Supervision guidance

Supervision in the context of speech and language therapy

This section covers:

• Clinical governance
• Supervision and HCPC
• Your responsibilities

Clinical governance

Clinical governance is the system through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care, by creating an environment in which clinical excellence will flourish (Department of Health 2018).

Supervision has been linked to good clinical governance, by helping to support quality improvement, managing risks, and increasing accountability.

By supporting supervision, organisations enable staff to deliver care and treatment safely and to an appropriate standard. A structured and effective system of supervision offers an organisation a rigorous way to support, develop and monitor best practice in their staff group. The appropriate level of resources and time need to be in place to effect this.

Supervision has been associated with higher levels of job satisfaction, improved retention and staff effectiveness. It is also one way for a provider to fulfil their duty of care to staff (CQC, 2013).

Supervision provides an essential opportunity for individual practitioners to reflect on clinical governance in the context of their own professional practice. It also provides an opportunity for open dialogue around fitness to practise.

Supervision and the HCPC

Health and Care Professions Council (HCPC) registration is a legal requirement for all practising SLTs, who must adhere to the following standards:

HCPC (2016) Standards of conduct performance and ethics

HCPC (2014) Standards of proficiency

HCPC (2011) Standards of continuing professional development

HCPC standards state that you, as a registrant, must understand the importance of participation in training, supervision and mentoring, in order to work within your scope of practice. Your scope of practice is the area or areas of your profession in which you have the knowledge, skills and experience to practise lawfully, safely and effectively, in a way that meets our standards and does not pose any danger to the public or to yourself.

See Professional Accountability and Autonomy for guidance to support you in meeting the HCPC’s standards.

Your responsibilities

• Your employer has a responsibility to support you to meet your supervision requirements.
• You should refer to their supervision and continuing professional development policies and procedures where in place.
• It is the responsibility of each individual practitioner to make sure that their knowledge, skills and performance are of a good quality, up-to-date, and relevant to their scope of practice.
• Each staff member remains accountable for their own professional practice and all supervisors are accountable for the advice they give.
• Self-employed therapists are responsible for ensuring they have adequate opportunity for support and supervision.

Defining supervision

This section covers:

• Supervision
• Managerial supervision
• Professional supervision
• Professional support

Supervision

Continuing professional development, or CPD, is the overarching, umbrella term used to refer to a wide range of learning opportunities that provide on-going access to knowledge, skills, advice and/or support.

Supervision is:

• A specific type of professional development.
• A mutually agreed, formal, regular 1:1 or group-learning relationship.
• The formal arrangement that enables an SLT, or assistant practitioner, to discuss their work regularly with someone who is experienced and qualified.
• A process of practice development.
• A mechanism through which you can reflect on your learning and practice.

Throughout your working life, as you progress in your skills, knowledge and experience, your supervision and professional support needs will change in terms of frequency, content and style.

Supervision forms an essential component of a good quality speech and language therapy service by:

• Ensuring accountable decision making.
• Enabling identification of risk.
• Facilitating learning and professional development.
• Promoting staff wellbeing.

There are a wide variety of terms applied to the activity of supervision in health and social care the terms used may overlap or vary depending on your employer. RCSLT uses the terms:

• Managerial supervision: to refer to ‘line-management’ supervision.
• Professional supervision: to refer to ‘clinical’, ‘personal’ and ‘practice’ supervision.

You should relate these to your employer’s terminologies.

Managerial supervision

The Care Quality Commission (CQC) defines managerial supervision as being carried out by a supervisor with authority and accountability for the supervisee (CQC, 2013).

Managerial supervisors may or may not have a speech and language therapy background.

Managerial supervisors must act within the scope of their practice and delegate accordingly.

Managerial supervision, both within and across professional boundaries, aims to:

• Ensure practitioners are aware of and support adherence to the HCPC professional standards and codes of conduct expected of them.
• Monitor progress collaboratively and identify professional development needs in relation to service delivery.
• Support practitioners to find appropriate ways of meeting their development needs.
• Support practitioners to meet their formal appraisal objectives and performance targets.
• Provide advice on managing caseloads and issues that may cause problems in the day-to-day functioning of the service.
• Enable practitioners to fulfil their person specifications and job descriptions.
• Ensure that an appropriate and transparent professional supervision arrangement is available and being regularly accessed.
• Ensure communication systems and boundaries between managerial and professional supervisors have been fully negotiated and agreed by all parties.

Professional supervision

RCSLT requires speech and language therapy assistants (SLTAs) and newly qualified practitioners (NQPs) to receive professional supervision from an experienced, HCPC-registered SLT.

Experienced therapists may choose to access professional supervision from an SLT or a non-SLT professional (e.g. psychiatrist, clinical neuropsychologist, Special Educational Needs Coordinator (SENCO), social worker, Ear, Nose and Throat (ENT) consultant).

Professional supervision offered across professional boundaries can readily address wider practice concerns, such as team dynamics, personal and professional development and broader service issues.

However, if the professional supervisor does not have a speech and language therapy background, they will need to pay attention to their scope of practice and delegate accordingly (e.g. for a specific clinical dilemma, a therapist would need to access a supervisor from their own profession).

Professional supervision aims to:

• Create a non-judgemental, confidential learning environment that promotes critical reflective practice and the opportunity to learn from experience.
• Reinforce and offer feedback on effective clinical skills and practice to enable practitioners to discuss areas of their work that they think are both effective and less effective.
• Promote solutions to establishing therapeutic alliances and managing professional boundary issues.
• Promote understanding of the dynamics in professional relationships for effective service delivery
• Increase confidence in managing complex interdisciplinary situations which may arise related to the point of service delivery.
• Reflect on professional issues which may be causing concerns, with an aim to promote health and well-being of staff and improving service-user experience.
• Promote confidence across the areas of clinical practice.
• Provide a supportive role to help prevent crises or disillusionment arising.
• Assist practitioners in relating practice to theory and theory to practice.
• Assist practitioners in ensuring their practice is evidence-based.
• Identify opportunities relating to the development and dissemination of research.
• Promote safety of the service-user experience and address any areas of concern.
• Ensure that an appropriate and transparent managerial supervision arrangement is available and being regularly accessed.
• Ensure communication systems and boundaries between managerial and professional supervisors have been fully negotiated and agreed by all parties.

Professional support

• The management structure of the employing organisation
• Colleagues within and/or outside the service
• RCSLT Clinical Excellence Networks (CENs)
• RCSLT Hubs
• RCSLT advisers
• Association of Speech and Language Therapists in Independent Practice (ASLTIP) groups
• Peer support groups
• Buddying by another SLT

Forms of support activities include:

• Opportunities to shadow SLT colleagues
• Joint working
• Attendance at clinical meetings, in-service training and training seminars
• Opportunities to access specialist advice to support clinical judgement and decision-making when needed either face-to-face, through ‘open door policies’ or via phone call or email
• Access to non-SLT health professionals (e.g. an educational psychologist, a psychiatrist, psychotherapist, ENT consultant) in situations where the practitioner’s scope of practice has been extended or is highly specialist
• Access to peer support networks, such as forums or support groups or peer ‘buddy’ systems
• Regular contact with peers and specialists in the profession

Adequate provision of support can lead to reduced stress levels and enhanced ability to manage distressing or complex situations. This is especially important for NQPs and those who may find themselves working in isolation. External personal support may be appropriate at times including access to the occupational health department, staff counsellors, employee assistance programmes or leadership training courses.

Individual practitioners are responsible for creating an on-going, flexible network of colleagues and organisations within and outside of the profession from which to access support.

The Interface

This section explains how managerial supervision, professional supervision and professional support interface with each other:

Roles and relationships

Managerial and professional supervision are best received from different people.

In instances where supervision is received from the same person, there must be clear delineation of role, and focus of each supervisory event.

Professional support can be accessed from a wide variety of people, groups and sources.

Content

The topics and themes that can be addressed in supervision are broad.

Some of these fall clearly into managerial or professional supervision, others may overlap:

• Managerial supervision: operational and strategic issues, such as mandatory requirements, organisational changes, service developments, record audits, GDPR.
• Professional supervision: clinical decision making, assessment and interventions, specific ethical decisions, personal response to work context or practice.
• Managerial or professional: clinical prioritisation and case load management, scope of practice, duty of care, safeguarding issues, user involvement, development of new service, team dynamics, values and interpersonal relationships.
• Professional support: ranges from being more immediate, ad hoc and short-term, offering a space to ‘off load’, seek validation or advice to providing an opportunity to develop skills, knowledge and practice in a more general way.

For example

• To demonstrate how managerial supervision, professional supervision and professional support interface in practice, ‘caseload management’ may be addressed in the following ways:
• In managerial supervision: by the supervisor in relation to departmental standards or waiting lists.
• In managerial supervision: by the supervisee with a view to discussing referral rates, equity of service delivery or the service to families.
• In professional supervision: by the supervisee to reflect on feeling overwhelmed, the pressures of managing a large and complex caseload or managing the high expectations of clients, families and colleagues.
• Through professional support from within or outside the organisation: by the supervisee to share concerns, creative ideas and practice experience.

Roles of supervisee and supervisor

The supervisor and supervisee hold different but equal responsibilities for achieving a successful supervisory relationship.

A supervisory relationship builds on mutual trust and respect.

Each supervisory contract/working agreement should be clear, transparent and flexible to meet the needs of the supervisor and supervisee.

It is important to review your supervisory arrangement regularly as what you are looking for in your professional supervisor may change over time.

What constitutes good quality supervision is personally defined as you will have your own particular supervision preferences – and what works well for you might not work as well for another. Multiple experiences of different supervision styles bring a greater depth of understanding and flexibility to the role of supervisor.

The supervisee

The supervisee must:

• Take responsibility for self-directed, lifelong learning including a commitment to ongoing professional development.
• Be proactive in organising and participating in your own supervision.
• Openly express needs and expectations related to supervision and ensure these form the basis of the supervision contract.
• Make the best use of supervision by coming prepared. This includes having an agenda of points to be discussed so time can be used effectively.
• Protect time for supervision, to keep scheduled supervision appointments, be on time and avoid interruption where possible.
• Be prepared to openly identify and discuss practice issues which are challenging the skills that need developing.
• Work at developing trust in the supervisory relationship so that you can discuss issues honestly and freely. This makes supervision more meaningful and relevant.
• Contribute to reflective discussion about your practice experience and learnings.
• Check your own tendencies to justify, explain or defend.
• Be open to learning and incorporating this learning into your work practice. Be prepared to be challenged in a supportive way.
• Be open to receiving support and feedback during supervision and take time to reflect and respond to this feedback.
• Take responsibility for seeking help when required, even if outside the regular supervision time. This ensures client safety and well-being are always put first.
• Commit to regularly reviewing the supervision process, and give honest feedback if it needs to be adapted to meet your changing needs.

The supervisor

Supervisors are required to:

• Have the skills, qualifications, experience and knowledge of the area of practice required to undertake their role effectively.
• Be supported through having their own clinical supervision.
• Be competent at providing individual and/or group supervision.
• Engage in ongoing reflection and training in relation to their supervisory skills.

A supervisor should have:

• An understanding of supervision as a process that evolves over time.
• Respect for others and promotion of positive working relationships regardless of individual differences and levels of experience.
• A commitment to negotiating and regularly reviewing supervision contracts, in order to be open to supervisees’ changing needs.
• Respect and hold clear boundaries, in order to ensure confidentiality and integrity which promotes open and honest self-reflection and discussion.
• A willingness to allow the supervisee to grow, experiment and become independent.
• A willingness to share experience, knowledge and skills in a relevant and timely way.
• A willingness to challenge practice that is perceived to be unethical, lacking in clinical rigour or competence.
• A willingness to be open to and accepting of honest and constructive feedback from the supervisee.

They should:

• Ensure a relaxed and safe enough space for the supervisee to bring and discuss practice issues in their own way
• Facilitate the supervisee to be actively involved and engaged in the supervision process
• Develop trust in the supervisory relationship, so that issues can be discussed honestly and freely resulting in supervision being more meaningful and relevant
• Enable the supervisee to explore and clarify the thinking, feelings and anxieties which underlie their practice
• Encourage the supervisee to conceptualise new and creative ways to construe their clients, colleagues and work in context
• Be proactive in supporting supervisees to maintain and manage their fitness to practice
• Use insight and empathy to understand and support the supervision process
• Initiate and organise their own supervision and CPD in relation to the above and ongoing supervision of supervision.

Supervision in practice

This section explores the following dimensions of supervision:

• Supervision culture
• Functions of supervision
• Forms of supervision

Supervision culture

• All staff having an annual performance review, supported by a systematic approach to training and development, including a PDP and appropriate CPD opportunities.
• A clear, up-to-date supervision policy, with practice that supports the policy (speech and language therapy/organisational).
• A clear system of supervision (managerial and professional) for all staff.
• Effective training of supervisees and supervisors.
• Strong lead and example by senior managers.
• Performance objectives for supervision practice, in place for all supervisors.
• Evaluation and monitoring of actual supervision practice, frequency and quality.

Functions of supervision

• developing knowledge and skills
• increasing self-awareness
• reflecting on practice
• integrating theory into practice
• facilitating professional reasoning

Normative: relating to the promotion and maintenance of good standards of work, ethical practice, accountability and adherence to policies of administration, including:

• clarification of roles and responsibilities
• workload management
• review and assessment of work
• addressing organisation and practice issues

Restorative: relating to the maintenance of harmonious working relationships, with a focus on morale and job satisfaction, including:

• developing a sense of professional self-worth
• sustaining practitioner morale
• dealing with job-related stress

These dimensions demonstrate the breadth of possibility within supervision. They provide a structure for both the supervisee and supervisor to negotiate the balance of content and to review these within sessions and over time.

Forms of supervision

Managerial and professional supervision may take the following forms:

Managerial

• One-to-one supervision between the line manager (supervisor) and supervisee. This can take place face-to-face, by telephone, video conference or online. Face-to-face is the preferred option and a balance between this and any other form would need to be negotiated and reviewed regularly.
• Alternate paired and 1:1 supervision sessions with the line-manager could be helpful when two therapists job-share.

Professional

• One-to-one supervision between supervisor and supervisee. This can take place face-to-face, by telephone, video conference or online.
• Group supervision in which two or more practitioners discuss their work with a supervisor.
• Peer or co-supervision where practitioners discuss work with each other, with the role of supervisor being shared or with no-one acting as a formal supervisor.
• A combination of the above.

The exact configuration of these different forms will depend on a number of factors, including the experience of the supervisee, the weight of their workload, their professional background and their work context (CQC, 2013).

Supervisory contract

Care Quality Commission (CQC) states that it is good practice to put in place a written agreement or contract between supervisor and supervisee at the outset of supervision sessions. Clear records should also be kept of supervision sessions. Each supervisory contract will be unique to the dyad or group concerned but it should take into consideration the following factors.

This page covers the core elements for consideration when creating a supervisory contract:

a) Frequency and duration

b) Environment

c) Confidentiality

d) Relational Factors

e) Performance and capability

f) Safeguarding and protection of children

g) Documentation

h) Topics and themes

i) Managing breach of supervision contract

j) Relational factors

a) Frequency and duration

There is no nationally prescribed frequency for supervision. Frequency of supervision can change at different points on the career pathway, for example as a practitioner develops their expertise, goes through transitional periods or extends the demands of their work and roles. Whilst it is important to monitor the frequency and duration of supervision, quality of supervision is as important as quantity.

Frequency of supervision needs to reflect the practitioner’s:

• Level of experience, competence and training within a particular field/specialist area (i.e. level of skills, the integration achieved between theory and practice, general ability in the work).
• Caseload at a particular point in time and the nature and range of the roles required (i.e. number of clients, complexity, skill-mix required, emotional intensity).
• Work context (i.e. full time/part time, working in isolation/working as part of a team), availability of informal support and advice, joint working opportunities).
• Practitioner’s personal context (i.e. specific difficulties encountered either in the work domain or home situation/personal life that could affect their availability for work; health related issues; emotional well-being).

The following tables cover the RCSLT’s recommendations for frequency of supervision.

We recognise that these targets may be challenging to deliver in some circumstances, but encourage all supervisees and employers of SLTs to explore creative solutions, including the use of technology, in order to meet these recommendations.

Professional supervision

The minimum time requirement for supervision can be distributed across different forms and is cumulative

For group supervision, if there are four or fewer in the group, each practitioner can count up to 50% of the time together as supervision. If there are five or more members, the time is divided by the number of practitioners in the group. For example:

• In a two-hour group with four practitioners, each practitioner can claim one hour of supervision.
• In a three-hour group with six practitioners, each practitioner can claim one-half hour of supervision.

A balance between duration and frequency will need to be negotiated and reviewed regularly. The adequacy of all supervisory arrangements needs to be regularly re-assessed and changes negotiated as necessary.

Frequency and/or duration may be adjusted on a pro rata basis for part-time employees as negotiated with the manager depending on hours worked, clinical roles and responsibilities and individual needs of the practitioner.

All supervisees and supervisors are entitled to request or suggest more supervision and in different forms, although this may be at the discretion of the employer.

Time boundaries need to be respected by both the supervisee and supervisor. They both need to commit and pay attention to beginning and ending supervision sessions at the agreed times. They also need to agree who will take responsibility for managing the time within sessions.

b) Environment

A neutral, safe, confidential space is key to good quality supervision.

Practitioners working across large geographical areas will need to negotiate a mutually-accessible location or consider the use of phone or video conference facilities. However, the ratio and balance of face-to-face and remote supervision needs to be considered in each supervisory relationship according to level of experience and personal preferences.

It is crucial to remove and/or minimise unnecessary distractions (e.g. mobile phone, bleep, staff entering the space).

Review of the literature suggests that having supervision sessions away from the workplace results in:

• Higher rapport with the supervisor.
• Increased reflective practice.
• Increased exploration of sensitive and confidential issues by the supervisee.

(Martin et al, 2014)

c) Confidentiality

It is extremely important that both the supervisee and supervisor have a clear understanding of what ‘confidentiality’ means from the outset.

The content of managerial and professional supervision should be treated as confidential to the parties involved except where required by law, statutory obligation or legitimate purpose, in line with HCPC standards of conduct, performance and ethics (HCPC, 2016b).

“Good clinical supervision relies on trust and therefore (within some limits) a supervisee has a right to expect the content of the session to remain confidential. The content of a supervision session will be agreed between the supervisor and supervisee. If concerns are identified in the course of supervision about a practitioner’s conduct, competence or physical or mental health, the supervisor may need to disclose information from a supervision session to an appropriate person, such as the practitioner’s line manager. This should be clearly set out in any policy on clinical supervision and in supervision contracts” (CQC, 2013, p.9).

Confidentiality needs to be agreed by the individuals and/or group as part of the supervision contract. The circumstances under which confidentiality might be broken and the process that will be followed according to the relevant codes of conduct and local guidance and policies also need to be transparent to all parties.
Mutual agreement also needs to be reached regarding record keeping for sessions from the outset (e.g. what is the purpose of the records, who will be documenting the sessions, where will the records be kept, who will have access to them).

For more information see for more information see section f) Documentation.

d) Performance and capability

Performance or capability issues must be addressed as soon as they become apparent through opportunities for formal feedback, additional support and adherence to local human resources (HR) policies according to the individual’s needs and context.

It is essential that the practitioner’s manager is trained in supervision and performance review skills as well as being able to deal with difficult situations that could result in disciplinary action.

The manager and practitioner should consider all possible avenues for resolving difficulties that may arise before resorting to disciplinary procedures, following organisational policy where this exists.

In instances where significant difficulties are encountered in achieving acceptable standards of conduct or performance, and where opportunities have been offered to help the practitioner overcome any difficulties, the manager needs to know their level of authority for implementing the disciplinary procedure, and should seek HR advice where appropriate.

e) Safeguarding and protection of children and vulnerable adults

Safeguarding issues can be considered within both managerial and professional supervision. Any issues relating to safeguarding that arise in supervision may need to be taken to a designated safeguarding supervisor, in keeping with local and/or organisational policies.

Depending on the role of the practitioner, specific child protection or safeguarding supervision may be required. Safeguarding/child protection supervision is different from, and in addition to, the forms of supervision and support recommended for all practitioners.

f) Documentation

• continuous professional development
• information governance

g) Topics and themes

Both the supervisee and the supervisor need to be aware of the breadth of topics and themes that can be brought to managerial and professional supervision sessions. These can encompass three overarching strands:

Clinical:

• ‘I don’t know how to help this client’.
• ‘Should I discharge/when should I discharge?’
• ‘How do I handle situation X?’
• ‘Boundaries: is this part of my job?’
• ‘I want to continue to work with this client, but I am not sure of my skills in this new area’.

Professional:

• ‘Balancing competing demands’.
• ‘Time management’.
• ‘Roles’.
• ‘Team dynamics’.
• ‘I don’t get on with my manager/colleagues’.

Personal:

• ‘Too much stress’.
• ‘I don’t like my job/I want to leave’.
• ‘I’m not a good enough therapist’.
• ‘There are lots of changes going on at work’.
• X is happening to me at home and it is affecting my work’.

The scope of the issues, questions and dilemmas within each of these strands that can be discussed in supervision or through professional support is broad and can span several domains of influence (Tudor and Worrall, 2002): clinical, professional, ethical, personal, legal, social or cultural. Any of these dimensions can be discussed in any order with any degree of emphasis at any time depending on the current situation and priorities of the supervisee.

Best-practice guidance recommends regular review of the range and balance of topics brought to supervision by both supervisee and supervisor. This will allow for the identification of patterns and preferences regarding what is brought to supervision over time and bring this to the supervisee’s attention in order to invite reflection and experimentation. It will also allow discussion of what may lie outside the scope of supervision (e.g. supervisor does not feel she can adequately supervise a given issue) and alternative sources of support.

h) Breach of supervision contract

Good practice requires that both the supervisor and supervisee invest adequate time in order to negotiate roles, responsibilities and processes from the start of their relationship. This contract clearly lays down the mutually-agreed rules of engagement for both parties.

Regular review opportunities will offer a platform for ongoing discussion and a mechanism for either party to raise any issues or concerns regarding this agreement as and when the need arises.

It is crucial from the outset that both parties understand the steps that each/both might need to take if/when the administrative and/or relational contract is not being adhered to by either person.

The relational contract

a) Supervisee history, views and preferences

At the outset of both managerial and professional supervision, it is good practice for time to be allocated to the supervisee for reflection on past helpful and unhelpful experiences of supervision. This will help to determine their views, wants and preferences in relation to the roles and responsibilities they would like their supervisor to take.

b) Supervisor philosophy and approach

It is important at the outset of the supervisory relationship for time to be allocated to the supervisor to detail their philosophy of supervision and approach in order to negotiate the roles and responsibilities both supervisee and supervisor will take.

Different styles of managerial supervision and professional supervision offer different learning opportunities.

In professional supervision it can be helpful to experiment and trial different approaches for development as a practitioner and as a current or future supervisor. For example:

• Joint sessions.
• Review of video and/or audio recordings.
• Creative approaches e.g. drawing, image work or use of 3-D materials.

c) Pre-existing relationships

Clear personal and professional boundaries are integral to effective supervision practice. Careful consideration needs to be given to relationship boundaries when setting up a supervision arrangement both within organisations and when sourcing supervision externally. A practitioner might find him/herself in a supervisory relationship with someone with whom they have a different role relationship either previously or currently (e.g. peer working relationship or friendship). As a result, an initial and on-going discussion will need to take place about the following:

• The roles and responsibilities they already have in relation to each other
• How these roles might differ or conflict with the supervisory relationship
• Boundaries that need to be paid attention to

Openness, honesty and mutual respect are qualities that need to be demonstrated by both parties when negotiating supervisory roles and relationships. It is important that everyone involved feels comfortable with the supervisory arrangement at all times. Supervisory relationships that cross close friendship boundaries are not advised due to a conflict of interest.

d) Process time

Regular, dedicated process time enables both the supervisee and supervisor to keep track of how each supervision session is working and to determine how the supervisory relationship is developing over time. This relates to both managerial and professional supervision and can lead to discussion about how best to address on-going learning needs. Dedicated process time might comprise 10 minutes at the end of every session for both parties to reflect on:

• the session as a whole
• recurrent themes
• changes in thinking/beliefs observed throughout the course of the session
• the supervisor’s style – what was most/least helpful
• key learning

e) Supervisory relationship

Supervisor-supervisee fit is important in both high-quality managerial and professional supervision. Opportunities to discuss and review the supervisory relationship on a regular basis are key to keeping the working alliance positive, productive and creative. A regular space needs to be created to allow both parties to openly share how they feel they are working together and to check out any issues, conflicts or concerns in relation to their roles, responsibilities and boundaries. The frequency with which this happens is flexible and can be determined by the dyad or group involved. Effective supervision practice is reviewed on a regular and on-going basis (e.g. every 4-6 sessions).

An open discussion about other options would be required if the relationship proved not to be satisfactory by either party. All practitioners, irrespective of level of experience, have a responsibility to explore alternative supervision options if any of their current supervision relationships are not working out or have broken down. Organisations have a responsibility to ensure that there is a process in place whereby the supervisee and the supervisor can address issues regarding supervision with a different senior member of staff if required.

Development in Supervision

Both managerial supervision and professional supervision are important at all stages of your career without exception. HCPC “recognises that a registrant’s scope of practice will change over time and that the practice of experienced registrants often becomes more focused and specialised than that of newly registered colleagues” (HCPC, 2013, p.4). In support, RCSLT acknowledges that the intensity of supervision required will change as an SLT develops their expertise or goes through transitional periods (e.g. moving from Band 7 to 8; returners to practice). See section on frequency for more information.

This section will consider the development of supervision at different career points:

1. student SLTs
2. NQPs
3. SLTs through their career
4. returners to practice
5. Support workers

Student speech and language therapists

As a student studying to become a professional in a regulated profession, you have certain responsibilities. You must adhere to the HCPC guidance on conduct and ethics for students in any issues relating to supervision (HCPC, 2016a).

Experiences of supervision as students and NQPs will directly influence attitudes towards, beliefs about and commitment to regular supervision in the long term. Consequently, it is important for all student SLTs to receive good quality supervision from the outset of their professional careers.

To this end, it is essential that student SLTs are given information on the different functions of supervision the roles of supervisor and supervisee and the supervisory process during their pre-registration education. This needs to include clear guidance on how to make best use of supervision, how to ensure that NQPs access quality supervision regularly and the range of issues addressed in this document.

There are areas of overlap between how students are supervised while on placement, and how NQPs use supervision. There are also important differences, primarily around the fact that while on placement, the student is undergoing pre-registration assessment.

Newly-qualified practitioners

This section outlines the additional recommendations on supervision and support for NQPs and refers to the supervision requirements for the completion of the RCSLT NQP competency-based transitional framework (RCSLT, 2007).

It is strongly encouraged that all NQPs consider the importance of managerial supervision, professional supervision and professional support when applying for their first post. It is also vital that managers and employers recognise their role and responsibility in ensuring all NQPs access both forms of supervision and professional support.

Speech and language therapists through their career

(including developing and specialist SLTs, SLT managers, SLTs working in public health and education)

Although supervision is strongly associated with training at a pre-qualification level, it is equally relevant to qualified SLTs at all stages in their career as it plays a central role in the maintenance and on-going development of their knowledge, skills and practice.

As all SLTs develop and diversify in terms of area of specialism and roles, their supervision needs to change. They will not only require different approaches to their own supervision, they will also take on the role as a supervisor in relation to other SLT and non-SLT staff.

Development in supervision has been written about extensively in the literature identifying four levels to the supervisory relationship, each with its own unique features (Stoltenberg & Delworth, 1987)

• Level 1: Childhood – Novice
• Level 2: Adolescence – Journeyman
• Level 3: Early adulthood – Independent craftsman
• Level 4: Full maturity – Master craftsman

Over the course of their career, a supervisee typically moves from a position of high dependence on the supervisor to more autonomy, self-awareness, self-confidence and flexibility. At this later stage, supervision is not viewed so much in terms of acquiring more knowledge, but in terms of allowing knowledge to be deepened and integrated.

In terms of the role of the supervisor, s/he needs to transition from providing a clearly structured, supportive learning environment to offering a more collegial relationship with a focus on listening to deeper meanings and wider implications.

This progression is not always linear for every practitioner. They may find themselves at different levels at different times in relation to different aspects of their role. Equally, they can find themselves moving back a level or two at significant transition points (e.g. when they take on a new position or role).

Returners to practice

HCPC returning to practice requirements apply to anyone who has not practised for more than two years (HCPC, 2012). This is the case whether you are unregistered and want to apply for re-admission, or whether you are still on the register but not practising.

These returners are required by HCPC to undergo a period of updating knowledge and skills. This period of updating varies from 30-60 days depending on the length of time out of practice and can be made up of any combination of supervised practice, formal study or private study.

‘Supervised practice’ is practising under the supervision of a registered professional, either as an SLT or as an SLTA. In order to complete a period of supervised practice, you need to identify a supervisor. According to HCPC your supervisor must (ibid, p.4):

• Be on the relevant part of the HCPC register;
• Have been in regulated practice for at least the previous three years; and
• Not be subject to any fitness to practise proceedings or orders (i.e. they must not be cautioned, or subject to ‘conditions of practice’).

Speech and language therapy support workers

• Supporting the development of individuals in line with personal need and service requirements.
• Ensuring consistency and quality in the delivery of services.
• Helping individuals to meet statutory obligations.
• Ensuring clarity about roles and expectations.

Professional supervision must be provided by the registered practitioner working with the support worker and must include consideration of:

• The level of experience and understanding of the support worker relevant to the task being delegated.
• Assessment of the support worker’s competence relevant to the delegated task.
• The complexity of the delegated task(s).
• The stability and predictability of the client’s health status.
• The environment or setting in which the delegated task is to be performed and the support infrastructure available.
• Availability of and access to support from an appropriate registered professional.

This may incorporate elements of direction, guidance, observation, joint working, discussion, exchange of ideas and co-ordination of activities, but the overarching three functions of supervision need to be maintained.

An identified process for recording all supervision and professional support needs to be agreed by all parties. An identified process for regular review and evaluation of the support workers performance is essential.

If for any reason a support workers designated supervisor is not able to provide the agreed level of supervision (e.g. maternity leave, long-term sickness), another state-registered SLT must be assigned to supervise as soon as possible. When the supervising therapist is absent from a setting where the support worker is working, there must be an identified contact in case of query or emergency.

Challenges

Some practitioners will not have easy access to the robust departmental structures and systems in place in larger practices and organisations, in relation to managerial supervision, professional supervision and professional support.

Unique challenges can include:

• The managerial and professional supervisor is the same person.
• The managerial supervisor is not an SLT.
• Less choice of supervisor as the department/team is small.
• Practitioner is the only SLT.
• Practitioner is working within the department for a short, defined period of time.
• Demands of working across large geographical areas in isolation, and often being the sole therapist.
• The demands of working across specialisms.

Working with these challenges requires the practitioner to be self-reliant and proactive in accessing regular managerial and professional supervision and professional support in order to adhere to HCPC requirements. They may also need to be creative and consider different forms of supervision.

This section aims to consider some of the alternative options available for SLTs:

• Working independently.
• Outside of a departmental structure.
• On a temporary basis (short-term contracts, bank staff and locums).
• In rural, remote or isolated settings (lone working).

The annual system of RCSLT registration and the HCPC personal declaration that each practitioner makes to confirm that all HCPC standards are being adhered to offers all SLTs a regular opportunity to reflect on their individual performance needs and CPD. SLTs working independently, outside of a departmental structure or on a temporary basis need to consider the full breadth of supervision and professional support available to them:

Managerial supervision

Alternative options include negotiating and agreeing managerial supervision:

• From a local NHS service.
• Through an employing independent organisation, if one exists.
• With a line manager who is another allied health professional or health professional.
• By accessing regular, paid, external, independent supervision.
• Through local ASLTIP groups, which aim to foster supervisory links, as well as peer or group opportunities to assist in objective setting and reviewing of personal development goals.

Professional supervision

Alternative options include negotiating and agreeing 1:1, peer or group professional supervision with:

• A local NHS service.
• An employing independent organisation, if one exists.
• An external independent supervisor.
• Through local ASLTIP groups, which aim to foster supervisory links as well as peer or group opportunities.
• A therapist identified through a CEN.
• A therapist working in another similar context with more experience.
• A specialist therapist working in a similar field.
• A specialist therapist working in a different area of specialism with experience of offering supervision.
• A local independent organisation.

Professional support

Alternative options include:

• Access to colleagues and MDT members working in the same organisation or locally.
• Access to colleagues working in a similar field either face-to-face or via telephone and video conferencing.
• Access to peers through RCSLT hubs, local ASLTIP groups or CENs
• Buddying.
• Shadowing.
• Joint working.
• Access to RCSLT advisers.

The aim is for all practitioners to reflect the systems in place in the NHS, as far as possible.

RCSLT does not recommend that NQPs work in independent practice, in independent organisations, as locums or undertake bank work during their transitional period without having confirmation from their employer that a line management structure is in place, and that they will receive professional supervision from an HCPC-registered SLT who also has certified membership of RCSLT in accordance with best practice guidance. NQPs working in an environment where there is not a speech and language therapy team require supervision to be bought in from the NHS, or an independent supervisory service.

In the event that external supervision is accessed, a three-way contract involving the therapist, supervisor and the organisation is required. This includes the need to clarify the roles, responsibilities, expectations and authority of all parties from the outset.

Key issues when supervising within, for, or when paid for by an organisation include:

• Responsibility and accountability for the work and lines of communication between all parties.
• The role of the external supervisor in a consultative capacity (e.g. if the supervisor hears things in supervision that are cause for concern).

Every supervisor is responsible for learning about and taking account of the different protocols, systems and processes that pertain to the different working contexts and cultures of their supervisees, not least because of implications for employment law. In addition, it is important that a supervisor demonstrates knowledge of individual differences with respect to gender, race, ethnicity, culture and age and understands the importance of these characteristics in supervisory relationships.

National Policy

• Providers must meet supervision and leadership requirements, in order to meet the skills required to support the needs of service users.
• Training and development needs should be evaluated at the start of employment and at regular intervals through the course of employment.
• Staff must be supervised until a level of competence is reached by which they can work unsupervised.
• Regular, ongoing supervision should be received throughout the period of employment.
• Staff should receive a regular appraisal of their performance in their role.
• Providers must not act in any way that limits or prevents access to further training that would enable the employee to fulfil their role.
• Where registration to a professional body is a requirement of the role, providers must ensure staff are able to meet the requirements of the professional regulator.

Support and supervision requirements of nurses, midwives and allied health professional staff across the NHS Career Framework for Health, Levels 5-9 (2013)

This post-registration framework includes a breakdown of the supervision requirements at different levels of career progression.

Staff Governance Standard: A Framework for NHS Scotland Organisations and Employees (2012)

This document sets out what each NHS Scotland employer must achieve in order to continuously improve, in relation to the fair and effective management of staff, including ensuring that all staff are appropriately trained and developed (pp. 8-9).

NHS Education for Scotland: The Knowledge Network: NMAHP: Supervision: Supporting Learning Environments – contains examples and tools for implementing supervision effectively.

Care Council for Wales (2012): Supervising and appraising well – a guide to effective supervision and appraisal for those working in social care.

NHS Wales (2017): All Wales Safeguarding Children Supervision Strategy.

Regional Supervision Policy for Allied Health Professionals (2014)
This document outlines the Allied Health Professions Policy on supervision and support for AHP staff working in Health and Social Care Trusts in Northern Ireland.

Improving Health and Well-being Through Positive Partnerships: A Strategy for the Allied Health Professions in Northern Ireland, 2012 – 2017 (2012).This strategy focuses on the roles and responsibilities of the AHP workforce at all levels and how these can be developed to enhance the planning and delivery of AHP practices that support the health and social well-being of the population of Northern Ireland. It includes an action of ensuring that “appropriate induction, preceptorship and supervision are in place to support transitions along the career pathway” (p. 53).

Quality 2020 (2016).

A 10-year strategy designed to protect and improve quality in health and social care in Northern Ireland.

Supervision Policy, Standards and Criteria: Regional Policy for Northern Ireland Health and Social Care Trusts (2008).

This policy sets the framework and minimum standards for Health and Social Care Trusts to implement an effective and consistent approach to child care supervision

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