Policy Checklist Name of Policy: Purpose of Policy: Directorate responsible for Policy Name & Title of Author: Does this meet criteria of a Policy? Staff side consultation? Equality Screened by: Allied Health Professions (AHP s) Supervision Policy To ensure that a culture of AHP supervision is embedded in the Southern HSC Trust and that the processes through which supervision is carried out are integral to the organisational arrangements for the delivery of safe and effective care. Executive Director of Nursing and Allied Health Professions SHSCT Senior AHP Governance Forum Yes Yes Yes Date Policy submitted to 13 th October 2008 RM&PC: Members of RM&PC in Attendance: Committee was quorate. Policy Approved/Rejected/ Amended Communication Plan required? Training Plan required? Implementation Plan required? Any other comments: Approved Yes Yes Yes Date presented to SMT 22 nd October 2008 Director Responsible Francis Rice, Executive Director Nursing & AHPs SMT Approved/Rejected/Amended SMT Comments Approved subject to amendment of paragraph 6.2 see below. Para 6.2 to be amended as follows: Title change from Executive director of nursing and AHPs to Accountability. Change first sentence to read The operational directors in the Trust are accountable to the Chief Executive for the implementation and maintenance of supervision in AHPs. Date returned to Directorate Lead for implementation (Board Secretary) Date received by Office Manager (HQ) for database/intranet Date for further review 23 rd October 2008 24 th October 2008 2 year default 1
POLICY DOCUMENT VERSION CONTROL SHEET Title Supersedes Title: AHP Supervision Policy Version: 1 Reference number/document name: Supersedes: N/A Description of Amendments(s)/Previous Policy or Version: Originator RM/Policy Committee & SMT approval Name of Author: SHSCT Senior AHP Governance Forum Title: Referred for approval by: Mr. Francis Rice, Executive Director of Nursing and Allied Health Professions Date of Referral: RM/Policy Committee Approval (Date) SMT approval (Date) 22 nd October 2008 Circulation Issue Date: 24 th October 2008 Circulated By: Review Issued To: As per circulation List (details below) Review Date: Responsibility of (Name): Title: Circulation List: 2
Allied Health Professions Supervision Policy September 2008 3
Contents Page No 1. Introduction 5 2. Aim of Policy 6 3. Policy Statement 6 4. Definition and Scope of the Policy 7 5. Supervision and Appraisal 7 6. Responsibilities 7 7. Legislative Compliance, Relevant Policies 9 8. Equality and Human Rights Considerations 9 9. Further Information 10 10. Appendices -Professional Bodies 12 -Health Professions Council 13 -Profile of Allied Health Professions 14 4
1.0 Introduction / Background The importance of effective supervision has been highlighted in regional critical incident inquiries such as the Lewis Review (2003) 1, Murtagh Review (2005) 2 and McCleery Report (2006) 3. The Quality Standards for Health and Social Care (DHSSPS 2006) 4 recommend that an effective system for supervision across H&SC can help organisations meet each of the clinical and social care governance standards. 1.1 Supervision processes have also been recognised as a method of improving organisational recruitment and retention of staff and already have an established association with job satisfaction, increased autonomy and reduced absenteeism. 1.2 1.3 1.4 Supervision has a vital role to play in supporting staff to deliver safe and effective services to patients/clients and carers within an agreed framework. Supervision is also one of the foundations of Service Governance and facilitates staff to be individually accountable for the quality of their practice. Supporting staff through supervision improves working practices and contributes to better service delivery and outcomes for service users. Supervision must be delivered in line with professional and Trust standards for supervision and given high priority by supervisors and supervisees alike. There is a strong consensus within the Allied Health Professions 5 (referred to hereafter as AHP s) that all Practitioners, irrespective of their level of experience, should have access to and be prepared to make constructive use of supervision to support lifelong- learning, professional regulation and clinical governance. To satisfy the Health Professions Council standards for registration, AHP s must demonstrate competence through Continuing Professional Development, which includes evidence of supervision activity 6. 1.5 This policy and attached procedural document has been produced to support the implementation, continuing development and maintenance of a robust system of 1 Lewis, RJ, Cole, D, Williamson, A (2003). Review of Health and Social Services in the case of David and Samuel Briggs. Belfast, DHSSPS. 2 Regional Quality Improvement Authority (2005). Review of the lessons arising from the death of the Late Janine Murtagh, Belfast, RQIA. 3 McCleery Inquiry Panel (2006). Executive summary and recommendations from the report of the Inquiry Panel (McCleery) to the Eastern Health and Social Services Board. Belfast, DHSSPS. 4 Department of Health, Social Services and Public Safety (2006). The Quality Standards for Health and Social Care. Belfast, DHSSPS 5 The AHP Disciplines that this policy refers to are Nutrition & Dietetics, Occupational Therapy, Orthoptics, Physiotherapy, Podiatry, Radiography & Speech & Language Therapy (appendix 3). 6 Continuing professional development and your registration. Health Professions Council. 5
supervision for AHP staff who work within the Southern Health and Social Care Trust (hereafter referred to as the Trust). 1.6 The SHSCT Senior AHP Governance Forum (appendix 4) was afforded the opportunity to revise legacy Trust supervision policies for AHP staff which led to a standardised approach within the Trust to organisational policy, recording, documentation, learning and development activities and evaluation processes supporting supervision activities within the AHP s. This policy has been guided by the advice and guidelines issued by AHP professional and regulatory bodies (appendices 1 and 2) by the governance arrangements existing within the Trust and by recommendations laid out in a number of other reports 1234. The revised Guiding Principles for AHP Supervision are: Guiding Principle 1 Supervision will contribute to the delivery of safe and effective care when practitioners have access to appropriate systems that facilitate the development of knowledge and competence through a culture of learning by reflection. Guiding Principle 2 A standardised organisational framework supporting effective leadership and performance management will ensure that supervision will become an effective and integral tool to improve the safety and quality of services. 2.0 Aim of the policy This policy will identify, operationalise, set a framework and minimum standards for supervisory practice to implement an effective and consistent approach to supervision practice within the AHPs across the Trust. The aim of the policy is to ensure that a culture of AHP supervision is embedded in the Trust and that the processes through which supervision is carried out are integral to the organisational arrangements for the delivery of safe and effective care within the Southern HSC Trust. 2.1 The implementation of an effective system of supervision for AHP s will help ensure: - - The promotion and maintenance of professional standards within the AHP s; - High quality practice; - A competent and skilled workforce; - Delivery of safe and effective care; - The rights and responsibilities of AHP staff in respect of supervision; and - A supportive professional environment for AHP staff. 2.2 Senior management teams in the Trust will ensure that appropriate measures are in place to implement supervision activities for both clinical and non-clinical teams. Operational and professional managers will refer to the Good practice Guidance for Professional 6
Interface Issues across Care Directorates, developed within the Trust to support professional standards within the Integrated Care Teams. 2.3 The main purpose of AHP supervision is to support: - The development of knowledge and skills within a role or clinical area, the focus being safe and effective practice and benefit to service users/carers. AHP s in non-clinical roles through providing an opportunity to discuss issues pertinent to the delivery of safe and effective care and / or professional issues; AHP s through difficult circumstances such as complex and challenging client caseloads or difficult interpersonal contact with other team members; and The development of competence, knowledge and skills through reflection and facilitation of personal and professional growth. 3.0 Policy Statement The Trust acknowledges the importance of AHP Supervision in ensuring the delivery of safe and effective AHP Services and the essential role it plays in protecting the public, the staff and the organisation. The Trust will ensure that all AHPs employed by the Trust are able to avail of a minimum of one formal supervision session per month. The Trust will facilitate this by ensuring that there are effective systems in place support supervision processes including ensuring that all supervisors have the appropriate knowledge and skills to competently undertake this role. All staff in rotational schemes and those taking up new posts will require more frequent/intensive supervision on a weekly basis. For newly qualified staff within post there will be a need for weekly supervision as part of a Preceptorship Model as a distinct process from the supervision policy for AHPs.( It is anticipated that training will be provided regionally on Preceptorship for all AHPs) 4.0 Definition and Scope of the Policy The SHSCT Senior AHP Managers adopted the following definition of supervision for AHP s following Their Review of Clinical Supervision for AHP S in the Trust undertaken by The Trust Senior AHP Governance Forum in March 2008. The role of clinical supervision is to provide support with the intention of improving therapeutic skills, transmit knowledge, test out new ideas, facilitate reflection on practice, help identify stress and clarify clinical, professional and personal goals with the intention of enhancing the quality of care to service users. (Cutliffe et al, 2001). An additional function of Supervision is to ensure meaningful engagement of the individual staff member with the organisation referred to in Morrison s (2001) definition of supervision. Supervision is a process in which one worker is given responsibility by the organisation to work with another worker(s) in order to meet certain organisational, 7
professional and personal objectives. The aim of supervision is to improve the quality of work in order to optimise service users capacity to lead independent and fulfilling lives. The functions of supervision are- Management (ensuring competent and accountable performance) Development of staff Support for staff Engagement (engaging the individual with the organisation) 4.1 The Southern Trust supports the following standards for AHP supervision :- All professionally qualified and support AHP staff with direct care roles can expect to have appropriate access to supervision. Individual clinical supervision is mandatory for all professionally qualified staff. Practitioners employed on temporary contracts or through an Agency are expected to take responsibility to ensure they are in receipt of supervision and can demonstrate access to this. All managers/supervisors can expect to have access to appropriate training to fulfil their role in a competent way. Professional line managers are responsible for identifying and choosing the most appropriate supervisor for their role. It is expected that the supervisor will have the relevant knowledge and skills to fulfil this responsibility. Where specialist clinical approaches are being used clinical supervision should take place according to professional standards. It is a requirement for all practitioners to ensure they engage in clinical supervision. This requirement must be supported and facilitated by managers and clinical leads. It is the responsibility of supervisor and supervisee to ensure that a record of the session is kept. A list of available clinical supervisors will be available for each service. 4.2 The Trust intends that each registered AHP will undertake a minimum of one formal supervision session per month (i.e. one to one supervision). In some instances it may be unrealistic to expect one to one supervision sessions for all AHP services all of the time and other methods of supervision such as group or team supervision will be deployed at the discretion of the professional line manager. Registrants are likely to engage in other activities which could also support the supervision process. The SHSCT Senior AHP Governance Forum acknowledged that a variety of diverse approaches and activities could be employed in implementing supervision (these are outlined in the procedural guidelines). 4.3 It should be noted that the scope of the Supervision Policy, Standards and Criteria produced by the Regional Reform Implementation Team (RIT) for child care supervision practice differs from supervision referred to in this policy. The former policy is separate 8
from, but complimentary to, other forms of supervision in that it provides a uniform supervision model within childrens services. The Supervision Policy, Standards and Criteria developed by the RIT is a mandatory policy that applies across the five Trusts for all social work grades of staff within childrens services. All Trusts will need to consider how this policy might be applied to all other staff i.e. multidisciplinary or other staff who work in children and young peoples services. AHP s who manage social work staff within children and young peoples multidisciplinary teams will implement the Supervision Policy, Standards and Criteria produced by RIT. Further information is available from the Supervision Standards, Policy and Criteria; Guidance for Northern Ireland Health and Social Trusts. (produced by RIT in June 2007 ) 5.0 Supervision and Appraisal It is important that supervisors and supervisees in the Trust recognise and differentiate supervision activity from other processes such as appraisal. Whilst supervision activity informs and is informed by the Agenda for Change Knowledge and Skills Framework annual review process, neither activity should be substituted for the other, each activity having a different purpose. 6.0 Responsibilities In the Southern HSC Trust there are key individuals in posts with responsibility for ensuring AHP supervision is implemented. They are: - 6.1 Chief Executive The Chief Executive of the Trust accepts responsibility and accountability for quality service provision at Trust Board level which includes systems, such as supervision in AHP s, which support clinical and social care governance. 6.2 Accountability The operational directors are accountable to the Chief Executive for the implementation and maintenance of supervision in AHP s. The Executive Director of Nursing and AHP s presents the Trust report to the Trust Board on an annual basis. In addition, s/he will act as a supervisor for the Assistant Director of AHP Governance, Workforce Development and Training and other senior professional roles as and when appropriate. 6.3 Operational Directors All Directors have responsibility for ensuring that arrangements are in place within their directorate to evidence compliance with this policy and that resources are available to support AHP supervision, monitoring and reporting processes. 9
6.4 Assistant Director of AHP Governance, Workforce Development and Training The Assistant Director of AHP Governance, Workforce Development & Training has responsibility to co-ordinate, facilitate, evaluate and maintain a system of supervision in the AHP workforce. S/he is accountable to the Executive Director of Nursing and AHP s and for presenting information relevant to the quantity and quality of the Trust supervision activity in governance reports or accountability reviews. 6.5 Operational Assistant Directors Operational Assistant Directors have responsibility to co-ordinate and facilitate implementation and maintenance of supervision for AHP s within their individual directorates. They are responsible for agreeing in partnership with the AHP Heads of Service the models of supervision to be employed within the division / directorate and must ensure appropriate resources are in place to enable AHP s to undertake at least one formalised session of one to one supervision or for some services group/team supervision monthly as advised by the Heads of AHP Services. They are responsible for monitoring the ongoing level of supervision activity within individual directorates and will facilitate the Assistant Director of AHP Governance, Workforce Development & Training in collation of reports. 6.6 AHP Heads of Services AHP Heads of Services have a responsibility to promote, co-ordinate and facilitate implementation and maintenance of all aspects of supervision for AHP s in Principal Practitioner, Clinical Specialist and Team Leader posts within their individual directorates/divisions. Where AHP staff are operationally managed within other care directorates the AHP Heads of Service have a responsibility to promote, co-ordinate and facilitate implementation and maintenance of professional and clinical supervision for AHP s in Principal Practitioner, Clinical Specialist and Team Leader posts. AHP Heads of Services will ensure that structures are in place to support clinical and professional supervision of all AHP staff within each division/directorate and will work collaboratively where appropriate with Operational Assistant Directors in relation to managerial and operational supervision. Operational and Professional managers will adhere to the Good Practice Guidance for Professional and Operational Interface Issues across Care Directorates within the supervision process. 6.7 AHP Principal Practitioners/Clinical Specialists/Team Leaders Principal Practitioners/Clinical Specialists/Team Leaders have a responsibility to rolemodel and facilitate implementation and maintenance of supervision for AHP s within their staff teams. They are accountable to the Heads of Services for ensuring appropriate structures are in place for the implementation of supervision and must maintain their professional standards on documentation of supervision within their teams. They can act as supervisors for clinical/professional supervision for other members of their profession 10
either within or outside their own team and carry out managerial/operational supervision for other disciplines where appropriate. 6.8 Supervisors All qualified AHP staff (at band s 9,8,7,6 & 5) will regularly be expected to provide supervision to a range of grades of staff within their own discipline. Where AHP s manage multidisciplinary teams they will be expected to managerially/operationally supervise these staff also. Supervisors at all levels have a responsibility to maintain and develop their own skills and competencies relative to supervision activity, contributing to the models of learning and to the approaches used. They must seek and undertake supervision themselves, maintaining records for both their personal supervision and all types of supervision of others. They must provide at least one to one formal session of supervision or where agreed with Heads of Service group or team supervision monthly for each supervisee. They must adhere to ground rules identified and conduct supervision sessions within the principles and process identified in these procedures. They are accountable to their operational and professional line managers for this activity. Training requirements for supervisors as specified within the procedural guidelines must be applied. 6.9 Supervisees Supervisees have a responsibility to engage fully in the AHP supervision process, adhering to identified ground rules. They have a responsibility to prepare for, and participate in, a minimum of one one or where agreed with Heads of Service, group or team formal supervision sessions per month, keeping accurate records of relevant actions. Activities undertaken between sessions should be used to inform formal supervision sessions. They are accountable to their professional and operational line managers to engage in a minimum of one to one or where agreed with AHP Heads of Service group or team formal supervision sessions monthly. Training requirements for supervisees as specified within the procedural guidelines must be applied. 7.0 Legislative Compliance, Relevant Policies, Procedures This policy should be read in conjunction with the: - - Southern HSC Trust Supervision Policy 2008 and RIT Supervision - Good practice Guidance for Professional Interface issues across Care Directorates (April 2008) - The Supervision Policy Standards and Criteria. Guidance for Northern Ireland Health and Social Care Trusts (produced by RIT June 2007) 8.0 Equality and Human Rights Considerations This policy has been screened for equality implications as required by Section 75, 11
Schedule 9, of the Northern Ireland Act, 1998. Equality Commission for Northern Ireland Guidance states that the purpose of screening is to identify those policies which are likely to have a significant impact on equality of opportunity so that greatest resources can be targeted at them. Using the Equality Commission s screening criteria, no significant equality implications have been identified. This policy will therefore not be subject to an equality impact assessment. This policy has been considered under the terms of the Human Rights Act, 1998, and was deemed to be compatible with the European Convention Rights contained in that Act. This policy will be included in the Trust s register of screening documentation and maintained for inspection whilst it remains in force. This document can be made available on request in alternative formats, e.g. Braille, disc, audio cassette and in other languages to meet the needs of those who are not fluent in English. 9.0 Further Information The Supervision Policy, Standards and Criteria; Guidance for Northern Ireland Health and Social Care Trusts (produced by the Reform Implementation Team, June 2007) The Good Practice Guidance for Professional Interface Issues across Care Directorates ( is available on the Trust intranet) 12
Appendix 1 PROFESSIONAL BODIES The Society of Chiropodists and Podiatrists The British Dietetic Association The British Association of Occupational Therapy The British and Irish Orthoptics Society The Chartered Society of Physiotherapy The Society of Radiographers The Royal College of Speech and Language Therapists 13
Appendix 2 Health Professions Council The Health Professions Council (HPC) was created by the Health Professions Order 2001. It was established as an independent UK wide statutory health regulator, whose function is to safeguard public protection. The HPC sets standards of professional training, performance and conduct for the professions detailed below. Arts therapists Biomedical scientists Chiropodists and podiatrists Clinical scientists Dietitians Occupational Therapists Operating department practitioners Orthoptists Paramedics Physiotherapists Prosthetists and orthotists Radiographers Speech and language therapists Currently there are over 180,000 professionals registered with the Health Profession Council, all of whom have protected titles. Web site: www.hpc-uk.org 14
Appendix 3 AHP Professions represented under the Assistant Director for AHP Governance/Workforce Development and Training Profession Main Function Patient/client groups Dietitians Occupational Therapists Orthoptists Assess, diagnose and treat diet and nutrition problems at an individual and wider public health level. Uniquely dietitians use the most up to date public health and scientific research on food, health and disease, which they translate into practical guidance to enable people to make appropriate lifestyle and food choices. Assess, rehabilitate and treat people using purposeful activity and occupation to prevent disability and promote health and independent function. Assess, diagnose and treat eye movement disorders and defects of visual function and binocular vision. All age groups with special dietary requirements or those needing advice and education on nutrition. All age groups where physical or mental functioning impact on everyday life, children, older adults and those with chronic disease. All age groups but mainly children and older adults. Physiotherapists Assess and treat people with physical problems All age groups especially those 15
Profession Main Function Patient/client groups caused by accident, ageing, disease or disability, using physical approaches to maximise the patient s recovery and alleviate pain. with neuromuscular, musculoskeletal, cardiovascular or respiratory problems. Podiatrists Radiography (Diagnostic and Therapeutic) Therapeutic Radiographers Speech and Language Therapists Diagnose and treat abnormalities of the foot. They give professional advice on prevention of foot problems and on proper care of the foot. Produce high quality images on film and other recording media, using all kinds of radiation. Treat mainly cancer patients using ionising radiation and, occasionally, drugs. They provide care across the entire spectrum of cancer services. Assess, diagnose and treat people with communication and/or swallowing difficulties. All age groups mainly older adults and those with chronic disease eg vascular, diabetes. All age groups. All age groups mainly individuals with cancer and tissue defects. All age groups especially children and those with neurological or cancer-related problems. 16
Appendix 4 Membership of Southern Trust Senior AHP Governance Forum Brian Beattie, Assistant Director of Primary Care Cynthia Cranston, Head of Occupational Therapy Alexis Davidson, Head of Radiography & Diagnostics Pauline Douglas, Locality Head of Children & Young People s Services Mandy Gilmore, Head of Nutrition & Dietetics Jane Hanley, Head of Orthoptics Carmel Harney, Assistant Director of AHP Governance, WFD & Training Ruth Nesbitt, Head of Speech & Language Therapy Teresa Ross, Head of Physiotherapy Sadie Sommerville, Acting Head of Podiatry 17