Recruitment has always been an issue for the care sector and it is likely to endure. The sector forecasts a shortage of 350,000 workers by 2028 assuming no significant changes are made. In reality, slow but steady technology improvements, provided the funding emerges, will chip away at this number. In the short-medium term, though, it will continue to be a problem.
It isn’t hard to detect the sources of the problem. Social care is mostly hard, unglamorous work for relatively poor pay, similar to other sectors such as hospitality. One think tank estimated that as many as half of the social care workforce may be being paid below the real living wage. In an era where young people are constantly comparing and contrasting each other’s lives using social media, spending your days caring for older people is unattractive. Even the potential for quick promotion due to the talent shortage is not enough to counter-balance this fact.
With funding pressures unlikely to be quickly alleviated, wages in the sector are unlikely to increase. The only structural factors that may have a positive effect on recruitment in the sector, ironically, would be an economic recession, releasing excess labour into the market. Unless there is significant economic pain following Brexit, this also seems remote. The job market, despite the problems in retail, has performed well in recent years. Brexit, depending on what deal is reached, may also reduce the ability of providers to source carers from EU states.
Larger care providers, of course, have the resources and freedom to be able to innovate with their recruitment. One provider is planning make more use of social media and capitalising on the real experiences of carers to spread its message. Skills for Care has been discussing the possibility of creating a clearer career pathway for carers, although this feels unlikely to seriously shift perceptions. For smaller providers, it looks like the challenge is going to remain.
2018, as well as an increased emphasis on mental health across all ages, saw numerous campaigns on loneliness among Britain’s older population (and to a lesser extent, in its young people too). Many of those older people who are lonely, of course, are not the types to be on social media campaigning themselves. Change has to come from specialist groups and volunteers.
Loneliness is a real problem. Age UK estimates an incredible 3.6 million older adults live alone, 2 million of which are over 75. They claim that this loneliness can be as damaging to their health as smoking 15 cigarettes a day and more harmful than obesity. The implication is a simple one: if we can put so much resources and attention on reducing smoking and obesity, why can we not do the same to combat loneliness?
It does not take a big leap to see how this impacts on social care. Lonelier adults are more likely to have poor health outcomes and to see their physical and mental condition decline, pushing them into social care. Creating a more social environment for these people would therefore have a big preventative effect, potentially reducing the burden on the health and social care system.
What can the sector and the government do about this? At the moment, the social care sector has no incentive to tackle loneliness. Its funding is based on those it helps, not on those it keeps out. The government is likely to support volunteer projects led by groups such as Age UK with grant funding and possibly facility access. Either way, expect more pressure from the third sector on the issue.
Reablement is becoming an increasingly hot topic in the health and social care sector. As budgets continue to come under pressure, reablement offers a way to reduce costs for councils whilst maintaining peoples’ independence.
In 2018, we released an ebook that covered the basics of reablement. We have now produced this in a blog format so that you can easily find out the information you need on this topic. You can still download our PDF ebook for free, though, if you prefer.
What is reablement?
Sometimes, when people experience a sudden deterioration in their health or physical condition, they need help to adapt so that they are able to maintain independence and live full lives. This help, usually short and intensive, is called reablement.
Reablement is becoming increasingly important for people and for society overall. As health and social care costs increase, the focus for services is to encourage people to live independently in their own homes for as long as possible. Technically speaking, reablement is a form of ‘intermediate care’, which is a type of short-term support from health and social care services. Intermediate care as a whole is designed to encourage independence and prevent unnecessary hospital or care services admissions.
The remaining three types of intermediate care are:
Crisis response – By definition, an assessment and short-term care that typically lasts 48 hours or less, and is designed to prevent a trip to hospital or a care facility.
Home-based intermediate care – Services provided in a person’s own home or in their care home.
Bed-based intermediate care – Services delivered in a hospital or care home.
Who can receive reablement?
Reablement is designed for people who have had a sudden change in their physical condition. They may have become disabled, suddenly frail from an illness, or they may be recovering from an accident. Reablement helps them perform normal, daily activities that we may take for granted, such as getting around the house, washing themselves or cooking. This may mean helping them adapt to their new physical condition and state of health, or relearning skills.Who exactly is eligible for reablement depends on the local authority.
Since one of the aims of reablement is to reduce costs to local services, resources tend to be targeted at people who are most likely to benefit physically from reablement. This means that individuals with severe mental illnesses, degenerative diseases, or who are receiving end of life care, are less likely to receive support. GPs or other health services can also refer people for reablement services.
Benefits of reablement
Many people benefit from reablement: the people using the service, their families, and their wider community.
The Social Care Institute for Excellence (SCIE) claims that reablement is typically welcomed by people receiving support, and they experience greater health and social care outcomes compared with those using home care. Their quality of life tends to be better, and their physical condition is more likely to improve.
Although we tend to talk of independence in terms of its benefit to local services, there is also the underestimated impact on the individual. Many people don’t like asking for help, and transitioning from being independent adults to being at least partly dependent on carers or family can be incredibly difficult.
Reablement allows these people to retain their pride and dignity. This means that their personal relationships are likely to be stronger. Although many families help members who are struggling physically, it can sometimes place strain on their relationships. Maintaining a person’s independence helps them, in turn, maintain strong relationship with their family, their friends and their local community. This prevents social isolation and loneliness.
The reablement process
Assessment: Reablement starts with an assessment, usually by a healthcare professional, of whether a person may benefit from it. The assessment will take into account factors such as the person’s mobility, what skills they still have, their physical strength, and their ability to perform basic tasks such as cooking and washing.
Frequent, longer visits: The purpose of reablement is to help a person very quickly become independent once again. This means that reablement workers may make frequent visits, but it also means they are less likely to intervene in the performance of tasks than a traditional care worker. They are more likely to observe and encourage, only taking over or helping directly when necessary. These visits are therefore likely to be longer than normal care visits. Workers may be specifically trained in reablement, but they may also be physiotherapists or occupational therapists.
More assessments: Reablement workers aim to help a person regain their independence as quickly as possible. They will assess often to determine when the person no longer needs support.
Adjustments or Equipment: The reablement workers, or an occupational therapist, may recommend that adjustments be made to a person’s home or that assistive aids be introduced to help them remain independent. Such aids may include a stairlift or support bars in the bathroom.
Forward Planning: If done properly, the planning for what happens after reablement ends should begin at the very start of the process. This planning will involve healthcare professionals, the reablement workers, the individual receiving support, and any family or friends who may be involved in any ongoing care and treatment.
The impact of reablement
Reablement has been an active policy since 2010. SCIE have reviewed the impact of reablement across numerous independent and official studies and have found that it has had an overall positive effect. They concluded:
Reablement is becoming a ‘default’ service whenever needs are identified, rather than just being available to those leaving hospital.
63% of reablement users no longer need the service after 6-12 weeks.
People and families appear to have welcomed reablement. People in the study seemed to have been particularly pleased with the speed of the service.
Reablement is proving likely to be cost-effective by reducing long-term care costs. Although the upfront costs are higher (on average £2000 for reablement compared to £1,392 for 6 weeks of home care), 26% of users had a reduced need for home care hours after going through the process. The overall need for care services is reduced by 60%.
Nevertheless, some issues were noted. Some people felt that they were not given enough assistance with performing domestic tasks at the start of the reablement process. There was also a concern that some of the reablement ‘ethos’ was lost in handovers between service providers.
SCIE have also noted that the skills required for reablement are very different from those required for traditional care work. For example, reablement staff are required to observe and watch rather than directly intervene, a skill that can be difficult for someone used to helping others. There is also a need for “active reassessment” at every session to track progress and identify need. Reablement workers also require more flexible working practices than is typical, since it’s important that the reablement worker(s) visiting the individual remains consistent. Managers and supervisors need to ensure any staff participating in reablement work have the appropriate training.
Perhaps the most interesting point from SCIE’s research summary, though, is that individuals receiving support need to change their expectations and attitudes if reablement is to work properly: “reablement was considered to be more successful if service users were motivated – ‘people have got to want to do it.” The reablement worker could be crucial here as a motivator, and managers and supervisors may wish to ensure reablement workers have positive outlooks themselves.
The remaining questions
Reablement is a relatively new concept in social care and there are still some questions that require more research. The National Institute for Health and Care Excellence (NICE) released a paper in 2017 outlining some of these questions:
How effective is reablement for people with dementia? Although local authorities are currently less likely to provide reablement services to people with dementia, there is still little evidence or research as to whether those with early stage dementia – or their families or carers – may benefit.
How effective and cost effective are repeated periods of reablement, and reablement that lasts longer than 6 weeks? Although this document has assumed a single period of reablement, there is no technical limit to how often reablement services may be provided to a person. In practice, reablement is only funded for 6 weeks, even if sometimes it is offered for longer and more frequently. Therefore, there are no studies as to whether these extended periods of support are cost effective or deliver better outcomes for the individual.
In our Future of Care Report, we forecast that eventually automation, AI and robotics would help change social care for the better, reducing costs and raising outcomes. Of course, this a long-term trend which is likely to take years.
Health and social care, in particular the NHS, is oddly conservative when it comes to embracing change. In 2018, it transpired that 9 out of 10 hospitals were still reliant on fax machines, a technology most businesses – peculiarly, apart from football clubs – regarded as redundant many years ago. No wonder the government felt obliged to insert into the Care Act 2014 a requirement for health and social care to embrace digital technology.
Anyone who therefore predicts an artificial intelligence or internet-of-things revolution in health and social care in 2019 is therefore not familiar with that fact, nor with the spending pressures within much of the sector. A number of reports have been circulating recently advocated dramatic technological change in the sector. Although these changes reduce costs and improve outcomes in the long-run, they require an initial capital outlay – whether funded from cash, borrowed funds or leased – that all but the biggest providers are simply not capable. Similarly, the introduction of voice recognition and smart home software into older people’s homes may have a very positive impact on their lives, but someone has to pay for it and show them how to use it.
This was, essentially, the conclusion of a 2016 report on IT in the social care sector compiled by the Local Government Association. In it, they made a range of suggestions and recommendations for introducing more technology into the sector to improve financial and care outcomes: remote working for carers, strategic data analysis, greater use of assistive technology, and online portals. The report also highlights some noteworthy examples from councils and other organisations across the country, but some are quite obviously stretching the point. Note, for instance, Rotherham Metropolitan Borough Council’s “holistic” digital strategy, that in reality appears to have little impact on social care. The report’s own conclusion states that “financial challenges experienced by the sector have been significant, with often limited resources available locally to implement many of the solutions highlighted within this paper”. It then quotes the statistic that only “32 per cent of councils strongly agreed that there were adequate resources for technology implementation and change management”.
Digital technology has the potential to have a huge impact on the social care sector, but for now, that impact will be limited to a handful of larger providers. The rest will have to settle for incremental change or their traditional methods.
Click here to read the first installment on our series on funding and the government’s green paper.
2019 is likely to see social care funding remain a top issue for British politics. The sector and the public are both awaiting a much delayed green paper on the issue. It’s likely, however, to disappoint more than it will solve.
The government has been talking of reform to social care in England – including its funding – for a number of years. The 2017 general election saw proposals emerge from all sides of the political spectrum. Arguably, the incumbent’s proposals, which would have seen those in homes valued at more than £100,000 liable for their full care costs, cost them a working majority. These plans, dubbed the ‘dementia tax’ by detractors, were quickly reworked, and then completely shelved.
New plans were touted to appear in the summer of 2018 but they have yet to be published. The indications from members of the team drafting the long-awaited green paper have already said that it is unlikely that free personal care would be on the agenda due to the expense. Indeed, most public pronouncements on the paper have focused on managing down expectations, with one already warning that it is likely to “disappoint” those who want more radical change.
One advantage that the government does have, though, should it choose to use it, is that the growing divergence between the different nations of the UK in health and social care. The current devolution settlement means that Wales, Scotland and Northern Ireland have independent health and social care policies. This means there is plenty of scope for experimentation and the devolved nations could be a ready source of knowledge in what works and what doesn’t. Scotland, for instance, is often held up as a model for deeper integration between health services and social care.
Based on the growing pain in the sector, however, and how these proposals tend to take shape, we can predict that the green paper may include the following:
A commitment to a step-by-step increase in social care funding, although likely to fall well short of the £20 billion promised to the NHS.
Those who can afford it being liable for certain aspects of their social care, similar to how people pay for prescriptions and eyeware on the NHS.
More integration between social care and the NHS, possibly using ideas from Scotland such as ‘integration authorities’, joint planning and monitoring committees.
A focus on preventative measures to keep people out of social care and hospitals, including reablement and home adaptation.
Whatever the result, it is likely to generate controversy from all corners. Social care funding and reform has been a political hot potato for a number of years, but with care providers failing and budgets falling, the government’s hand is being forced.
Whatever the result, it is likely to generate controversy from all corners. Social care funding and reform has been a political hot potato for a number of years, but with care providers failing and budgets falling, the government’s hand is being forced.
The Government published its long-term plan for the NHS this week. We’ve looked at what it means for mandatory, clinical and specialist training for the next decade:
Focus on mental health
There has been a huge emphasis on mental health in the media and in politics in recent times, and this has carried over into the NHS. Mental health training features on a number of occasions. There is a recognition in the plan that certain groups of young people are particularly vulnerable to mental health issues, and it says that teams will receive “information and training to help
them support young people more likely to face mental health issues – such as Lesbian, Gay, Bisexual, Transgender (LGBT+) individuals or children in care”. The plan recognises that “preventative support” is important to help address problems before they have serious repercussions.
The plan also says that ambulance staff will receive training to help deal with people with mental health issues who are “in a crisis”. Some trusts are already doing this, but growing awareness of the scale of mental health problems in the UK and the impact it has on 999 calls means that all ambulance staff will soon be able to help with issues.
Training to improve end of life care
One of the aims of the plan is to “personalise” and “improve” end of life care. This, it says, will mainly be accomplished by training to help staff identify patients’ needs as they head into the final stages of their life. The plan hopes that this will reduce emergency admissions, but the majority of people will see this as a necessary part of a caring modern society.
There is little new about a wish to improve end of life training. Former guidance has included breaking down training into “bite-sized” sessions to build knowledge quickly, as well as role modelling good practice at every opportunity. It will be interesting to see how this new commitment bears out in practice, and whether it will mean mandatory, classroom-based courses for practitioners.
Learning disabilities and autism awareness
The plan states an intent to roll out training in awareness of learning disabilities and/or autism to NHS teams. The plan alludes to a consultation published in 2018, which says that the aim of the training is ultimately to help staff “support people with a learning disability, their families and carers; to ensure that perceptions of learning disability do not prevent a robust assessment of physical health, and that staff can make personalised, reasonable adjustments to care”. The skills and competencies required for this awareness have already been outlined in the Learning Disabilities Core Skills Education and Training Framework.
If this roll-out follow the recommendations included in the consultation, it means that a further consultation on proposals will begin in March this year, as well as an audit on skills in the NHS workforce. The CQC will monitor the uptake of the training from its full introduction.
Dealing with violence
The long-term plan mentions that a programme has already been launched to train staff in how to handle violence. This may include positive behaviour support, de-escalation training, and breakaway techniques. Its inclusion in the plan emphasises that this is a growing problem and such training is here to stay.
Click here to see what courses Advantage Accreditation can support you to deliver.
Advantage is an independent accreditation body. This means that our Awards and the courses of our centres are accredited against national frameworks and standards. Here is a brief overview of what we map all courses, lesson plans, syllabi, assessment materials and other resources against to robustly test quality:
Legislation and Regulation
Most training in the health and social care sector is linked in some way to government legislation or regulation. The starting point for the review of any Award or course is ensuring that the relevant legislation and regulations are discussed, as well as any relevant regulatory bodies. It is important that the impact of the legislation and regulation on individual job roles is highlighted in the course materials so that learners are clear as to how it links to them personally.
Often, the list of any legislation and regulations relevant to any Award or course can be extensive. However, there will typically be two or three specific pieces of legislation or regulation that will be particularly pertinent. Our Curriculum Team checks that these items are emphasised. For example, there are more than twenty pieces of legislation and regulation that effects safeguarding adults in some way, but not all them will be relevant to the target audience of a particular Award or course. On the other hand, there are ten separate pieces of legislation and regulation relevant to the Safe Handling of Medicines that are all important.
National Occupational Standards
The National Occupational Standards are sector-specific standards of the knowledge and skills that workers should have to perform effectively. They are developed by the relevant Sector Skills Council and approved by sector regulators, giving them an official weight.
Advantage uses the Standards to ensure that our Awards and centre courses are meeting the skills requirements for the care sector. With any course submitted for approval, pertinent standards are highlighted and mapped to the course content.
Skills for Care has developed qualification specifications that training should be linked to so that learners can demonstrate career development. We map Awards and courses against these qualification specifications so that learners get the best possible outcomes and so that all necessary knowledge is incorporated.
Skills for Care and Skills for Health also develop additional frameworks to help standardise training and career development in the sector. Examples include the Care Certificate and the Core Skills Training Framework. We map Awards and courses against these frameworks too where relevant.
Different sectors and even areas of specific knowledge have expert bodies that produce guidance. Examples include the Resuscitation Council for CPR and first aid, and the National Institute for Health and Care Excellence (NICE). The interaction between these bodies and organisations such as Skills for Care often means that their guidelines, advice and publications on best practice are incorporated into National Occupational Standards or RQF qualifications, but it is nevertheless important that learning materials are mapped accordingly. This helps ensure that Advantage Awards and centre courses are at the cutting edge and include the latest best practice.
Are you ready to get your own courses accredited or to use our Advantage Awards? Complete our simple, online application form.
Ever since the HSE deregulated (in a manner of speaking) the first aid training market, the number of providers has increased and differentiation has become more difficult. Awarding bodies and accreditation bodies often pitch themselves to first aid training providers as being to help them overcome the competition. But what’s really the case for accreditation? You may find the below useful if you’re a training provider wondering whether to get your first aid courses accredited, or if you’re a consumer looking to see if it’s worth paying the additional cost.
The story so far
In the past, the Health and Safety Executive (HSE) approved first aid training providers. Although the title of the course changed over the years (from Appointed Persons First Aid to First Aid at Work, for example), the importance of the HSE’s stamp of approval was a constant and ensured a quality standard in the market.
After 1 October 2013, however, the HSE ceased approving first aid training providers. The argument from the HSE and the government at the time was to allow organisations more flexibility, but it was also part of a wider shift in regulatory practice of moving the onus on to the organisation itself. It is now the responsibility of organisations to ensure that the training they have received is sufficient and proportionate according to their own risk assessment.
The situation now
The HSE no longer approves first aid training providers. Instead, it has criteria that it recommends organisations look for when choosing a provider. The criteria includes:
That the trainer has an appropriate qualification
An organisational quality assurance scheme to monitor training delivery
Able to produce accurate certificates
Appropriate course content
Technically, there is nothing that forces organisations to adopt this guidance. The issue only emerges when there is an inspection by either local enforcement agencies or the HSE itself and the organisation must demonstrate that the training is appropriate. However, the number of proactive visits carried out by such bodies has plunged by nearly 70% since 2010, meaning most inspections only occur after an accident or complaint. There are a good number of organisations who are happy to play the percentages.
Why get your first aid training accredited?
So, in that context, why should first aid training providers seek to deliver a regulated qualification or seek accreditation?
1. Rising above the competition
Deregulation meant that the number of smaller training providers increased. Plimsoll has consistently said that the market is either stagnant or growing by very small amounts, but this is only half the story. Plimsoll only looks at the sales revenue of registered companies. The reason that the sales of those companies is falling or flat, however, is because of the large number of sole traders and unregistered providers who have begun to offer their services. This may explain why, in the detail of their report, you will see that the very small – insurgents with little overhead – and very big providers – with recognised brands and marketing power – are growing, whilst the middle-ranking providers are being squeezed.
In other words, first aid training has effectively become commoditised, meaning differentiation has become more and more important. Demonstrating that your courses are of a high standard that you are a reputable provider could be the difference between sales growth or slow decline.
2. Making clients’ lives easier
Although some organisations will seek shortcuts, many will want to ensure that their staff are trained to suitable standards. A small business owner reading the HSE’s criteria may therefore panic about checking that their chosen providers meets all of the best practice checklist.
An accreditation scheme helps make their life easier. If your training is accredited, it gives comfort to prospective clients and makes choosing you as their provider just that little bit easier.
3. The HSE criteria
Unfortunately, incidents do occur and the HSE or other bodies do have to investigate. In those scenarios, the business will need to demonstrate that it chose its first aid training provider in good faith, and the provider will need to show that its product is fit for purpose.
The easiest way to do this is to meet the HSE’s own criteria, which recognises that some providers “operate under voluntary accreditation schemes (including trade/industry bodies)”. Accreditation of your first aid training will help with all the HSE’s criteria, but there are two elements of their checklist that it can particularly help with.
Is there a quality assurance system in place to monitor the quality of training? Many organisations will be too small and too busy to spend vast amounts of time preparing quality policies and carrying out quality visits. An accreditation scheme will either provide that system for you, or help you to put yours in place.
Is first aid taught in accordance with currently accepted first-aid practice? Staying up to date with the guidance issued by bodies such as the HSE and Resuscitation Council UK can be difficult, particularly if you’re working in a market this competitive. Accreditation schemes such as Advantage typically offer some form of curriculum update service where they update you on the latest changes in best practice or regulation.
4. In-house training
The HSE criteria has a specific section for organisations carrying out in-house training, although in reality the requirements are similar to those expected of external providers. The challenge is record-keeping. Accreditation schemes may help you with keeping those records. Advantage, for example, offers an online accreditation portal to manage training and qualification records. We also help centres to put internal record systems in place, including checking their in-house trainers’ qualifications.
Getting your training accredited does not make you a great first aid training provider, nor does it prevent you from serious reputation damage if it is found that you cannot back up what you say. It may, however, help steer you in the right direction and show that you take training standards seriously an increasingly difficult marketplace.
Regardless of your sector, there are many different accreditation schemes available. Some people automatically reach for accreditation services, whereas others seek to go it alone. But what are the actual benefits of getting yourself accredited?
1. Confidence to regulators and external bodies
Every sector has regulators, although some are more involved and prescriptive than others. As much as you want to work with those regulators, you want to give them as much confidence as possible in what you do so that you can get on with delivering your products and services. In the health and social care sector, that means giving the Care Quality Commission (CQC) confidence in your ability to provide adequate care and to train your staff with the skills they need.
2. Confidence to customers and service users
Social media and review websites have made the public more mistrustful and cynical about the claims made by organisations. Accreditation protects against this by showing that, unlike others, you take your obligations to them seriously. For supermarkets, using accreditations such as the Red Tractor on their products shows that they take their advertised commitments to British farmers and British produce seriously. For training organisations, getting your courses accredited is testament to the fact that you place great stock in accuracy and training quality.
3. Confidence to employees
Employees, particularly Millennials and those of Generation Z, are becoming much more discriminating when choosing for whom they work. Talented employees now want employers who have a core purpose, have ethical practices, and offer good working conditions. Gaining accreditation proves to them that you are out to swindle anyone but provide a substantial service or product. There are accreditation schemes specifically designed to prove to prospective employees that you care for the people who work for you, such as Investors in People.
4. Help and support
Many accreditation or awarding bodies also offer support and guidance. The Federation of Master Builders offers members a suite of legal forms and a free helpline. Others may offer knowledge updates or seminars.
Above all, accreditation is about reassurance for yourself and for others.
The Care Certificate was launched in April 2015. At the time and since, it has been subject to many myths and misconceptions. What is the Care Certificate? What do your staff need to do to be able to complete it?
What is the Care Certificate?
The Care Certificate is a set of 15 standards that care workers should follow in order to do their job successfully and provide a good level of care. It was developed together by Health Education England, Skills for Care and Skills for Health and based on the requirements of the Cavendish Review. It replaced the Common Induction Standards and National Minimum Training Standards, its direct precursors.
The Care Certificate is fairly similar to the Common Induction Standards in a number of ways, but included new standards that recognised the modern challenges in the health and social care sector, such as mental health issues and dementia (Standard 9), safeguarding (Standards 10 and 11) and information privacy and governance (Standard 14).
Who need to do the Care Certificate?
Any new health and social care workers from April 2015 were required to ‘do’ the Care Certificate. If you use agency, bank or temporary staff, it is up to you to determine whether they have training suitable to perform their role.
If you have hired someone who claims they have undertaken training in the standards with a previous employer, then you should still take steps to verify their claims and assess their competence in the workplace.
Is it mandatory?
Technically, the Care Certificate is not mandatory. Although it was widely expected pre-April 2015 that this would be the case, Skills for Care confirmed in 2015 that the Care Certificate had no statutory power behind it.
In their own words, however, “the Care Quality Commission will expect that appropriate staff who are new to services which they regulate will achieve the competences required by the Care Certificate as part of their induction”.
In practice, this means that the Care Certificate is effectively mandatory, or at the very least expected best practice for care providers. The CQC actively look for evidence that:
The Care Certificate forms part of the staff induction process, or if not, a suitable alternative is used;
Staff know the standards and that they have been trained in them and assessment against them;
The provider is actively assessing against the competencies in the Care Certificate.
The CQC use the Care Certificate as a baseline because that is precisely what it was intended to be, to apply to both regulated and non-regulated workforces. Assessing against the Care Certificate help ensure a minimum standard of care for everyone.
Is there a time limit?
Another myth perpetuated at the time of launch was that Certificate had to be completed within 12 weeks of induction. This belief actually originated from Skills for Care’s own pilot project that showed that 12 weeks was the approximate time it would take someone to demonstrate the competencies and knowledge. Again, technically, there is no time-limit. All the CQC need to see is that it forms part of the “induction process”.
What do staff need to do to complete the Care Certificate?
‘Completing’ the Care Certificate is not as easy as sending staff on a training course. That is because it requires a joint-effort on behalf of both the care worker and the employer. Care workers must demonstrate knowledge and understanding of the Care Certificate, but the employer must assess this is their everyday work.
Many providers use a combination of methods to help new staff understand the Care Certificate. Classroom-based training, distance learning or e-learning can help with many of the more theory-based standards, although distance learning or e-learning alone is likely to be insufficient for Standard 12: Basic Life Support. The assessor should then look for examples in their everyday work that they are actively applying the standards, or, if such situations do not present themselves, create scenarios to help them demonstrate their knowledge and skills.
What resources are there to help?
Skills for Care and Skills for Health have produced a number of free resources, including guidance on all standard, a self-assessment tool, and free e-learning.
Advantage have also developed a distance learning package designed to meet the needs of both staff and employers, including assessment sheets and easy-to-follow knowledge guides. Get in touch to find out more.
We hear and read a lot about accreditation (especially us), but what does it actually mean, both in theory and in practice? We attempt to summarise.
A definition of accreditation
Accreditation is the external recognition of your adherence to a set of standards to perform an activity or hold a certain status. Typically, accreditation is held by education institutions or organisations. However, schemes exist in a variety of industries. It can show that an organisation subscribes to certain quality standards or adheres to a voluntary self-regulatory code.
There are numerous benefits to accreditation, depending on the scheme. In general, it shows that the organisation takes their responsibilities seriously. This gives confidence to external regulators and customers. It can lead to more business or more engagement, and can give customers or service users confidence in your standards and your ability to comply with regulations and laws.
It can give an organisations confidence in itself, too. Many schemes give you advice on best practice or advice on common problems. The National Landlords Association, for example, offers commonly used forms that members can use and offers advice on common disputes between landlords and tenants. CHAS provides model procedures and documents that members can use to help become health and safety compliant. At Advantage, we offer curriculum updates so that centres can be sure they’re using up to date and compliant course materials.
To identify the right accreditation, assurance or association body for you, you should ask the following questions:
Is this scheme right for my sector or niche? ISO standards are often the go-to certifications, but they may not actually say anything about your technical competence.
Do they have evidence of their expertise? What are their quality processes? Do they have in-house experts that provide advice to their staff and to you and make sure that the body is up to date with the latest knowledge and best practice? Can they help you with technical queries?
Do their values match yours? Do they actually do anything for their money? Some bodies want your membership fee, but then do not offer any real help.
Do they conduct audits? It may not seem to be in your interest to welcome audits, but a body that audits their members takes their standards and responsibilities seriously.
And of course, make sure they’re responsive to your needs.
The results of an Advantage survey for a new report on the Future of Care show that many in the care sector are pessimistic about the future of the sector and the quality of care.
The survey asked respondents to rate their optimism about the future of the sector out of 10, with 10 being very optimistic, and 0 being very pessimistic. The average rating was just 3. Of those that delivered very low ratings, the main reason stated was a fear of demand outstripping supply and funding. Only 13% of respondents gave a rating of 6 or above.
A majority also felt the quality of care would suffer in the foreseeable future. Of those that answered ‘Other’, the general feeling was of stagnation.
Why did our survey respondents feel so negatively? What can we do to help our social care system prosper? Download our new report on the Future of Care to find out.
Person-centred care should be at the heart of any health and social care provider’s approach to care. But how do we embed it into training and development? The person-centred approach framework released by Skills for Health, Skills for Care and Health Education England includes a section advising organisations on how to embed these approaches using training and development. The framework recommends a number of “underpinning principles” to guide an organisation’s approach to training and development on the topic.
The most important of those principles is “behaviour change”. As with the whole idea of a person-centred approach, this concept is now fairly old, but its implications have still not been felt by a vast number of organisations in the sector, and indeed across all sectors. Unfortunately, the framework is frustratingly light on how behaviour can be changed in a positive way, reflecting only that it is more successful than “isolated training”. It does note, however, that any training geared towards changing behaviour will fail if the organisation’s structure and processes reward an old, habitual behaviours rather than reward the behaviours enshrined in the framework:
Development of capability must simultaneously be supported with the right processes, system and opportunity together with locally relevant incentives, which build those intrinsic and extrinsic motivations.
The framework also recommends that training is co-produced to a certain extent. This boils down to having the carer or even the service user contributing stories and reflections about their experiences during the course, or even during the planning of the course.
This shouldn’t be new to any good provider or trainer. A good trainer will seek to engage the people on the course, getting them to talk about how they can relate to content of the course and whether they can think back to any relevant experiences. A classic reflection exercise is ‘What would you have done differently?’, getting the learner to retrospectively apply their new learnings to a previous experience.
Again, the framework highlights that the best co-produced training will have people involved in the planning stage without them even knowing it, with HR processes that continuously seek feedback from service users and staff.
Again, we are all familiar with the importance of getting members of the team to reflect on what is working, what isn’t working, and on the needs of others.
The challenge for many health and social care providers, of course, will be finding the time for members of staff (including managers) to engage in reflective practice. As resources become more stretched, it will become more and more difficult. One possible solution is to stress its importance during the induction period, to effectively train staff to continuously reflect ‘on the job’.
The framework focuses on the structural element of continuous improvement – of managers consistently providing feedback to staff. The framework does not mention, though, the significance of a continuous improvement culture. The best companies in industry that practice continuous improvement have it as part of their culture, running through everything they do, encompassing HR, finance, production and service delivery processes.
Achieving culture change, of course, is difficult to accomplish and can take a long period of time. It requires concentrated effort and the full support of senior leadership. As any continuous improvement organisation will tell you though – and this includes the likes of General Electric and Mitsubishi – it is well worth it.
This part of the framework primarily refers to recruitment and retention. Unfortunately, the section of the framework seems a little too aspirational. The news this week has been full of reports about the huge number of vacancies with the NHS, with retention proving as much of an issue as recruitment. This is compounded by applications from the EU dropping off significantly in anticipation of Brexit and the end of free movement. Even a brief perusal of any job site will tell you that care settings are also continuously recruiting in a sector renowned for its high staff turnover.
Increasingly, health and social care providers are taking what they can get. Recruiting on the grounds of values and outlook, as the framework advocates, is simply not possible for those who cannot afford to go and do it. The emphasis has to be on training and induction. This is helped by having a strong culture that new workers can be embedded in to quickly.
Methods for delivering training
The ‘narrative’ section of the framework does not elaborate on this principle much, although content further down in the document does by discussing “permitted time for e-learning”. As ever, the key is deciding which approach is most suited for each person and for each subject area. E-learning is often perfect for entry-level staff being trained in compliance topics where answers are often binary (i.e. yes or no, right or wrong). It may not be suitable for training that requires reflection and where judgement may be more subjective.
Although the framework raises some great points, it does feel a little too aspirational and abstract at times. Many health and social care providers will feel that it doesn’t account for challenges in recruitment and funding issues. If you take anything from the framework and this post, let it be these three points:
Culture, culture, culture: if behavioural change, continuous improvement and a person-centred approach are going to take hold, it needs to be embedded in your culture.
The method of training delivery needs to be suitable for the person and the subject area.
Train people to reflect on their work every day and ‘on the job’. This embeds it into their behaviour, and means they are doing it even if you can’t set aside specific time for them to do so.