Making sure health professionals are supported: untangling supervision and regulation

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Professional regulation is a controversial topic – on the one hand we want professionals to be unconstrained by red tape, to be motivated and to have autonomy to carry out their jobs. On the other we want to protect the public from staff who aren’t fit to do their jobs.

In April 2014, The King’s Fund was commissioned by the Nursing and Midwifery Council (NMC) to undertake a review of how midwives are regulated in the UK. The work was fascinating, challenging and complex. We looked at a wide range of evidence, interviewed people from across the United Kingdom, and worked with Ipsos MORI who talked to midwives, managers of midwifery services and members of the public.

The regulation of midwives is different to all other health professionals because it includes an extra layer of investigation and sanction. But the issue that raised the most feeling in our review was supervision. Unlike other health care professionals, by law midwives must have a named supervisor with whom they meet once a year to consider their practice. They must have access to a supervisor 24 hours a day, by phone or in person. These supervisors are usually practising midwives within the same organisation, not necessarily managers, and have about a day a month to carry out their regulatory duties (which includes supervisory and investigatory duties), with a target ratio of one supervisor to 15 midwives

Support from a supervisor was highly valued by the professionals we spoke to, with one commenting: ‘supervision is about supporting and enabling, and giving an opportunity for midwives to talk through cases in a safe environment. So to be able to reflect articulately, really honest reflection, and have an honest discussion back from somebody who is wiser than them.’ It was clear too that supervisors often provide more than the quite-limited supervisory tasks set out in legislation.

But is it appropriate for the regulator to be responsible for providing functions under the umbrella of 'supervision', including clinical support, development, and mentorship? Our review concluded that it is not: while supervision is important and valuable, it should not be the job of the professional regulator (in this case, the NMC) to provide it. Many midwives recognised this, but when we probed a bit more we found that some were concerned that if supervision wasn’t required by law, then cash-strapped employers just wouldn’t provide it. The midwives we spoke to pointed to what they saw as a lack of access to supervisory support in nursing, where supervision is not required by law.

We heard a similar concern raised at The King’s Fund’s breakfast event on mental health services last month, where some felt that, unless there was a national target about waiting times for mental health services, meaning that organisations would be penalised for failing, improved waiting times for mental health wouldn’t be delivered.

But can it be right that the only way to ensure best practice is to put it into law or a punitive target?

Enlightened employers know that investing in the wellbeing of their staff is money well spent in the long run. As the Boorman report into NHS health and wellbeing demonstrated, investing in staff wellbeing is likely to increase job satisfaction and reduce turnover and absence through sickness and stress, which is notably high in the health service. We know that the wellbeing of staff means better and safer patient care.

Some employers we spoke to believed that midwifery supervision would continue and some even felt that by taking away the statutory, regulatory responsibilities they would find it easier to motivate midwives to take on supervisory roles. One employer said: ‘If you took the supervisor of midwives away, people would still be supported and developed because, as an organisation, there’s a huge, huge weight on us to do that anyway’.

We’ve argued previously that much less emphasis should be placed on the use of external pressures such as targets and regulation to improve health services, and much greater priority should be given to reforming the NHS from within by supporting staff and learning from high-performing organisations in England and elsewhere.

The key for real improvement in the quality of NHS services is to have organisations that provide support to all staff, not just midwives, and allow professionals to access the training they need to flourish.

This blog was co-authored by Joanna Goodrich, Head of Evidence and Learning at the Point of Care Foundation.


Smoke To Live

Comment date
06 February 2015
Yes it is necessary to alote this kind of regulations.

Sam smith

Senior midwife,
Comment date
06 February 2015
I am concerned by your lack of judgement and naivety that you seriously think that acute trusts will keep supervisors on .All acutes trusts need to save millions of pounds and this is an easy money saver regardless that supervisors actually save lives, retain staff and support both mother and midwives.
Too late it will be realised how important supervisors are. Remember that when they are no more. And there is no one to support you with difficult decisions.

Angela Lewis

Independent public health consultant,
Self employed
Comment date
08 February 2015
Laudable sentiments but I fear the reality is that organisations under pressure support neither supervision or CPD as a priority.

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