Local Supervising Authority
Supervisory Investigation Report
Midwife Firstname Surname
(Separate report for each midwife)
NMC PIN:
Report written by –
First name Surname
Supervisor of Midwives appointed to
Date of final submission to LSAMO:
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Local Supervising Authority
Contents page
Contents page.................................................................................................. 2
Section 1 – Summary of concern/incident ………………………………………..3
Section 2 – Midwife personal details (EACH MIDWIFE TO HAVE A
SEPARATE REPORT) ..................................................................................... 6
Section 3 - Supervisory investigation report ..................................................... 8
Recommendation to the LSA ........................................................................ 11
Appendix 1 – Chronology of LSA investigation process followed…………. 14
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Section 1 – Summary of concern/incident
1.1 Summary of the case
Short description of incident(s)
(There may be more than incident that needs description. Use initials for the mother
and the baby and include case records identifier).
Hospital number mother –
Hospital number baby –
Exact date(s) & Time(s)
Location of where incident
Name of ward/area
Address
Location where incident occurred
Witnesses:
List all staff involved and their job titles and include their contact details
Name
PIN number
Job Title
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Contact Details
1.2 Facts of the case with SoM review against best
practice standards
Detailed chronology of clinical care (timeline)
Guidance
(For each period if all the care met current best practice standards then a
detailed chronology is not required. For example antenatal care no concerns
identified.)
Date Chronology
&
time Summary of midwifery clinical assessments undertaken
Antenatal
Intrapartum
Postnatal (MOTHER)
Postnatal (BABY)
Other incidents
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Supervisor of Midwives
critique of care with
good practice any
concerns identified
1.3 Investigation of the facts
(list all documents reviewed as part of this investigation)
Maternity Records
Tick all that apply for this
investigation
Antenatal records
Labour and delivery notes
Midwifery and clinical notes
Vaginal examination forms
Partogram
CTG traces
Postnatal records hospital
Midwifery postnatal notes
Infant record
Test results
Haematology
Blood gas analysis
Microbiology
Serology
Imaging – antenatal ultrasound
Drug prescription and IV administration
sheets
Discharge summaries
Root cause analysis investigation report
List any other document below:
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Section 2 – Midwife personal details


Complete/check with midwife at interview
Each midwife to have a separate report
Name of Midwife:
Date of Birth:
NMC PIN:
Date of registration:
Date of annual payment due:
Date of Intention to Practise (ItP):
Month/Year 3 yearly Notification of Practice due:
Home address:
Post Held:
Band:
Place of Employment:
Work address:
Place of midwifery education / training
Date training completed:
Relevant brief employment history:
Page 6 of 21
Relevant supervisory history:
[This includes any previous investigations, previous concerns about practice, PREP. The
named SoM to submit a formal report to this effect].
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Section 3 - Supervisory investigation report
(The standards that the NMC upholds and requires of midwives, and which the public
is entitled to expect, are set out in:-

The Code: Standards of conduct performance and ethics (NMC 2008),

Midwives rules and standards (NMC 2012)

Record keeping: Guidance for nurses and midwives (NMC 2009)

Standards for medicines management (NMC 2007)

Raising and escalating concerns: Guidance for nurses and midwives
(NMC 2009)

Standards for pre-registration midwifery education (NMC 2009)

The PREP handbook (NMC 2011)
4.1 Area of commendable/notable practice identified
List areas of commendable/notable practice identified
Link to NMC Standards
Evidence (maternal record/witness statement/ interview records)
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4.2 Areas of concern
(If you have identified that a midwife has failed to do something then you also need to
demonstrate that there was an obligation for that to happen)
Alleged area of concern identified
[State the concern and why it is important].
Link to NMC standards The Code/Midwives Rules
A midwife must be capable of meeting the competencies and essential skill
clusters set out in Standard 17 of Standards for pre-registration Midwifery
education (NMC 2009) that are within her scope of practice.
Evidence (clinical records/account of events/ interview records)
Review of facts
Records that support the allegation
 What standard did the midwife fail to uphold and where is the evidence
to support the allegation?

What was the standard of care that you would expect from a
reasonable responsible midwife?
Assessment of continuing fitness to practice
Interview – discussion of conduct and competence and any mitigation
Learning needs identified
(Was this a competence issue (knowledge/skills) or was this misconduct)?

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Mitigation
Mitigation
(Consider previous history, reflection, insight and practice of the midwife)
Human factors identified
(Identify if – ill, hungry, angry, late, tired stressed and impact on workload)
System delivery problems identified
Governance problems identified
Repeat this section for each area of concern
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Recommendation to the LSA
Recommendation to Local Supervising Authority:
In summary
On consideration of all the facts and evidence, it is my recommendation at the end of
this investigation, that for this midwife

There should be no further action as evidence was found that NMC
standards had been upheld at all times.

There should be a local action plan (for minor mistakes) as there was
evidence that NMC Standards were not upheld but this could be remediated
with named Supervisor of Midwives.
The suggested learning outcomes should include:o

There should be a Local Supervising Authority Practice Programme as
assessment and development of the midwife’s practice is required as NMC
Standards were not upheld consistently.
The period of the programme should be for
maximum 450 hours).
hours (minimum 150
Suggested learning objectives/outcomes should include:o

There should be a referral should be made to the Nursing and Midwifery
Council and the LSA should consider whether to suspend the midwife from
practice.
Process for appeal
The midwife may appeal any recommendations made and can do so in writing
to the LSAMO within 10 days of receipt of this report.
Investigating SoM Name: ………………………………………………………………..
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Signature:…………………………………………………..………...
Date:………………………………..……………………….……..
Date report agreed…………………………………
LSAMO name…………………………………
Signature…………………………………
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Appendix 1
Chronology of LSA investigation process followed; this is the master process document for the
investigating SoM.
All supervisory activities and delays such as extra interviews, email contacts, annual leave, sickness must be recorded at the step
in the process it occurred. This should be done by adding in an extra row and detailing: Date; Event; SOM Commentary and
Appendix (reference to documents e.g emails, letters phone calls, texts).
Investigation process steps
Outcomes for each step
Supporting documents
and information
This process has been written to meet with the NMC LSA
standard 1.1 “LSAs must provide for an open, transparent fair
and timely processes that stand up to external scrutiny”
Stage one - setting up the investigation
Step 1 Inform the LSA/LSAMO via the LSA database that a
supervisory investigation is being undertaken.
You may in addition contact the LSAMO by email/phone to
discuss the incident and the plan for the investigation.
Terms of reference may need to be written if there are several
serious incidents or if the investigation is complex.
The LSA must monitor the progress of all current investigations
as this is reported to the NMC on a 1/4rly basis.
Step 2 Investigating SoM to establish a chronology of all key
investigation events (dates letters sent, dates advice sought
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LSA database completed
Link to database
Date:
http://www.midwife2.org.uk/
Name in full:
Sign:
Read guideline and have
available
SoM must use LSA
procedures for investigation
Investigation process steps
Outcomes for each step
This process has been written to meet with the NMC LSA
standard 1.1 “LSAs must provide for an open, transparent fair
and timely processes that stand up to external scrutiny”
etc.).
and follow all the steps
The aim is to complete the investigation within 45 working days
(this means that the final report should be with the LSAMO
within 30 working days).
http://www.lsamoforumuk.sc
ot.nhs.uk/guidelines.aspx
Step 3 Inform the employer of the need to initiate a LSA
Name of line manager:
investigation. The aim of the letter is to discuss any practice
concerns with the employer who, after discussion with the SoM, Date of meeting:
must consider whether continuance at work is appropriate.
Follow up letter/email sent
date:
Record actions taken:
Step 4 The LSA has a duty to ensure that investigations are
properly resourced. The SoM should negotiate protected time
and should inform the LSAMO if resources are an issue.
Supporting documents
and information
Number of days
negotiated =
Stage two - collecting the evidence
Step 5 Review documentation and gather information and
relevant facts (records, incident forms, clinical guidelines, off
duty rotas etc.).
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Investigation process steps
This process has been written to meet with the NMC LSA
standard 1.1 “LSAs must provide for an open, transparent fair
and timely processes that stand up to external scrutiny”
Step 6 Commence an incident timeline of key events.
Outcomes for each step
Supporting documents
and information
Incident time line
commenced date:
Section 2 of this report

Establish the facts through various means of data
collection starting with the medical records.
• Compile a time line of the key clinical events
• Establish from the time line the critical factors that may
have impacted on the outcome (care delivery problems
or service delivery problems).
• For each of the critical factors establish immediate and
root causes and prepare any questions that you may
wish to ask the midwife at interview.
Step 7 Inform the midwife (and named SoM) in writing of:a. The issues/concerns that are being investigated.
b. The need to complete a factual account of events that
provides any additional information that is not included
within the clinical records. This should be provided
before the interview but receipt of this should not delay
the interview.
c. A suggested date for the investigation interview.
d. Where she can obtain a copy of the LSA investigation
process.
Time line complete date:
Interview schedule
commenced:
Date letter sent:
Confirm copy sent to named
SoM:
website:
http://www.lsamoforumuk.scot.nhs.uk/guidelines.aspx
e. The potential recommendations/outcomes following an
Page 15 of 21
Template letter step 7
Upload letter to LSA
database
Investigation process steps
Outcomes for each step
This process has been written to meet with the NMC LSA
standard 1.1 “LSAs must provide for an open, transparent fair
and timely processes that stand up to external scrutiny”
investigation.
Step 8 (see guidance in Appendix 1)
Consider whether it is appropriate to inform the woman (or her
family) that an investigation is underway and then obtain an
account from the woman if appropriate.
Please ALWAYS contact LSAMO prior to contacting the
woman or her family.
Contact LSAMO date:
The SoM team may want to identify a separate SoM to act as
the “family liaison” after identification of the serious incident to
provide them with support.
Name of SoM family liaison:
Actions taken:
If the clinical records are going to be sent to the NMC the LSA
must seek permission from the family before sending them.
Guidance for named SoM to support midwife under
investigation
The LSA advise that the named SoM:1. Makes initial contact with the midwife to offer support
and to set up a meeting.
2. Meets with the midwife to discuss the incident, to assist
with writing a factual account, to identify any
development needs (it is suggested that the named
SoM develops a draft action plan and takes a copy to
the investigation interview).
3. Make sure the midwife understands the investigation
Page 16 of 21
Supporting documents
and information
Investigation process steps
Outcomes for each step
Supporting documents
and information
Dates and names of any
persons:
1.
2.
3.
4.
Template letter step 9
This process has been written to meet with the NMC LSA
standard 1.1 “LSAs must provide for an open, transparent fair
and timely processes that stand up to external scrutiny”
process.
4. Attends the investigation interview with midwife as
support.
5. Assists with making sure any identified development
needs are met.
Step 9 (see guidance in appendix 2)
Request a factual account of events from any other relevant
individuals involved (Dr’s, nurses, paramedics and maternity
support workers).
Step 10 Inform the LSAMO and midwife if there are any delays
over the investigation 45 day period.
Date LSAMO informed
Date midwife informed
Actions taken:
Step 11 Prepare a schedule of questions to discuss with the
midwife at interview.
Step 12 (see guidance in appendix 3)
Interview(s) with midwife/midwives.
LSAMO will review draft
questions if requested.
Date of interview:
Page 17 of 21
Upload to database
Investigation process steps
Outcomes for each step
Supporting documents
and information
Date interview notes sent:
Upload to LSA database
This process has been written to meet with the NMC LSA
standard 1.1 “LSAs must provide for an open, transparent fair
and timely processes that stand up to external scrutiny”
The aim of the interview is to gather facts relating to the
incident in order to assess the competence and conduct of the
midwife.
.
Step 13 Compile interview notes and send to midwife for
agreement and signing for accuracy (or send digital recording
to midwife if used).
The Investigating SoM should agree with the midwife the
process by which she wishes to receive feedback and
recommendations from the investigation.
Stage 3 – conclusions
Step 14 Review and analyse all factual information and decide
whether the investigation is complete. The SoM may want to
interview the midwife a second time if additional information
has become available or if points need to be clarified.
Start to formulate conclusions.
The SoM should consider seeking external professional advice
if health issues have been identified (occupational health
assessment).
Step 15 Complete the investigation report and outcome
summary letter/report within 30 working days and send to the
Page 18 of 21
Investigation process steps
Outcomes for each step
This process has been written to meet with the NMC LSA
standard 1.1 “LSAs must provide for an open, transparent fair
and timely processes that stand up to external scrutiny”
draft to LSAMO (allow time for LSAMO to review and return
report).
The LSAMO should review the process of the investigation and
recommendations made and assess whether they are
proportionate. The aim of the investigation is to assess
continuing fitness to practise. LSAMOs play a major role in
managing the threshold at which cases are referred to the
NMC.
(Reports must be sent from secure email account)
The LSAMO must agree the final version of the report before it
is sent to the midwife.
Step 16 Agree the final report recommendations with LSAMO
and also all recommendations made within the outcome
summary letter/report to the provider organisation.
Step 17 At interview the Investigating SoM should have agreed
with the midwife the process by which she wishes to receive
feedback and recommendations from the investigation. The
midwife also needs to be informed in writing of any
recommendations and the process for any appeals.
Step 18 If involved, the SoM must inform the family of the
recommendations made on conclusion of the investigation. The
investigation report is the property of the LSA and the SoM
Date for meeting:
OR
Date report sent:
Date:
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Supporting documents
and information
Investigation process steps
This process has been written to meet with the NMC LSA
standard 1.1 “LSAs must provide for an open, transparent fair
and timely processes that stand up to external scrutiny”
must discuss with the LSAMO what reports are to be made
available to the woman and her family as the midwife has a
right to confidentiality.
Step 19 Record completion of the LSA investigation on the
database.
Step 20 Send an outcome summary letter/report to Head of
Midwifery (HoM) and Director of Nursing (DoN).
Outcomes for each step
Comments:
Date:
Date:
This letter/report must include the service and organisational
contributing factors and any changes that the investigating SoM
perceives should be implemented as action plans should be
developed.
Good/notable practice should be identified within the outcome
summary letter.
The LSA must inform the HoM/DoN if other health care
regulators are going to be informed of concerns identified.
Step 21 In order to take the supervisory recommendations
forward the investigating SoM, Midwife and Named SoM must
meet and agree the learning objectives/outcomes (Local action
plan or LSA Practice Programme).
Step 22 The LSA, through the local SoM team, will follow up
whether systems and/or governance actions/recommendations
made are implemented in a timely way.
If LSAPP recommended
date set to discuss with
midwife:
List actions that need to be
followed up:
Page 20 of 21
Supporting documents
and information
Page 21 of 21