We are all aware there are going to be changes to statutory supervision of midwifery following recommendations from recent inquiries and reviews. To date, there is no formal decision as to how the future of supervision will look, or how it will affect individual midwives or supervisors. Mostly, it appears that the regulatory function will no longer be undertaken by local teams of supervisors but via management procedures and referrals made to the Nursing and Midwifery Council (NMC) as required. This is said to bring midwifery in line with how nurses are investigated, and also address a perceived disparity of decision-making.
As an NMC Fitness to Practise panellist and supervisor of midwives, I can see the importance of using rigorous processes for investigation that apply to all midwives, whoever and wherever they are. Being scrutinised by a colleague who works alongside you and knows your capabilities could hinder an impartial review. Also, assessing a more senior colleague's capabilities could be a challenge. Both these scenarios introduce conflict and possible inconsistencies in outcome. For example, I have seen referrals to the NMC where midwives under investigation have raised what appear to be valid concerns about the organisation of their practice programmes. This might be the assessment of those programmes by the same midwives who raised concerns about their practice in the first place. Added to this, it is likely another investigation via the management route is also taking place alongside the supervisory one. This is clearly not a good use of resources, and can lead to conflicting outcomes. One example is where a midwife is dismissed from the Trust while Supervision recommends a practice programme. The midwife is then in the position of trying to find a placement to carry out the programme, which adds further stress to the situation.
So how are midwives and supervisors reacting to these changes? I am involved in running one of the country's Preparation of Supervisors of Midwives courses, which started in January, just as the changes were announced. The students, who are experienced midwives with diverse experiences, and their mentors/supervisors were quite despondent, struggling to see the value of undertaking the programme or whether their newly acquired skills would be needed. The students understood that they still needed to know the process of investigating incidents fairly and rigorously using the Local Supervising Authority toolkit, which aims to ensure there is equity. However, to respond to the proposed changes, the focus of some of the lectures shifted to look in more depth at the associated skills of leadership, supporting midwives undergoing investigation and preventing incidents through positive role-modelling. The students fully supported these changes and were extremely positive about driving forward supervision in this slightly different guise. They also worked in action learning sets critically evaluating aspects of ‘supervision’ in preparation for the ‘new look’ role, and even developed a potential new title for the supervisor of midwives role to promote the supportive and advocacy element.
By the end of the programme, some 26 weeks later, we had a group of enthusiastic individuals ready to work with midwives to ensure the ongoing protection of women and babies by maintaining standards in the profession. The overarching feeling was that, if supervisors did not have to be involved in investigations, more time and energy could be given to supporting women, families, midwives and student midwives.
Of course, it is hoped that supervisors will still have a presence in management investigations, offering essential advice and facilitating retraining. This might mean supervisors making themselves and their role known within the workplace but, in my experience, this is not something they shy away from.
Individual midwives have also responded well to these changes. Historically, some midwives have been reluctant to engage with supervision, feeling it was punitive. Others could not see the value of the role. Since the changes have been highlighted, I have noticed many midwives have supported the continuing presence of supervisors and have been more likely to discuss any concerns with them. While participating in recent Local Supervising Authority audits of supervision, it is apparent that teams of supervisors are making a real difference to the service and are the creators of innovative practices often cascaded through the Trust as good practice. Time allowed for supervision is sometimes an issue, with many variations across the country; however, most have some protected time or, increasingly, the employment of full-time supervisors. Hopefully, without the support of statute, time will continue to be given to this essential role. If the regulatory function is taken away then hopefully supervisors can use their time to focus on driving the profession forward. It has also been suggested that they can play an active role in the revalidation process, and it certainly seems like this would sit well with the current annual review process.
Overall, I feel that the profession has responded well during this time of uncertainty and has risen to the challenge of beginning to reinvent supervision of midwifery to improve services for women and their families while continuing to support midwives. Perhaps it was time for a review of supervision, to reflect the needs of the changing face of maternity services.