The NHS Long-Term Plan: What it means for training

NHS Long Term Plan - Advantage AccreditationThe 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.

 

First aid training accreditation - Advantage Accreditation

Why get your first aid training accredited?

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.

First aid training accreditation - Advantage Accreditation

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.

  1. 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.
  2. 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.

Conclusion

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.

Completing the Care Certificate - Advantage Accreditation

What you need to complete the Care Certificate

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.

Your work experience checklist

If you’re a residential or domiciliary care organisation taking someone in on work experience, there’s a big benefit to yourself and the sector as a whole. Hopefully, you’re getting someone who’s enthusiastic who may even end up working for you someday and making a real difference. However, it’s easy to forget the basics when it comes to work experience, so here’s your checklist to make sure you and the person get the most out of their work experience.

 

1. Get the right person

Normally, if someone is applying for work experience in your care setting then it’s because they want to be there, but not always. Find some way of vetting the person beforehand to make sure you’re getting someone who will put the effort in. There’s nothing worse in any work environment than someone who doesn’t want to be there.

 

2. Basic housekeeping

Make sure you give the work experience person everything they need to know on the first day. That means all the things you take for granted, such as expected working hours, where the toilets are, who to ask for help, how long the lunch break is, and where the first aid kit is located.

 

3. Don’t mistake anxiety for laziness

Most of the people you get on work experience will be young, and teenagers are complex creatures! Sometimes they may be giving off an attitude that can easily come across as sulkiness or laziness. Make sure, however, you prod a little deeper, because it could just be anxiety. Remember, it is likely to be there first experience of working life and outside of the comfort zone of the controlled classroom environment.

 

4. Ease them in

As stated above, this may be their first experience of working life, so don’t throw them in at the deep end. Make sure they get a full induction and tour, and maybe try them out on a few easier tasks before moving them on to more intense activities.

 

5. Give them a rounded experience

We all know that a care organisation is not just the front-line. There’s also the business management, finance and coordination sides, as well as others. Give the work experience person a full picture of your organisation and all of its aspects. If the person isn’t quite enjoying one aspect of the organisation, you can move them to another where they might thrive.

 

6. Give them a supervisor who will make time for them

The front-line of care can be hectic. It’s hard enough for your supervisors and managers to give time to full-time staff, let alone work experience people. Of course, we know that it is important that they do. Choosing the right supervisor for the work experience person can be crucial, so have a think about someone with the right personality traits and who has the time to dedicate to helping someone through the whole experience. You may even want to consider lightening their other duties for a period to ensure they have enough time for the person.

 

Do you have any other tips? Leave your comments below!

Old and young lady - Advantage Accreditation

CQC report finds good care in mental health services

Although the media will no doubt focus on the negatives, a new CQC report on the state of care in mental health services has actually uncovered a lot of good news.

A study of mental health services conducted between 2014 and 2017 has found that 68% of core services provided by the NHS are good and 6% outstanding, while the ratio is 72% and 4% respectively for independent services. Among those services for which special praise were delivered were community services for those with learning disabilities or autism. Even providers labelled as requiring improvement have made “real progress”.

Unfortunately, the report also highlights a “substantial minority” of services where improvement is needed, and cited a number of familiar areas of concern, including staffing shortages, locked rehabilitation wards, poor quality clinical information systems, and the variation in the use of physical restraint and restrictive practices.

The latter is certainly a hot topic in the sector today, and the reason behind Skills for Care’s recent push on positive behaviour support. Clearly, services needed to embed the latest guidance in their training programmes more deeply to achieve change.

The full report and data is available on the CQC website.

Person-centred approach – training and development

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.

Behaviour change

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.

Behaviour change in training - Advantage Accreditation

Co-producing training

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.

Reflective practice

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’.

Continuous improvement

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.

Value-based approaches

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.

Conclusion

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.
Old lady

New report shows the importance of basic skills

A number of news outlets are leading today with the news that the CQC has found that 32% of nursing homes in England and Wales are failing on safety:

Inspectors making unannounced visits to care homes found medicines being administered unsafely, alarm calls going unanswered and residents not getting help to eat or use the toilet. Some residents were found to have been woken up by night-shift care workers, washed and then put back to bed, apparently to make life easier for staff.

Training, recruitment and retention of skilled staff was cited by the CQC's chief inspector of adult social care, Andrea Sutcliffe, as one of the key causes for failed safety standards across the sector:

“Many of these homes are struggling to recruit and retain well-qualified nursing staff and that means that this is having an impact on delivering good services to people who have got very complex needs".

This shows that staff training is still a difficult issue for many facilities. It is likely that this is going to become a hot issue for the CQC over the coming months and years. 

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Mountain climbers

The biggest problem with training, and what you can do about it

We've all been on a training course of some form or another. It might be something compliance based - like health and safety - or something that really impacts on how we perform in our role. The problem, however, is that it often isn't built around the learner.

The reason why is clear: training and education has traditionally been a process of passing knowledge from one person to another or to several others. Consider the typical set-up of a classroom: the teacher stands and speaks, authoritatively, the children sit and listen as subjects. The teacher is focused on passing on the knowledge, not on addressing its meaning and application to the learner. 

It is well established, though, that people who discover their own learning are better for it. Carl Rogers, one of the founding thinkers of 'student-centred learning', stated that "the only learning which significantly influences behaviour is self discovered". If you're a tutor a small proportion of any classroom will be able to take in what you say and remember it. A much larger proportion will keep it with them if they have discovered it themselves.

That's why inductive learning, otherwise known as guided discovery, is the big fashion in modern teaching and training. With language, tutors often now provide learners with an example of a phrase or sentence and facilitate learners to work out the rules for themselves. Even in football, Manchester United manager Jose Mourinho is a well known practitioner of guided discovery, coaching his players to be able to make decisions for themselves on the pitch based on an overall model of play. 

So, when you're building your own training programmes, think about how you can aid learners to discover facts and patterns of behaviour for themselves. For example, you can give them real world scenarios, and ask them how they would react. Rather than explain the Social Model of Disability to them, get them to empathise and see things from the perspective of those for whom they care. If you are able to observe them working afterwards, talk to them at intervals and ask them how they think they could improve based on the training. It's only little details, but they can add up to make a big difference to changing behaviours for the long-term. 

 

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