Executive summary
Overall, learners within the midwifery department described a supportive training environment with accommodating staff. A small number of areas have been identified that require improvement to enhance the consistency of educational experiences.
Areas working well include:
- Substantive midwifery staff were consistently described as accommodating and supportive of learner needs, with excellent multi-professional working. They were particularly praised in theatre environments where staff provided detailed explanations and dedicated learning opportunities.
- Learners were appropriately maintained in supernumerary status and reported never being asked to undertake activities beyond their competency level, with most feeling supported to access learning opportunities.
- The Professional Midwifery Advocate (PMA) service and education team provided accessible support for learners wishing to raise concerns, with learners demonstrating confidence in these support mechanisms.
- The Trust demonstrated active commitment to improvement through various initiatives, including student-focused medication teaching sessions and plans for enhanced educational opportunities.
Areas requiring attention for improvement include:
- Induction processes showed inconsistency, particularly for learners transitioning to the new hospital building. Some reported inadequate orientation to facilities and equipment locations affecting their confidence in the clinical environment.
- Limited protected time for supervision and assessment activities, with practice supervisors reporting these essential educational functions frequently occurring during breaks or personal time due to clinical pressures.
- Cultural dynamics in specific clinical areas where some learners reported feeling excluded from established staff relationships. They also felt unable to raise concerns or ask questions with select groups, potentially impacting learning opportunities and wellbeing.
Areas for further consideration:
- The Trust’s implementation of the Safe Learning Environment Charter across clinical areas may benefit from review. This is to ensure consistent awareness and application amongst all practice supervisors and assessors, supporting standardised educational experiences for learners.
It should be noted that the review team was only able to meet with a small number of learners during the visit, and the findings in this report reflect the perspectives of a small proportion of the wider cohort who have trained at the Trust.
Based on these findings and areas of concern identified, the panel will be recommending this item remains at an Intensive Support Framework (ISF) category 1. A trust improvement plan will be required against the mandatory requirements outlined in this report.
Review overview
Background to the review
This exploratory education quality review was prompted by the outcomes of the 2024 National Education and Training Survey (NETS), which identified several areas of concern across midwifery training at Sandwell and West Birmingham NHS Trust. The survey responses highlighted issues relating to various aspects of the learning environment including supervision and overall learner experience that warranted further investigation.
Resident doctors had previously highlighted midwifery concerns during an exploratory review at the Trust regarding the delivery of obstetrics & gynaecology training, and the NETS outcomes identified similar patterns affecting midwifery learners across multiple domains.
Who we met with
Learners
- Pre-registration midwifery students
Educators
- Practice Supervisors and Practice Assessors from across maternity services.
- Ward-based supervisors
- Community-based practice supervisors
Education team
- Lead Midwife for Risk, Governance and Education
- Clinical Educators
Review Panel
Education Quality Review Lead
- Deputy Director of Clinical Leadership and Education, NHS England
Specialty Expert
- Senior Education Manager – Midwifery, NHS England
External Specialty Expert
- Midwifery Quality and Professional Development Lead, NHS England
NHSE Education Quality Representative(s)
- Quality Deputy Manager, NHS England
Review findings
Learning environment and culture
Learners consistently described the substantive midwifery staff as accommodating and supportive of their learning needs. The multi-professional working environment was particularly praised, with learners highlighting excellent support from theatre staff who provided detailed explanations during procedures and created dedicated learning opportunities. Learners also reported good educational support from medical colleagues and resident doctors, who were willing to share knowledge and include them in learning experiences across the maternity services.
However, learners reported concerns about cultural dynamics within certain clinical areas, particularly labour ward. Some learners described feeling excluded from established working relationships amongst substantive staff. These experiences were concentrated in specific areas rather than Trust-wide, with learners reporting more positive experiences in antenatal, postnatal, and community settings. Additionally, some learners reported feeling unable to raise concerns, ask questions or seek the support they needed with select groups of midwives. Learners described feeling invisible when on shifts with particular groups, which impacted their confidence to engage in learning opportunities.
Learners confirmed they were appropriately maintained in supernumerary status and were never asked to undertake activities beyond their competency level. The majority felt supported to ask questions and access learning opportunities, though this appeared to depend on individual confidence levels and the specific staff they were allocated to work with.
Educational governance and induction
The Trust’s induction processes showed variation in effectiveness, particularly following the move to the new Midland Metropolitan University Hospital building. Whilst the education team described comprehensive induction plans, learners reported inconsistent experiences. Some learners who commenced training in the original hospital building did not receive adequate orientation to the new facilities, leading to difficulties navigating the environment and locating essential equipment.
The education team demonstrated awareness of these challenges and confirmed they were actively revising induction processes to ensure they meet learner needs. They described plans to enhance induction content, including improved access to learning resources, digital training opportunities, and integration with multi-disciplinary training days.
The Trust works with multiple university partners, which creates complexity in delivering standardised induction programmes due to varying requirements from each institution. The education team reported challenges in managing different induction timeframes expected by partner universities.
Supervision and Assessment
Both learners and practice supervisors reported challenges with allocated time for supervision and assessment activities. Practice supervisors consistently highlighted that busy clinical environments limited opportunities for protected supervision time, often requiring these activities to occur during breaks or personal time. Learners described having to come in on their days off or during annual leave to meet with supervisors or assessors, particularly when trying to arrange meetings with night shift staff for competency signoffs. This created additional pressures for learners who needed to coordinate around complex shift patterns and limited availability of supervisors and assessors.
The education team acknowledged that structured learning hours are not a daily occurrence due to staffing constraints and clinical demands. They recognised the challenge of providing dedicated time for supervisors to sit with learners for competency signoffs and documentation review, noting that much of this activity falls into supervisors’ personal time.
Learners described positive relationships with their practice supervisors and assessors, though experiences varied. Some learners reported excellent continuity with supervisors over placement periods, whilst others worked with different midwives daily, limiting relationship building and progression tracking. Learners highlighted this as commonplace in both community placements and ward-based settings.
The electronic portfolio systems presented ongoing challenges, with practice supervisors noting difficulties navigating different university platforms. Some supervisors reported that learners occasionally provided guidance on system use, suggesting training needs in this area.
Practice supervisors demonstrated commitment to supporting learners but expressed frustration about time constraints that limited their ability to provide comprehensive supervision. The allocation of practice assessors showed some inconsistencies, with uneven distribution of assessment responsibilities across the department.
Communication and Feedback
Learners praised the accessibility of the Professional Midwifery Advocate (PMA) service and education team for raising concerns. However, learner awareness of other support mechanisms, including Freedom to Speak Up Guardians, appeared limited despite poster displays with QR codes in clinical areas across the service.
The timeliness of off-duty allocation was highlighted as an area of previous concern that showed improvement. Learners reported that whilst off-duty was sometimes provided at short notice, this had become more reliable over recent months. However, learners also described difficulties in accessing off-duty information due to the paper-based system, which created additional challenges in planning their schedules and commitments.
Feedback processes varied in effectiveness, with learners receiving constructive feedback when requested, though this often-required proactive effort from learners rather than systematic provision.
Learning Opportunities
The Trust provided various learning opportunities beyond routine clinical exposure, including skills drill participation, medication teaching sessions, and multi-disciplinary training days. Learners particularly valued recent initiatives such as student-focused educational sessions led by specialist midwives and neonatal placement experiences that included opportunities to observe neonatal resuscitation from the neonatal team perspective. However, learners reported that they often had to be proactive in asking for learning opportunities, which could disadvantage less confident students who were reluctant to speak up or make requests. Some supervisors and assessors expressed expectations that learners should be proactive when on clinical placement. This has created variability in educational experiences depending on individual learner confidence levels and assertiveness.
The education team described plans to expand educational offerings, including learner-only teaching sessions and enhanced simulation opportunities. However, engagement levels from learners varied, with the education team noting that attendance at optional sessions could be improved.
Community placements provided good continuity of supervision, though some learners reported working with numerous different midwives during placement blocks, limiting learning progression.
Areas that are working well
| Description | Reference number and or domain(s) and standard(s) |
|---|---|
| Multi-professional working environment Excellent support from theatre staff providing detailed explanations and dedicated learning opportunities. Learners consistently praised the accommodating and supportive approach of substantive midwifery staff across clinical areas. | |
| Supernumerary status protection Learners supernumerary status is appropriately maintained and they are never asked to undertake activities beyond their competency level. Most learners felt supported to access learning opportunities appropriate to their stage of training. | |
| Professional support systems Accessible Professional Midwifery Advocate (PMA) service and education team providing effective support for learners wishing to raise concerns. Learners demonstrated confidence in these support mechanisms. | |
| Educational initiatives Active improvement initiatives including student-focused medication teaching sessions and multi-disciplinary training day participation. The education team demonstrated commitment to enhancing learning opportunities. |
Areas for improvement
Mandatory requirements
| Review findings | Required action | Reference number and or domain(s) and standard(s) |
|---|---|---|
| Induction processes Inconsistent induction processes, particularly for learners transitioning to the new hospital building, with some learners reporting inadequate orientation to facilities and equipment locations. | Ensure all learners receive a comprehensive induction to clinical areas including orientation to the new hospital environment, equipment locations, and essential systems. This should be standardised regardless of university partner requirements. | MR1 |
| Protected supervision time Limited protected time for supervision and assessment activities, with practice supervisors reporting these activities frequently occur during breaks or personal time, impacting quality of supervision. | Review and implement arrangements to provide adequate protected time for practice supervisors to conduct supervision and assessment activities during scheduled hours, including systematic feedback provision rather than learner-initiated requests. | MR2 |
| Cultural inclusivity Cultural concerns in specific clinical areas where some learners reported feeling excluded from established staff relationships, potentially impacting learning opportunities and wellbeing. | Review and address cultural dynamics in clinical areas to ensure all learners feel included and supported, implementing specific measures to promote inclusive learning environments. | MR3 |
Recommendations
| Recommendation | Reference number and or domain(s) and standard(s) |
|---|---|
| Safe Learning Environment Charter implementation Consider strengthening implementation of the Safe Learning Environment Charter across all clinical areas, with enhanced awareness programmes for practice supervisors and assessors. This should include the use of the charter to support actions required in the mandatory requirements, particularly around cultural inclusivity and creating supportive learning environments. | |
| Off-duty allocation processes Consider standardising off-duty allocation processes to provide greater consistency and advance notice for learners across all clinical areas. | |
| Electronic portfolio training Enhance training provision for practice supervisors and assessors on electronic portfolio systems to improve confidence and efficiency in assessment processes. | |
| Supervisor and assessor continuity Explore opportunities to enhance continuity of practice supervisor and assessor allocation where operationally feasible, to support relationship building and cohesive feedback provision across placement periods. | |
| Practice assessor distribution Explore opportunities to redistribute practice assessor allocation more evenly across clinical areas to prevent overload of individual assessors. | |
| Learning needs identification Consider developing more structured approaches to capturing learner learning needs during shift handovers to optimise learning opportunities. | |
| University partnership communication Enhance communication channels with educational providers, particularly establishing formal feedback mechanisms when escalations are made to university lecturing teams to ensure collaborative resolution of learner concerns. |
Report approval
Report completed by: Kalpesh Thankey, Quality Deputy Manager, NHS England
Review lead: Carol Love-Mecrow, Deputy Director of Clinical Leadership and Education, NHS England
Date signed: 7 August 2025
NHS England authorised signature: Prof Jonathan Corne, Regional Postgraduate Dean Midlands, NHS England
Date signed: 15 August 2025
Final report submitted to organisation: 12 September 2025