Executive Summary
Feedback from the learners at this meeting highlighted notable improvements to the learning environment when compared with our visit in April 2024.
The following were areas identified during this visit that are working well or showed improvement:
- Learners reported that the processes for the trust and departmental inductions have significantly improved which has been ‘helpful’ in preparing them for their placements.
- Interactions with the Practice Learning Team (PLT) within the department were reported to be positive, with learners advising that the team are approachable and visible.
- Allocation of learners to Practice Supervisors had improved, with learners advising that they always have a supervisor to work with.
- We identified improvements with access to multi-disciplinary educational opportunities and complementary placements. Learners shared that they are able to spend time within various clinical environments, and attend multi-disciplinary training sessions to support the development of their skills and knowledge.
- All learners showed an understanding of the mechanisms to raise concerns and felt that where they had escalated an issue, they were supported and received feedback regarding how their concern was managed.
- Previous issues regarding access to IT and clinical systems have been resolved, with learners receiving access to the relevant systems in time for the start of their placement.
There were reports of ongoing concerns which require further improvement:
- There were individual reports of poor behaviours being displayed by members of the Midwifery and the Gynaecology Nursing teams. This was said to affect the ability for learners to feel welcomed into the placement environment.
- Concerns continue to be shared by learners and practice supervisors and assessors regarding placement capacity, particularly on delivery suite. This was reported to affect the number of learning opportunities available to learners who had been allocated to this area.
In addition to the above, a new area of concern was noted:
- Learners felt that they are experiencing difficulties with receiving feedback on performance and completion of evidence in their electronic portfolios. Learners shared that this appeared to be due to a lack of capacity for practice supervisors to complete the relevant documentation.
The findings from this visit indicated that the previously raised concerns had been recognised, and the trust had taken the appropriate actions to address them. The trust described robust governance arrangements which ensure that there is oversight of the improvements, and demonstrated how they are utilising the NHS England Safe Learning Environment Charter to support some of the actions to address the previously identified concerns. Feedback from those we met with showed that the trust has ensured active involvement of both learners and practice supervisors/assessors, with tangible changes felt across both maternity departments.
Of the 23 pre-registration midwifery learners that we met with during our visit, all would recommend the department as a place to train and to receive care as a patient / service user.
Based on the improvements observed, we will be recommending this item is reduced from an Intensive Support Framework (ISF) category 2 to an ISF category 1. The ISF category 1 will be maintained whilst the required improvements are fully implemented, and the outstanding areas are addressed. A trust improvement plan will be required against the mandatory requirements outlined in this report.
Review Overview
Background to the review
This quality intervention was held as a follow-up to the April 2024 learner educator meeting to test progress against the trust’s active improvement plan for pre-registration midwifery training.
Who we met with
Learners
- learners undertaking the pre-registration midwifery programme
Educators
- practice supervisors and assessors within midwifery
Education team and senior team
- Deputy Chief Nurse – Education (feedback summary only)
- Deputy Head of Nursing (feedback summary only)
- Director of Midwifery (feedback summary only)
- Medical Director (feedback summary only)
- Practice Learning Team (PLT)
- Senior Nurse for Clinical Practice Development
Review Panel
Education Quality Review Lead
- Jackie Brocklehurst, Assistant Director of Clinical Leadership & Education (Nursing and Midwifery)
Specialty Expert
- Molly Yeardsley, Clinical Leadership Fellow, Midwifery
NHS England Education Quality Representative
- Amelia Harbon, Quality Deputy Manager
Observer
- Paula Clapham, Senior Education Manager
Review findings
Induction
During our visit in April 2024, pre-registration midwifery learners shared that they had not received a formal induction into the department in preparation for their placement. Resources, such as welcome packs, were reported to be out of date, and there were discrepancies in the feedback from practice supervisors and assessors about whether there was an induction programme in place.
Feedback from learners at this visit highlighted the improvements made to ensure that a robust trust and departmental induction is provided. It was reported that the induction includes a welcome video, tours of both hospital sites, and a university visit by the trust’s PLT to introduce themselves and share information about their roles. The Community team were reported to hold virtual meetings with the learners during the evening to answer any queries in advance of their placements.
Learners also shared that the department held a session where key topics were discussed to aid the transition from university into the clinical placement environment, and updated welcome packs were provided for both the acute and community settings. Orientations to the clinical area had been provided to all of the learners that we met with, and the learners commended the trust for the preparatory activities they had scheduled. This included ‘a day in the life of a midwife’ where learners reported they were given different scenarios that they were asked to consider as if they were a qualified midwife working in the clinical setting.
Practice Supervisor and Assessor allocation
Improvements were reported regarding the allocation of learners to Practice Supervisors, with learners advising that they always have a supervisor to work with. Although there are still some short notice changes made to supervisor allocations, learners reported that these are due to unforeseen circumstances such as sick leave and are resolved appropriately.
Learners also shared that they felt they would benefit from having fewer allocated Practice Supervisors. They reported that having some consistency would support the supervisor’s awareness of their clinical skills and areas for development. In addition, learners reported that they would find it helpful to work with their Practice Assessor for 1 or 2 shifts across their placement. Learners felt that this would allow them to build positive relationships with their Practice Assessors outside of the formal assessment process.
Multi-disciplinary learning opportunities & complementary placements
We identified improvements to accessing multi-disciplinary educational opportunities and complementary placements.
Learners shared that they are able to spend time with the Care Fertility team, with specialist midwives, and within gynaecology as part of their complementary placements. They are also able to take part in neonatal resuscitation training, attend perineal repair review training sessions, mortality diabetes review meetings and cardiotocography review meetings to support their learning. Invites to mandatory training are shared with the universities in advance of placements so that learners can attend, and there are opportunities to attend Trauma Risk Management (TRiM) sessions, which supports team members after a potentially traumatic experience.
In addition, learners praised the department for their offer of ‘tea trolley’ teaching sessions. Learners described these as multi-professional learning sessions which take place within delivery suite and across the wards. Those that attend the teaching sessions are given the opportunity to consolidate their learning, or receive teaching to support a new skill, as well as being offered refreshments.
Learners reported that they would appreciate being included within multi-professional obstetric emergency training. Learners felt this would be useful to take part in towards the end of their programme, as they will be required to have these skills to support patients once they are qualified. When we spoke with the Education team, they advised that plans are in progress to include learners within these sessions.
Supportive environment
The majority of learners reported supportive and welcoming clinical environments at both sites of the trust. The PLT were praised by the learners and practice supervisors and assessors, who shared that they are visible in the clinical areas of the hospitals to provide support where it is required. In addition, the PLT advised that they had responded to learner feedback regarding challenges with the availability of their support whilst in the community setting by arranging regular, virtual drop-in sessions.
The department was reported to be utilising the ‘team of the shift’ model to allow learners to introduce themselves and share their learning needs with the multi-disciplinary team during handover. This was described by learners as a ‘helpful’ communication approach.
Some learners commended the midwives on delivery suite and the Professional Midwifery Advocates (PMAs) for their support, advising that they will regularly check in on learners if potentially traumatic incidents have occurred.We also recognised the efforts of the trust to support learners, with the Education team sharing a number of initiatives that have been implemented to help those experiencing financial hardship.
Whilst learners shared a mostly positive experience of being on placement at the trust, some felt that poor behaviours continue to be displayed by individual midwives and a member of the gynaecology nursing team. Individual examples were shared of negative interactions with these team members, including where learners had felt undermined by those who were supposed to be there to support them. These instances of poor behaviours were reported to be negatively impacting on learner wellbeing and not feeling part of the team.
Raising concerns
During our visit in April 2024, all of the learners that we met with showed an awareness and understanding of the mechanisms to raise concerns. However, they reported that they often felt that where they had raised issues, they did not receive regular feedback from the trust regarding any follow up actions taken to address their concerns.
At this visit, all learners were able to describe the mechanisms in place for them to raise concerns. The PLT were reported to regularly encourage learners to raise concerns in real time, and provided support to learners throughout the process. This was echoed by the practice supervisors and assessors, who advised that an open approach to raising concerns is being taken across the department. In addition, it was shared by the Education team that the department holds ‘Tea with the Matron’ sessions. These sessions have been designed to increase the visibility of the senior team, and to provide learners with an opportunity to raise or address any concerns they may have.
Learners were aware of the roles of the Freedom to Speak Up Guardian, and the PMAs, and shared that there are several resources displayed across the department to support all team members to raise concerns. Learners shared that if they identified concerns during a shift, they would escalate these to the midwife in charge. Where learners had escalated an issue, they felt that they were supported and received feedback regarding how their concern was managed.
When we spoke with the Education team, it was shared that they have also recently implemented a ‘check out’ QR code within the PMA service, which both trust colleagues and learners can utilise to share feedback about their time on shift and to request support. This process was reported to help promote wellbeing and facilitate communication, allowing the trust to support the team when concerns are raised.
Access to IT and clinical systems
Learners at this visit shared that access to the relevant IT and clinical systems had been arranged in advance of their placement. Whilst the majority of learners had been able to access the systems, a small number of learners shared that they had not been able to successfully log in.
On further discussion, it was identified that when learners are granted access to the systems, it is communicated to them that they are required to log in within a certain timescale. Anyone who does not complete the process within this timeframe will have their permissions revoked, in line with the trust’s governance arrangements. The Education team advised that they are aware of the learners who have been affected by this and were actively supporting them with regaining access to the systems.
Placement capacity
Concerns continue to be shared by learners and practice supervisors and assessors regarding placement capacity, with focus particularly placed on high numbers of learners within delivery suite. Learners felt that this was affecting the number of educational opportunities available to those who had been allocated to this area.
Practice supervisors and assessors shared that there had been occasions where they had more learners in the clinical areas than there were midwives to supervise them. As a result, they have utilised Midwifery Support Workers (MSWs) and Nursery Nurses to support the learners. Practice supervisors and assessors recognised that the department has recently undertaken an audit of placement capacity across the birth centres and delivery suite to understand any challenges.
The trust shared that they have worked with the universities to implement an agreement about sharing placement capacity fairly, and that capacity is discussed regularly at placement meetings. It was reported that the Director of Midwifery is a member of a national expert advisory group which has been formed to better understand the impacts of some of the regulatory standards for pre-registration midwifery programmes on learners, educators and the wider service.
Proficiency sign off
Whilst learners praised the department for the breadth of learning opportunities available, it was felt that completion and sign off of evidence on their electronic portfolio was challenging to obtain. Learners shared that this appeared to be due to a lack of time and capacity for practice supervisors to complete the relevant documentation.
Learners shared that they are encouraged to ask practice supervisors to complete electronic portfolio evidence during their shifts, however, in busy clinical areas such as the wards, they feel that this is not possible. Learners reported that they are having to chase midwives by email to update their electronic portfolio, which is not always successful, or that some midwives are updating the system outside of their normal working hours. This has impacted on the learners’ ability to evidence the required clinical skills, and potentially could impact on the wellbeing of the midwives who are completing work outside of their designated shift time.
Review findings
Areas that are working well
Description | Domain(s) and standard(s) |
|---|---|
|
Induction Learners reported receiving a robust induction into the trust and the maternity department, sharing a number of initiatives which have been implemented to provide a fluid transition from the academic environment to the placement setting. Learners described the induction process as ‘helpful’ to prepare them for their placement. |
3.9, 5.1 |
|
Practice Supervisor allocation Improvements were noted to the allocation of learners to Practice Supervisors, with learners reporting that they always have someone on shift to work with. |
4.2, 4.3, 4.6 |
|
Multi-disciplinary learning opportunities & complementary placements Learners shared improvements to accessing multi-disciplinary educational opportunities and complementary placements. Learners advised that they are able to spend time with the Care Fertility team, with specialist midwives, and within gynaecology as part of their complementary placements. Neonatal resuscitation training, Trauma Risk Management (TRiM) sessions and perineal repair review sessions are available for learners to join. They are also invited to attend mortality diabetes review meetings and cardiotocography review meetings amongst others, to support their learning.
|
1.12, 5.4 |
|
Practice Learning Team (PLT) All learners, practice supervisors and assessors recognised the support provided by the PLT, describing them as supportive, approachable and actively responding to any queries or challenges. The trust shared that they had invested in allowing some protected time to be allocated to these roles to allow them to focus on supporting learners and improving midwifery education and training. |
1.1, 2.4 |
|
Raising concerns All learners showed a comprehensive understanding of the mechanisms to raise concerns and felt encouraged to do so. They felt that where they had escalated an issue, they were supported by members of the maternity team and received feedback regarding how their concern was managed. |
1.7 |
|
Access to IT and clinical systems To support the delivery of educational opportunities from the outset of their placements, learners shared that access to the relevant IT and clinical systems had been arranged in advance by the trust. |
1.11 |
Good practice
Description | Domain(s) and standard(s) |
|---|---|
|
Induction – a day in the life of a midwife As part of the induction process, learners reported they were given an activity where they were asked to consider and respond to different scenarios as if they were a qualified midwife working within the clinical setting. Learners commended this approach taken by the trust, advising it was a ‘good’ way to prepare them for placement.
|
3.9 |
|
Tea trolley teaching Learners praised the department for the ‘tea trolley’ teaching sessions which are undertaken within delivery suite and across the wards. Those that attend the multi-professional teaching sessions are given the opportunity to consolidate their learning, or receive teaching to support a new skill, as well as being offered refreshments such as tea and biscuits. |
5.4 |
|
Financial hardship support The Education team shared that the trust has implemented initiatives to support learners experiencing financial hardship. This includes providing accommodation and setting up food donation services for learners to access as required. |
1.1, 1.2, 1.3, 3.1 |
Areas for improvement
Mandatory requirements
Review findings | Required action | Reference number and domain(s) and standard(s) |
|---|---|---|
|
Culture – supportive environment There were individual reports of poor behaviours being displayed by some members of the Midwifery team and a member of the Gynaecology Nursing team. This can impact negatively on the learner’s ability to feel safe within the clinical environment. |
We recognised that whilst the concerns raised with us are focussed on individuals and do not appear to highlight an ongoing theme of a poor culture, we require assurance to evidence how the trust addresses these behaviours, including where concerns are reported by learners. |
MR1 1.1, 1.7, 3.6, 3.8 |
|
Placement capacity |
The department needs to continue working with university partners to implement a clear |
MR2 1.4, 3.7, 5.1, 6.1 |
|
Concerns continue to be shared by learners and practice supervisors and assessors regarding placement capacity, with focus particularly placed on high numbers of learners within delivery suite. In addition, learners feel that they are experiencing some difficulties with receiving feedback on performance and completion of electronic portfolio evidence. Whilst completion of electronic portfolios is encouraged during working hours, learners reported that this is not always possible due to lack of capacity in some clinical areas, such as the wards. |
strategy to ensure there is sufficient placement capacity and capability to allow learners sufficient opportunities to meet the pre-registration midwifery curriculum. Assurance is required to evidence the current capacity within the department in comparison to placement activity. |
|
Recommendations
Recommendation | Reference number and or domain(s) and standard(s) |
|---|---|
|
Practice supervisor allocation Learners shared that having more consistency in the allocation of their Practice Supervisors would support awareness of their clinical skills and areas of development. We would recommend that the trust reviews whether increased consistency in Practice supervisor allocation is viable, and will support learners in achieving the skills and competencies required for the training programme. |
1.9, 3.4 |
|
Learners should be encouraged to take an active role in this process to provide an opportunity to learn about decision making processes and to be aware of the outcome. |
|
|
Developing professional relationships- working with Practice assessors Learners reported that they would find it helpful to work with their Practice Assessor for 1 or 2 shifts across their placement. Learners felt that this would allow them to build positive relationships with their Practice Assessors whilst in the clinical setting. We would recommend that the trust reviews whether learners being able to work with their Practice assessors is viable, and will help to support the opportunities that practice assessors need to inform assessment decisions. As per the recommendation above, learners should be encouraged to take an active role in this process to provide an opportunity to learn about decision making processes and to be aware of the outcome.
|
1.9, 3.4 |
|
Obstetric emergency training Learners reported that they would appreciate being included within multi-professional obstetric emergency training sessions. Learners felt this would be useful to take part in towards the end of their programme, as they will be required to have these skills to support patients once they are qualified. We recognise that the Education team are progressing with plans to include learners within these sessions. We would recommend that learners are included in these sessions where possible to support clinical skills development, situational awareness, and to promote teamworking. |
5.4 |
Report approval
Report completed by: Amelia Harbon, Quality Deputy Manager
Review lead: Jackie Brocklehurst, Assistant Director of Clinical Leadership & Education (Nursing and Midwifery)
Date approved by review lead: 27 February 2025
NHS England authorised signature: Prof. Jonathan Corne
Date authorised: 10 March 2025
Final report submitted to organisation: 14 May 2025