Serious concerns about the standard of midwifery and nursing education programmes in North Wales have been identified by a review for the Nursing and Midwifery Council.
The NMC has published two reports following an “extraordinary” review of education programmes and midwifery supervision in North Wales, centring on Betsi Cadwaladr University Health Board.
“The reports from our extraordinary review show that there are serious concerns around the nursing and midwifery education programmes and the LSA function in North Wales”
The reviews were commissioned after concerns were raised with the regulator about the provision of education for midwifery students – and to a lesser extent, nursing students – and the supervision of midwives.
The concerns focused on the pre-registration nursing (adult and mental health) and midwifery education programmes run by Bangor University and the Local Supervising Authority function, which is managed by Health Inspectorate Wales.
The regulator said a number of concerns had been raised by Bangor University students over a two-year period about care services in Betsi Cadwaladr University Health Board.
The concerns relating to the care of patients in placement areas provided by the health board had been escalated the NMC by the university.
In addition, in June this year the university removed all midwifery students from Ysbyty Glan Clywd maternity services due to concerns about an unsuitable practice learning environment.
“The mandatory training records of nurses and midwives, including mentors and sign-off mentors, are at a low level of compliance”
The new review took place between 20-22 July and was carried out for the NMC by workforce consultants Mott MacDonald.
After speaking to students, service users, members of the nursing and midwifery programme teams and LSA representatives, the review team identified “several key issues and found that a number of our standards were not being met”.
Firstly, the trust and university were judged to have “inadequate” resources to deliver the education programmes to the standards required by the NMC and also to enable students to achieve learning outcomes in practice settings.
The first review report, which focused on the role of the university and health board, stated: “We found the teaching resource for the delivery of the pre-registration midwifery programme is below that which is required to deliver the programme at the level of quality that was specified at the programme approval. The current level of input by teaching staff appears unsustainable.
“In some midwifery areas there is a shortage of sign-off mentors and many students reported a lack of continuity of mentorship which created problems when completing their practice documentation,” the report added.
In addition, there was inadequate governance of, and in, practice learning, the programme providers failed to provide learning opportunities of suitable quality for students, and assurance and confirmation of student achievement was “unreliable or invalid”.
“We found that the mandatory training records of nurses and midwives, including mentors and sign-off mentors, are at a low level of compliance and do not provide evidence that nurses and midwives are competently using up-to-date knowledge and skills,” said the report.
The programmes also failed to address all the NMC’s required learning outcomes and audited practice placements failed to address all required learning outcomes in practice.
“In the pre-registration midwifery programme, the practice assessment document does not provide sufficient information to evidence that European Union and other essential statutory requirements are guaranteed,” said the report.
“The current level of input by teaching staff appears unsustainable”
Only in two areas were the standards found to have been met or partially met – quality assurance and admissions and progression.
The reviewers found that safeguards were in place to prevent unsuitable students from entering and progressing to qualification, meaning it was rated green.
Meanwhile, they said improvement was needed with the programme providers’ internal quality assurance systems, giving it an amber rating.
The second report, also published today, focused on the supervision of midwives and the role of the LSA in this process.
It found standards had not been met surrounding the operation of the LSA midwifery officer and the LSA’s responsibilities for supervision of midwives.
The report noted that the health board and the supervisors of midwives used IT systems that were “not compatible when trying to transfer information” and supervisors did not have “adequate accommodation” in the maternity units, which presented a “challenge when undertaking their role”.
In addition, the report highlighted evidence that not all annual supervisory reviews were completed annually and updated onto the LSA database.
The report added that an annual audit of the supervision of midwives within health board has “not been undertaken or completed”.
Jackie Smith, NMC chief executive and registrar, said: “The reports from our extraordinary review show that there are serious concerns around the nursing and midwifery education programmes and the LSA function in North Wales.
“We need to be assured that our standards for education and for the supervision of midwives are being met, and that the public’s safety is protected,” she said. “It is essential that all the relevant organisations collaborate to address the issues raised by the review.”
Ms Smith said the regulator would be working closely with Bangor University, Health Inspectorate Wales and other stakeholders “to improve the situation and strengthen public protection”.