Executive summary

Feedback from the learners at this meeting highlighted some improvements to the learning environment when compared with our visit in March 2024.

The following areas identified during this visit are working well or showed improvement:  

• Learners positively described the processes for the trust and departmental inductions, sharing that they helped in preparing them for their placements.
• Learners shared improvements to their experience of the continuity of carer placements, advising that the trust has implemented mitigations to ensure that their clinical placement hours are achieved.
• Access to multidisciplinary and extended placement learning had improved, with learners able to share several opportunities that they can experience at the trust.
• The culture and support provided within the department was positively reported by the learners. Midwives were praised for their helpful approach, with learners recognising that openness and transparency has helped forge good professional relationships with the team.
• The learners, practice supervisors and practice assessors commended the support and visibility of the practice facilitators within the department.
• 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.

There were some reports of ongoing concerns which require further improvement:

• Learners continued to share concerns regarding the short length of time they spend in each of the clinical areas while on placement, and the lack of consistency in allocation of practice supervisor. This impacts on being able to maximise learning new skills and embedding existing ones.
• Learners also shared that they are experiencing difficulties with receiving feedback on performance and completion of evidence in their electronic portfolios. It was felt that this was due to issues with supervisor capacity and a lack of consistency in allocation of a practice supervisor.
• Concerns continue to be shared by learners and practice supervisors and assessors regarding placement capacity due to a large cohort of learners. This was reported to affect the fulfilment of practice assessment criteria, with specific concerns raised by learners regarding achieving the necessary number of births during the time they have on their education programme.

The findings from this visit indicate that some of the previously raised concerns have been actioned by the trust. While it is clear that issues regarding placement capacity persist, we acknowledge that overall progress in improving the learning environment has been satisfactory.

The director of midwifery described the governance arrangements which ensure that there is trust level oversight of the improvements, and close working arrangements in place with the education provider at a senior level. All the pre-registration midwifery learners that we met with during our visit would recommend the department as a place to train and to receive care as a patient or 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 while the required improvements are fully implemented, and the outstanding areas are addressed as indicated within this report.

We would recommend that active involvement from both learners and practice supervisors or assessors is encouraged, as well as maintaining close working relationships with the education provider, while addressing the remaining concerns. 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 virtually as a follow-up to the March 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

• Director of midwifery (feedback summary only)
• Deputy director of midwifery (feedback summary only)
• Preceptorship lead midwife
• Practice placement manager (feedback summary only)
• Practice facilitators
• Lead professional midwifery advocate (PMA) 
• Retention midwife 
• Lead assurance and compliance midwife 
• Practice development midwife
• Colleagues from the education provider

Review panel

• Education Quality Review Lead – Jackie Brocklehurst, Assistant Director of Clinical Leadership and Education (Nursing and Midwifery)
• Specialty Expert – Joanne Hadley, Midwifery Quality and Professional Development Lead and Professional Midwifery Advocate
• NHS England Education Quality Representative – Amelia Harbon, Quality Programme Manager

Review findings

Induction

Learners spoke positively about the induction that was delivered before the start of their placement. They reported receiving a welcome pack and advised that they were invited to an in-person event that was held to provide an overview of the trust and the department.

Learners felt that the event adequately covered all the information they needed to prepare them for their placement.

In addition, learners shared that they received orientations into the placement areas, which covered the key topics that they needed to be aware of before they started their shifts.

This was echoed by the practice supervisors and assessors, who recognised the need to provide an orientation of the clinical area, as stated within the learner’s proficiency documentation.

Learning opportunities

Overall, learning opportunities at the trust were positively described by learners. They shared that they are invited to departmental training such as practical obstetric multi-professional training (PROMPT), and they can join the Perinatal Mental Health team, the neonatal unit and the transitional care unit as part of their extended placements.

During our last visit in March 2024, learners raised concerns about not gaining appropriate exposure to meet their clinical placement hours while experiencing the continuity of carer model. It was reported by learners that they were being sent home rather than being offered alternative opportunities to learn.

At this visit, learners shared improvements to their experience of the continuity of carer placements, advising that the trust has implemented mitigations to ensure that their clinical placement hours are achieved.

The Education team shared these mitigations. This included learners being able to access other ‘spoke’ opportunities as part of the hub and spoke model, such as spending time with specialist midwives, to maximise their learning while on placement.

Practice supervisor allocation and proficiency evidence

While learners shared positive feedback regarding the overall quality of the supervision they receive, frustrations continue to be expressed regarding the time they spend in each of the clinical areas, and the lack of consistency in allocation of practice supervisor.

Learners advised that they spend 1 week in an area before they are moved on to the next part of their placement. During this time, they may be allocated a different practice supervisor for each shift and may not see the same supervisor twice during their placement. This was said to impact on them being able to learn new skills and embed existing ones.

In addition, learners shared that they are experiencing difficulties with receiving feedback on performance and completion of evidence in their electronic portfolios. It was felt that this was due to capacity issues for practice supervisors to complete the relevant documentation, and the lack of consistency in allocation of practice supervisor.  

The Education team recognised the issues that have been shared. They felt that some of the feedback stemmed from a high number of learners within the clinical areas who all need to receive equal opportunities to learn. They reported that they are holding regular meetings with education provider partners to discuss returning to a longer, block model of placements.

It was shared that learners within the first year of their programme will now experience a 5-week placement block in the community setting, to consolidate some skills before they are moved into the acute setting.

Culture

The culture and support provided within the department was positively described by the learners, who reported being welcomed into the different clinical areas.

Midwives were praised for their supportive and helpful approach. Learners recognised that being open about their knowledge, skills, and support needs has helped to establish the positive connections that they have with the team.

The support provided by the practice facilitators was also commended by all learners, practice supervisors and practice assessors. Learners reported that the practice facilitators undertake daily walk arounds of the clinical areas, and that they hold a bleep so they can be contacted if urgent support is required.

In addition, where learners may experience potentially traumatic events, the professional midwifery advocates within the department are available for meetings, and student link midwives are also on hand to help if needed.

Raising concerns

All learners were able to describe the mechanisms in place for them to raise concerns. Learners were aware of the roles of the freedom to speak up guardian, and the PMAs, and shared that there are resources displayed across the department to support and encourage raising concerns.

Learners explained that if they identified a concern while on shift, they would escalate to their practice supervisor, or the ward manager.

Where issues have been raised, learners felt that the midwives and practice facilitators have provided good levels of support, and they have received feedback regarding how their concern was managed.

This was echoed by the practice supervisors and assessors, who shared that there is an open approach taken by the department to support the team to raise concerns.  

The Education team also shared that they have identified maternity and neonatal safety champions within the department. This has been implemented to embed acceptable and professional behaviours that create a safe clinical environment for the learner to carry forward into their career.

Placement capacity

As identified during our last visit, learners, practice supervisors and practice assessors continued to raise concerns about placement capacity.

It was noted by all that the 2nd year cohort had significantly higher numbers of learners and there are several learners in their final year of training who have minimal birth numbers and birth experience.

Learners shared their worries regarding their ability to fulfil placement hours and felt that completion of course proficiencies were not being prioritised. All felt that this is due to placement capacity being exceeded within the department.

The Education team reported that they are continuing to work with education provider partners to action concerns relating to placement capacity by reviewing future cohort sizes.

However, current cohorts of learners felt that the existing issues with placement capacity will impact on them being able to complete their programme on time.

Areas that are working well

Areas for improvement

Mandatory requirements

Report approval

Report completed by: Amelia Harbon, Quality Programme Manager

Review lead: Jackie Brocklehurst, Assistant Director of Clinical Leadership and Education (Nursing and Midwifery)

Date approved by review lead: 27 March 2025

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

Date authorised: 3 April 2025

Final report submitted to organisation: 7 May 2025