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01st May 2016

Clinical Supervision in Welsh Adult Social Care in 2016

In this article I am beginning to consider the benefits of clinical supervision for all Welsh staff directly involved in delivering care and support. It is a theme I will develop further in future weeks by looking at some different supervision models and clinical supervision perspectives.

Back in March my colleague Paul Rees started to explore the requirement for supporting direct care staff to achieve positive client outcomes under the Social services and Well-being (Wales) Act, 2014 (SSWA). He was at pains to point out that under the new legislation the whole system of support and care provision is moving away from an inputs and process focus`to one based upon well-being outcomes (or determinants as they are characterised in the Act). In order to deliver these outcomes staff will need to be more person-centred than previously and consequently will need to carry out a wide range of support based activities in order to fulfil the policy agenda.

The developing Welsh environment for care now includes:

  • Social Services and Well-being (Wales) Act2014, especially at implementation (April, 2016);
  • Mental Health (Wales) Measure, 2010;
  • Demography of(aging) population and increase in dementia;
  • NHS and Social Services continued push to community based care;
  • Failures of care (Winterbourne View Report, DH, 2010; Andrews Report into care atPrincess of Wales and Neath Port Talbot Hospitals, 2014);
  • NHS austerity combined with longstanding policy direction of reducing NHS exposure to inpatient care;
  • Commissioning priorities involving value-for-money and outcome focussed care packages;
  • Regulatory training standards driven by Social Care Induction Framework (Care Council for Wales, 2012);
  • A competitive care market-place.

Scheme of Training and Support

I’ve recently been asked about what the Social Services and Well-being (Wales) Act, 2014, requires in terms of staff supervision. So I’ve been examining the case for including support workers within professional supervision processes more often associated with nursing, social work and the professions allied to medicine. Of course this approach needs to sit within a scheme of development and training bespoke to the individual’s role if it were to be effective. Under the Act the focus for care and support is now wholly person-centred and supervision will need to adopt that focus in order to provide the necessary framework for practice. In other words supervision will now be, at least in part, a tool for ensuring compliance with the SSWA legislation specifically and the wider regulatory environment.

Support workers comprise by far the largest number of care staff, and were previously required to meet standards set out in the Care Standards Act, 2000. However this has changed and a new benchmark has been established by the Social Care Induction Framework which itself converges on care and treatment principles explicit in part ii) of the Welsh Measure (2010) and the Social Services and Well Being Act (2014).

QCF/NVQ health care diplomas form the core of vocational training for this group and standards are specified and monitored by accrediting bodies (City and Guilds and AQA). Course content is updated periodically to a national specification. Assessors need to be credible within the field. Standards within the QCF/NVQ sector are variable but generally acceptable. The diplomas themselves are vocationally focussed and assessed within the workplace, thereby maximising relevance and convenience but these too will need to reflect the SSWA determinants and this is something Assessors will need to incorporate within schemes of work .

Supervision Arrangements

My contention is that in addition to sound training senior support workers are likely to have supervisory responsibilities themselves in addition to direct client contact, whilst more junior staff would also benefit from the ‘professionalisation’ of supervisory arrangements in order to help them develop quality, skills and accountability.

The legislation itself does not make explicit mention of supervision, but these arrangements are reasonably felt to fall outside of the scope of legislation and are covered by both professional standards and DoH/CQC/CSSIW guidance, especially the Framework for the practice of Clinical Supervision (CQC, 2013). In particular the report into the care scandal at Winterbourne View (Transforming Care a National Response to Winterbourne View Hospital, 2012) led to consideration of management and supervision of care staff.

Recommendations included; establishing a culture of quality and clear accountability for standards of care throughout the organisation delivering care;  the need for monitoring the appropriateness of placements and support packages both at commissioning and provider levels; the need for staff to be able to speak out if they see things which they consider to be unacceptable; the provision of adequate training and support to support staff in dealing with what are often complex and challenging situations.

What is Clinical Supervision?

The professions allied to medicine all have a requirement for and culture of including clinical supervision within their practice and this is something that care organisations can draw upon when considering how to roll-out clinical supervision for other care staff. Essentially clinical supervision comprises, “an accountable process which supports, assures and develops the knowledge skills and values of an individual group or team”(CQC, 2013) .

They (CQC) note that in some professions and occupations, alternative titles may be used, such as ‘peer supervision’, ‘developmental supervision’, ‘reflective supervision’ or just ‘supervision’, but generally clinical supervision is seen as complementary to, but separate from, managerial supervision, which is about monitoring and appraising the performance of staff.

“The purpose of clinical supervision is to provide a safe and confidential environment for staff to reflect on and discuss their work and their personal and professional responses to their work. The focus is on supporting staff in their personal and professional development and in reflecting on their practice.” (Supporting information and guidance: Supporting effective clinical supervision; CQC, 2013).

The document continues to state that whilst clinical supervision is often primarily intended for registered professionals (for example, nurses, doctors, social workers and allied health professionals) there is scope to broaden its application. They note in particular that in learning disability or autism services, support staff should have access to “appropriate forms of support, including clinical supervision”. This includes staff who are not professionally registered.

Professional Mission for Support Workers

Given the move towards a more person-centred model of care, a greater focus upon outcomes and the need for staff to be involved in a wider range of support activities, it is opportune to consider whether clinical supervision should be available to all direct care and support staff. Support workers both individually and collectively are on a journey towards professionalisation, registration appears likely at some point, and clinical supervision can assist them on that mission whilst also assisting care organisations to assure quality.

*All information is correct at the time of publishing. Use of this material is subject to your acceptance of our terms and conditions.

Nic Bowler

Welsh Care and Social Services Inspectorate Specialist

Dr Nicholas Bowler is a researcher and consultant to government-level [Welsh Government Review of Secure Services, 2009] – specialising in QA/compliance focused projects. He has interests in clinically relevant training, service development and research. He enjoys working with clients to support them in identifying problems and initiating projects to improve practice.

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