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Supervision – Do we still need it 4 or 6 times a year?
In social care, the word supervision has more precise overtones than in its more general usage. While general “supervision” is taken to mean the checking of a worker’s output by another senior or experienced worker, in social care the word is taken to mean the detailed checking of whether a worker’s actions are correct in terms of legality and the norms and culture of the employing service.
Standard 36 of the National Minimum Standards for England, in force up to April 2010, stated:
“36.1 The registered person ensures that the employment policies and procedures adopted by the home and its induction, training and supervision arrangements are put into practice.
36.2 Care staff receive formal supervision at least 6 times a year. (note: similar requirements, but 4 times a year for domiciliary care )
36.3 Supervision covers:
_ all aspects of practice;
_ philosophy of care in the home;
_ career development needs.
36.4 All other staff are supervised as part of the normal management process on a continuous basis.”
In contrast, Outcome 14 the Essential Standards of Quality and Safety for England, in force from April 2010, states:
“14C. People receive a service from a provider that supervises its staff, because:
Staff are supported and managed at all times and are clear about their lines of accountability:
Supervisory or peer support arrangements are in place, monitored and reviewed, for all staff involved in delivering care, treatment and support. This is in line with relevant national guidance from professional regulators and/or professional bodies, and is monitored and reviewed. These supervisory arrangements mean that:
- staff can talk through any issues about their role, or about the people they provide care, treatment and support to, with their line manager or supervisor
- a support structure is in place for supervision which includes one-to-one sessions or group meetings. They are undertaken at a time and frequency agreed between the line manager or supervisor and the staff member, and they are recorded.
The development of staff is supported through a regular system of appraisal that promotes their professional development and reflects any relevant regulatory and/or professional requirements.”
A superficial reading of the changes could lead to the conclusion that supervision standards had been relaxed, particularly in relation to the specific frequency of supervision i.e. “at least” 6 times a year in a residential setting, and 4 times a year, one of which should be on a client’s premises, for domiciliary care and supported living . It might also be tempting to read the reference to professional regulators/bodies, and think that the provisions of 14C apply only to professionally qualified staff.
Nothing could be further from the truth. Under the new CQC regulatory regime, an understanding of the underlying intentions of the regulations points clearly to the increased importance of supervision of all workers, whatever their function or status. To understand this assertion we need to briefly revisit the underlying philosophy of the Health and Social Care Act Regulations. In the past, regulators had a distinct tendency to be very specific in their requirements of providers, that is, they published detailed specifications for the structures and processes of care services.
"the provider is not given free rein to produce acceptable outcomes by any means they see fit"
Under the new Act, the CQC specifies the outcomes of the structures and processes, but avoids wherever possible specifying the structures and processes themselves. However, the provider is not given free rein to produce acceptable outcomes by any means they see fit; the provider must prove that the structures and processes they use are designed to, and likely to, produce the outcomes required.
The CQC do not leave things to chance; it will not satisfy them to find that a satisfactory outcome has been achieved at any one time. What they are looking for is evidence that the satisfactory outcome was achieved because the service diligently worked towards achieving it, and that it did not happen because “it was a good day”. This approach is illustrated by the phrase “and is monitored and reviewed” in the first paragraph of 14C. The meaning of this phrase is that the process of supervision itself is monitored for its effectiveness; it is not good enough that the process simply produces output. The provider needs to show that they monitor the supervision process, and regularly review its output to look for opportunities for improvement of that output. That is, the examination process is itself examined. It is up to the provider to now demonstrate that their supervision process, as designed and carried out in practice, produces the desired outcome, and that the process itself is continuously improved to produce continuously improving outcomes.
Back to Basics
Therefore we need to go back to the basics of supervision, away from slavish “6/4 times a year”, and look at what supervision is for. The intention of supervision is that the management of the service satisfies its responsibility to ensure that all workers in the service are working to the required organisational standards, using the skills, processes, tools and equipment, and approaches that the service has designed in order to achieve the outcomes that it wants to achieve. This process is not about qualifications and training courses. It is about “how we do it here”.
As stated above, the new regime allows providers to achieve their outcomes by any demonstrably sound and proven method, thus allowing them to respond much more sensitively to the ever varied and changing needs of the service user. Therefore the provider cannot rely on third party endorsement of its workers in the form of qualifications. What the provider must do is be very specific about “how we do things here”, and check the performance of workers against that standard, using a method which is demonstrably sound, recorded, monitored and reviewed.
"supervision is about all workers, and about all aspects of their performance"
It should also be noted how wide the new standards cast the supervisory net. No longer is there an unintended implication that the supervision process is focussed on direct carers, and by implication only care. By placing the standard within the 'support for workers' section, the CQC clearly indicate that supervision is about all workers, and about all aspects of their performance, and is not confined to their care practice. This approach is entirely consistent with the “how we do it here” approach, because that implies that all actions by all workers, whatever their role, should be supervised.
In essence, this is no different from the process embedded within the QCS supervision policy, which was designed many years before any regulatory requirements, is based on good managerial practice - but with the frequency requirements of the regulations added - and which recommends that it cover all staff and considers other matters relating to good management of employees and not just their care practices. Even the removal of the specified spacing of supervisions is consistent; the QCS policy always pointed out that the spacing was a legal requirement (which in the past had to be adhered to), but that in practice, supervision of an individual employee should take place as often as it is needed in order maintain that worker’s performance. This could be as frequent as every shift when experiencing problems bordering on or contained within disciplinary procedures.
Separate Supervision from Appraisal
One final point; both old and new standards sow the seed of confusion between 'supervision' and 'appraisal'. As the QCS policy points out, these two processes, while related, are quite different in intent and content, and it enhances the success rate of both if they are clearly delineated and kept separate.
"Appraisal is forward looking, supervision is backward looking."
An appraisal is a process where, to use a metaphor, the worker and supervisor sit side by side, discuss the objectives of the organisation and the workers role in delivering those objectives, then discussing the needs of the worker and the skills which will be required to enable them to achieve their personal/professional objectives. In contrast, to continue the metaphor, in a supervision the worker and supervisor will sit opposite each other, clearly demonstrating that this process is about assessment and monitoring of performance by a supervisor, and the discussion will centre around the recent performance of this worker, where it needs to improve, and how it is to be improved. The outcome of appraisal is likely to set some of the standards against which the worker will be supervised during the following year. Appraisal is forward looking, supervision is backward looking. If supervision techniques and mannerisms are used in an appraisal, that appraisal is likely to not meet its objective, and conversely for supervisions.
The author has deliberately used the term “worker” throughout this article. Supervision must not be confined to only employees of the service. Everyone working within the service, whatever their employment status (for instance agency staff, independent contractor or volunteer) impinges on the outcomes, and therefore must be supervised.
The Welsh standards are similar to the pre April 2010 English standards. The principles dependent on good practice are the same as above, and CSSIW still require a minimum number of sessions.
The Northern Ireland Staffing Guidance is less specific, but still requires supervision; therefore all the preceding good practice can be applied. No specific time scales are required.
Within the Scottish National Care Standards a search for “supervision” does not find a match; therefore the recommendation is that services follow good practice as set out above.