Supporting and Escalating Concerns in Clinical Learning Environments during Covid-19

Health Education England is stopping all routine education quality activities during the Covid-19 pandemic. Information on this can be found here. However, our focus remains on the quality of the clinical learning environment and its impact on the safety of learners and patients. We recognise the need for all healthcare learners and Directors of Education to be able to raise and then escalate concerns if they feel either their own or patient safety is at risk.

We recognise that during this unprecedented and challenging time, ‘normal’ expectations around learning environments may not be fully met as set out in HEE’s Quality Strategy and Framework (for example, timetabled release to attend teaching sessions). However, as a minimum, HEE expects all learners to receive sufficient induction and supervision to ensure learner and patient safety. Learners and those responsible for them should therefore be asking:

  • Has a basic orientation to the workplace taken place (e.g. location of fire escapes, key clinical equipment, rest facilities, patient rooms)?
  • Is there access the necessary systems (e.g. Log-ins for IT access, for test results, scans etc.)?
  • Have learners received mandatory training relevant to their role (e.g. Basic Life Support, Advanced Life Support, Advance Trauma Life Support, Safeguarding, Infection Control)?
  • Are learners being asked to undertake tasks beyond their level of competence/training or which they do not feel confident to undertake?
  • Do learners have access to appropriate clinical colleagues who can provide clinical supervision/support and advice when they need it? (e.g. nurses, specialty doctors, peers)?
  • Do learners know who to notify (and how) within the ward area/ department/organization if they have concerns?

Each organisation will have policies that enable its staff to raise and escalate concerns and HEE would encourage healthcare learners to raise any concerns in this way in the first instance, particularly if the above minimum requirements are not being met. However, it is important that, during this time of intense pressure on NHS services, HEE also continues to enable learners to provide feedback on the clinical learning environment.

At this time, the following process is advised:

COVID wellbeing 3 step image

All trusts have Freedom to Speak Up Guardians in place and they will be available during this. Learners should be satisfied that they have received an adequate response to their concern.

Local office contacts are below:

East of England 
East Midlands 
West Midlands 
North East England 
North West England 
Yorkshire & Humber 
Kent, Surrey & Sussex 
Thames Valley 
South West 

This process does not replace Serious incident Reporting procedure in trusts and local processes should be followed for serious incidents.

Further advice and guidance in relation to education and training within the context of the Covid-19 pandemic, which is continually being updated, can be found via the professional regulatory bodies websites, including the GMC, NMC and HCPC.