will be recommending that pre-registration nursing and SNA are given an Intensive Support Framework (ISF) category 1 and an improvement plan will be requested against the mandatory requirements detailed below. There are no further actions for

AHP which will be monitored through our routine quality processes.                                                             

Review overview  

Background to the review

In March 2024, the Care Quality Commission (CQC) found concerns at Nottinghamshire

Healthcare NHS Foundation Trust whose overall rating was dropped to ‘inadequate’. The Workforce, Training and Education (WT&E) directorate of NHS England undertook a quality intervention to ascertain what, if any, impact this was having on the experience within the clinical learning environment.  

Who we met with

Learners and Apprentices

• SNAs
• Student nurses from a range of professional backgrounds
• AHP students o Occupational Therapy (OT) o Physiotherapy

o Speech and Language Therapy (SaLT) o Dietetics

• Trainee Mental Health and Wellbeing Practitioner

Educators

• Practice Leads
• Clinical/Practice Educators, Supervisors, and Assessors
• Practice Learning Tutors

Education team

• Senior colleagues from Nottinghamshire Healthcare NHS Foundation Trust

Review panel

• Panel Chair, Bridget Hoad, Senior Education Manager – Nursing
• Panel Chair, Helen Marriott, Assistant Director of Clinical Leadership and Education: AHPs and Advancing Practice
• Specialty Expert, Rosalyne Cheeseman, Head of Pharmacy
• Quality Representative, Cassie Morgan, Quality Manager
• Quality Representative, Natalie Brown, Quality Officer

Review findings

Induction

All AHP learners spoke positively about the induction process. Emphasis was placed on the usefulness of receiving an induction booklet ahead of placement by OT learners. SaLT learners spoke positively about the IT induction they received.

Student nurses and SNAs gave variable feedback on the induction process with some receiving a good induction and others reporting that they have not received one. Some learners advised they had received a ‘walk around’. 

Clinical supervision

No issues were raised by AHPs regarding clinical supervision. Both SaLT and Dietetic learners advised the panel that they had received tailored feedback based on their preferred feedback mechanism and they had received good debriefing of patient encounters. Dietetic learners praised the use of MS Teams to share feedback between supervisors. They added that this timely sharing of feedback has led to them being able to progress with their training efficiently and effectively. SaLT learners found the pre-meet between their University and Placement team very helpful in determining where they were in their studies. No learners reported feeling out of their depth whilst on placement. 

Positive feedback was heard from student nurses and SNAs regarding their allocated supervisors. They reported feeling well supported by their supervisors and found them helpful and welcoming. Student nurses and SNAs reported challenges when their supervisor was not present due to sickness or annual leave. They reported that it was difficult to get proficiencies signed off and they were often left without any direction if their supervisor was not present. Student nurses and SNAs advised that staffing levels are having a negative impact on their training opportunities with supervisors not having time to support them and leaving them feeling like a burden. They also added that supervisors lacked having protected time to teach. 

Training opportunities

AHP learners highlighted the large amount of training opportunities available to them. They described working across multiple settings and teams which has enhanced their training experience. OT learners specifically praised the use of break away training and insight days which they found beneficial.

Whilst some nursing and SNA learners shared that they felt there was a robust process in place for gaining proficiencies, some reported having to chase for weeks to get theirs signed off. Some student nurses advised us that on occasion they have found that their placement was not suitable for the level of training they were at and felt that their placement would be better for a more experienced learner.

Culture

All AHP learners spoke positively about the culture of the organisation. Learners reported feeling welcomed and supported by colleagues.  AHP learners described a supportive environment where morale was high with good multidisciplinary team working via a shared office space. Physiotherapy, SaLT and Dietetic learners advised us that they valued the flexibility their placements had offered and added they were able to attend training/CPD due to this flexibility. All AHP learners reported that they knew how to raise concerns. 

Student nurses and SNAs reporting being aware of how to raise concerns however, some student nurses felt that although concerns were listened to, they were not sure if they were acted upon.  No student nurses or SNAs reported feeling out of their depth and the majority of learners were aware of the Freedom To Speak Up (FTSU) process. The culture was reported to be varied based on the team they are working with. 

Facilities

Learners and educators discussed occasional challenges with facilities due to having limited space. Due to the isolated nature of some clinics there is not always a separate space to eat lunch and educators advised that there is limited office space resulting in not enough chairs for colleagues and learners to sit down. 

Educator feedback

Nursing and SNA educators were very passionate about education and training and advised us that they enjoyed supporting learners and felt proud to do so. They felt well supported in their role however, at times felt they were not able to provide the level of support they wanted. Nursing and SNA educators advised us that due to staff shortages and a vacancy control panel they are currently running with limited resources resulting in them offering diluted support to learners. Educators also discussed how they felt the large number of preceptees within the trust was negatively impacting on the experience of student nurses and SNAs. Multiple educators reported feeling overwhelmed with the number of learners and felt they were spread thin in supporting these learners as well as providing educational opportunities for other colleagues including preceptees. Educators added that this has resulted in them having to ask students to study from home as well as them missing out on supervisor/assessor updates. They also advised that at times they were undertaking work outside of their working hours. 

AHP educators spoke positively about the support they had received from the practice learning team. They advised that they found the team valuable and felt it made their journey as an educator easier. They praised the sessions that the practice learning team were facilitating for learners, which included content such as record keeping and consent. Multiple AHP educators raised challenges with IT and smart card access advising that it would be beneficial for learners to have a smart card that travels round with them. They added that late notice of them having a learner compounds this. AHP educators advised that they do not have protected time to support learners with some adding they have to do work outside of their working hours. 

Although feedback from AHP learners was positive and educators reported feeling valued by them, they were less confident that the leadership team were aware of what an AHP placement entails. AHP educators also raised that the the value of AHPs in an inpatient Mental Health setting was not always recognised by the wider multidisciplinary team. 

They also advised that although they felt their team was very positive, the wider trust was a negative place to be and morale was low.  

Good practice

Areas for improvement

Mandatory requirements

Recommendations

Report approval

Report completed by: Cassie Morgan, Quality Manager
Review lead: Helen Marriott, Assistant Director of Clinical Leadership and Education: AHP and AP
Date approved by review lead: 26 November 2024

NHS England authorised signature: Professor Jonathan Corne, Regional Postgraduate Dean

Date authorised: 5 December 2024

Final report submitted to organisation: 19 December 2024