Appeals from the family of Oliver McGowan have led to new mandatory training in learning disability and autism.

As an infant, Oliver suffered meningitis and received diagnoses of mild hemiplegia, focal partial epilepsy, a mild learning disability and high functioning autism. Throughout his childhood, Oliver developed a good sense of humour and aspirations for the future. As a teenager, with several sporting accomplishments under his belt, Oliver began to train as a Paralympian.

Oliver was admitted to a children’s hospital in October 2015. He was experiencing partial focal seizures and felt scared and confused. He was discharged after a few weeks and given antidepressants. His seizures worsened and he was readmitted that December. Despite having no diagnosis of mental illness or psychosis, he was given antipsychotic medication and held against his will. This had a hugely negative impact on his mood. Doctors noted he was sensitive to antipsychotics. After the removal of the medication, his mood and seizure activity returned to normal.

In April 2016, Oliver was admitted again with partial seizures. He was given antipsychotics again. He suffered an Oculogyric Crisis causing his eyes to roll upwards and stay there. After 6 hours, during which the doctor believed his symptoms were behavioural, he was eventually given Procyclidine to counteract the reaction. Oliver suffered other potential side effects including hallucinations, up to 30 seizures a day, problems urinating, extremely high blood pressure and sweating. Oliver was moved to a specialist adult hospital. Staff restrained him, gave him no privacy and prescribed different antipsychotic medication.

Oliver was then transferred to a Psychiatric Intensive Care Unit. Here, staff immediately saw he did not need to be detained and they reduced all antipsychotic medications. He received support from a specialist learning disability team.

That October, Oliver experienced a cluster of partial seizures and was admitted to general hospital. He developed pneumonia and was intubated. Staff sedated him and gave him antipsychotic medication. Oliver’s temperature reached 42°. He suffered tonic-clonic seizures. His brain was badly swollen. He would be severely disabled. Doctors suspected neuroleptic malignant syndrome, a life-threatening reaction to antipsychotic medication.

After a week on life support, Oliver died on 11th November 2016. He was 18 years old.

The McGowan family strongly believe the hospital staff are to blame for Oliver’s death, especially those who prescribed antipsychotics after his previous bad reactions. They believe staff did not make reasonable adjustments to accommodate for the needs of someone with a learning disability and autism. The family have campaigned for years to see improvements made in healthcare.

Their hard work has paid off. The Health and Care Act 2022 has written the Oliver McGowan Mandatory Training in Learning Disability and Autism into law. This is a standardised training package developed by Health Education England and Skills for Care. The training was designed, delivered and evaluated with the help of people with learning disabilities and autism.

In trials across the UK, researchers have seen positive results. 61-88% of learners reported changing their behaviours after the training. 80-94% said the training provided new information, helped them recognise unconscious bias, made them aware of the needs of autistic people in healthcare settings, and gave them new ideas about how to support autistic people.

We are happy to see these results as this training can prevent further deaths. We applaud the McGowan family for their dedication to changing our healthcare system and hope they are comforted by this result.

High quality training courses are absolutely vital, especially in health and care settings. If you share our passion for training and would like to become an accredited centre, please get in touch.

You can find out more about Oliver McGowan and his family’s work at olivermcgowan.org

How does accreditation work? What are your next steps? The information below will help you understand the process of becoming an accredited training centre with Advantage Accreditation. We recommend first reading our guidance on What is Accreditation? and Why get Accredited?

What are accreditation requirements? What are the accreditation standards?
We have our own criteria for centres, trainers and courses.

Centres:
Do you have the necessary set up, processes and polices for training?
Do you have an appropriate equipment and space?
Is the environment up to safety standards?

Trainers:
Do you know who will be conducting training?
Are staff qualified to train others?
Do staff have enough specific subject knowledge?

Courses:
Does the course provide learners with appropriate knowledge?
Does the course grow the learners’ skills?
Is the course well-presented? I.e. no typos or grammatical errors, high quality images, clear structure

Our team will support you through the various stages of accreditation.

How do you prepare for accreditation? How long does it take to prepare for accreditation?
To get started, make sure you have the right staff who are capable of conducting training. You may want to hire someone with teaching experience and qualifications, or train your existing staff.

Next, you can begin to plan and prepare a curriculum. This is not essential, as we provide our own Advantage accredited awards which you can use. If you are looking to create a new course, you will need to create the relevant learning resources. For example, a lesson plan, presentation slides, worksheets, etc.

Once this is all complete, you can sign up online here

This may take a few weeks or months, depending on your organisation’s needs and capacity.

How do you get accreditation? What happens during accreditation process? What are the steps to the accreditation process?
Advantage Accreditation uses a simple, four-step process:

1. Centre Approval
Our team will visit you on site to ensure you are equipped to carry out training. We will discuss any changes or improvements you need to make, and support you in making these improvements.

2. Trainer Approval
You will need to register your trainers with us. This often involves staff at your organisation completing a Train the Trainer course. We will ensure staff have sufficient subject knowledge and teaching skills.

3. Select Courses
This works differently depending on whether you are creating your own bespoke courses. If so, our Curriculum Team will check every detail of your learning materials to ensure they are of a high standard. If not, you can use our own awards. These are already accredited and used by many of our approved centres.

4. Deliver Accredited Training
After this, you can begin training. We will continue to support you through our online portal. Here, you can arrange training, view reports, and create certificates featuring our stamp of approval.

If you have any questions about the process of gaining accreditation, please get in touch with our team today.

We are here to answer all of your questions about accreditation. Perhaps the most important of these is: Why get accredited?

Is accreditation mandatory?
This comes up most often within health and social care settings. Rules and regulations around providing health and social care training can be very confusing. Put simply, accreditation is not mandatory to provide internal staff training. You do not need to be accredited to provide external training either. So, why does anyone get accredited at all?

What is the purpose of accreditation?
Our main goal is to make sure you can provide high quality training that provides an impact to the learner. Once you have gained approval, you can provide reassurance to any learner or external body that your training has been externally quality assured.
We complete an in-depth analysis of your course materials and curriculum, ensuring it is mapped to the appropriate national frameworks, regulations and industry best practise. We also teach an Advantage Accreditation Train the Trainer course to equip your organisation with skilled and knowledgeable staff who want to become trainers.
Altogether, the purpose of accreditation is to show learners and training managers that your centre is a trustworthy and impactful educator.

What are the benefits of accreditation?
– Save money on training for internal staff
– Make a profit by training externally
– Save time on admin with the Advantage portal
– Provide dual-branded certificates featuring our Approved Centre logo
– Access our portfolio of subjects
– Improve skills of staff
– Improve training based on our feedback
– Keep content up-to-date
– Improve your brand credibility
– Demonstrate your organisation takes responsibilities and quality seriously

We believe one of the biggest benefits to becoming accredited is the confidence it gives our centres. After completing the accreditation process, our training providers feel proud of their high quality, externally validated work.

You can find more Guidance in our website’s Resources section. If you have any further questions, please contact us.

Accreditation can seem like a complicated topic, with all sorts of unfamiliar terms thrown in to confuse you. What does accreditation mean? We are here to help! Advantage Accreditation is run by a friendly, experienced team. Let us explain some more about what we do…

What is accreditation?
What is the difference between accredited and non-accredited?
In short, it is a stamp of approval. Non-accredited training has not been checked for quality. It’s anyone’s guess whether the course is any good. Accredited training has passed a number of quality checks, including basics like spelling and grammar and more complex checks such as: “How does this training impact learners?”
Accreditation is external recognition of your adherence to a set of standards, allowing you to hold a certain status or carry out a certain activity. Accreditation is typically held by educational organisations, but may be held by other industries.

What are the types of accreditation?
What is an example of accreditation?
At Advantage, it all begins with centre approval. We make sure your organisation is equipped with capable trainers and can offer a good learning environment. What happens next depends on your individual needs.
You may have your own unique courses in need of accreditation. In this case, we will apply our stringent methods of analysis to your course content, making sure it meets our standards.
Alternatively, you can access our vast portfolio of awards. Examples of our accredited courses range from Level 2 Award in Effective Communication to Level 3 Award in First Aid at Work. We regularly update our learning materials with new terminology and legislation, ensuring all information is correct.
Some of our centres require accreditation for their own courses, and wish to use our content too. We create bespoke accreditation to suit individual needs.
Well-known accreditation schemes include the Red Tractor Scheme, the National Landlords Association, CHAS, Law Society Accreditation and the Federation of Master Builders.

What is the difference between accreditation, regulation, certification and affiliation?
Is accreditation better than certification?
There are so many terms to get your head around! Here is a little “Cheat Sheet”:
• Regulations: Rules created and enforced by an authority (e.g. UK Government)
• Certification: A document showing an achievement
• Affiliation: A connection between two or more organisations
• Accreditation: Official recognition of quality standards to carry out training

What does accreditation body mean?
What is the role of an accreditation body?
Advantage Accreditation is an example of an accreditation body. We support training providers to deliver high quality training by checking course materials, trainers, and more. At Advantage, we also provide our own accredited training materials.
Part of being an accreditation body is staying up-to-date with national standards & regulations, making updates to course content, and providing ongoing support. These national standards are often based on advice from sector skills bodies, voluntary industry bodies and professional associations. Examples include Skills for Care, Energy and Utility Skills, Association of British Travel Agents (ABTA), British Insurance Brokers Association.

We hope this helps you understand more of what accreditation is and what we do! If you have any questions, please contact us.

For many providers, reaching an ‘outstanding’ rating with the Care Quality Commission (CQC) can seem like a difficult task. For others, it’s an ambition that is at the centre of their mission.

Of course, achieving ‘outstanding’ is meant to be difficult. Only 2% of inspected social care services achieved the rating in 2018, a statistic that has remained largely static since 2014. More domiciliary care services rank outstanding compared to residential services, and similarly nearly five times as many residential settings are rating as ‘inadequate’ as domiciliary services. This speaks to the different challenges between the two types of service provision.

Below are some tips that may help you if your ambition is to be outstanding. It may not surprise you that planning is key.

 

Planning and Preparation

As with anything, the key to a great CQC inspection is plenty of planning and preparation. There should be no surprises when the inspector calls: all the standards they measure you against are available for free online.

Firstly, you should be aware of what type of inspection you are due to receive. There are three types:

• Comprehensive inspection – A holistic inspection usually carried out where there is a risk of a deterioration in quality or an upturn in quality that may affect your rating.
• Focused inspection – More structured, narrow inspections carried out in response to a complaint or to follow up on specific findings from a previous inspection. These are usually unannounced.
• Combined inspection – Where the organisation provides services that span different areas of health and social care, for example, “mental health, community health, and care homes”. Different inspections are carried out by specialists for each service area.

If you know what type of inspection you are likely to receive, you will be able to plan more effectively. Focused inspections are the simplest to plan for, since you will likely already be aware of the issue to which they are responding. Comprehensive inspections require much more planning and work. All inspections will emphasise your equality and diversity credentials – such as providing reasonable adjustments – and your compliance with the Mental Capacity Act and Deprivation of Liberties Safeguards.

Fortunately, the CQC’s criteria is public and open for all. Here’s two of the key documents you should be aware of:

 

Assessment Methodology

The CQC document ‘How we regulate health and social care’ should be your first port of call when planning for an inspection. The document summarises how the CQC inspects. It also includes the appeals and complaints procedures should the inspection not go the way you hoped. The document signposts you to other documents that will be of help.

 

Assessment Framework – the Key Lines of Enquiry (KLOEs)

The KLOEs are the primary questions any CQC inspector will ask as part of their visit. There are five key areas of focus:

1. Are service users safe from abuse and harm?
2. Is the care delivered effective? Does it lead to good outcomes?
3. Are staff caring and compassionate towards those in their care?
4. Are services responsive to the needs of service users?
5. Is the organisation well-led? Are there effective governance arrangements in place?

Beneath these areas of focus are a series of questions that the inspector will ask. They will, of course, need evidence to support any answers you provide. The CQC KLOEs documentation also gives an explanation as to what providers must do to get an outstanding rating for each question. It is important to compare your service against these criteria. This will give you an indication as to where you are likely to fall in your inspection.

The KLOEs underwent some changes in November 2017. Advantage have a guide to the updates available to download for free.

 

CQC reports online

As since the CQC is a public regulator, all its reports are available online. Reading the reports of ‘outstanding’ services will give you a good indication of what inspectors are looking for when they visit. Conversely, reading reports of ‘good’ services will give you an idea of the gap between these ratings and ‘outstanding’ and what you need to correct. All inspection reports can be found on the CQC website alongside the details of the different providers.

You will notice in some reports that there are specific mentions of instances where the inspector believes the organisation is exceptional or innovative. If you have developed a particular procedure or use a piece of technology that you believe will differentiate yourself from other providers, make sure you highlight it on your inspection.

 

Aim for two questions to be outstanding

Not many know that, of the five key questions asked by the CQC, only two need to be outstanding for you to get an overall outstanding rating. Although you need to need to deliver as best as you possibly can in all five areas, you will likely already be relatively strong in at least two areas compared to others.

If that is the case, you should build on your strengths. You should understand why you are so strong in these areas and focus on them. It is easier to concentrate your efforts and to make a real impact with staff on a limited number of areas, rather than spread your resources too thinly.

 

Use an evidence file

It is not enough for you to answer questions well. Inspectors need evidence. Nor should you rely on the inspectors being able to find good or outstanding practice. You need to be proactive. You should maintain an evidence file that you are constantly updating, preferably something that the inspector will be able to take away with them. This may include documents such as:

• Your policies and procedures
• Organisation chart
• Minutes of senior management meetings and meetings with outside agencies
• Records of any incident investigations, including the outcomes, or any meetings where safeguarding issues are discussed
• DBS records for staff
• Health and safety and fire risk assessments
• Training needs analyses and evidence of staff training
• Legionella test records
• Equipment maintenance records, including PAT tests
• Compliance with data protection requests

If you are consistently updating this file – best categorised as per the KLOEs – then will be fully prepared when an inspection occurs.

This file is not just about ticking boxes, though. You should record examples of where you feel your organisation has developed practices or delivered care that are innovative or particularly exceptional. You should also record examples of good team work, where your staff have gone above and beyond, or great feedback from service users and/or their families. If you have had any requests for information from the CQC, such as online provider information collection (PIC) or provider information return (PIR) requests, keep records of what the request was and your response.

 

Surveys and feedback

The best evidence that you are delivering excellent care is feedback from the people in your care and their families. Of course, you can obtain this through individual requests, and it may be a good idea for you as a manager to get out and talk to the people in your care or their families.

If time is a factor, though, a survey – paper or digital – can help. Any survey must strike a balance between hitting some of the key criteria required by the CQC, and ensuring it is not too long and foreboding for someone to complete. Do not be tempted, however, to throw out any survey results that criticise your services. Negative feedback collected in these surveys is, in fact, hugely beneficial for two main reasons:

• It validates the survey and all the other responses by showing that the results are genuine and unfiltered
• It provides an opportunity for you to demonstrate to the inspector that you have acted on people’s concerns

It is best, if you can, to collect feedback consistently over a long period of time. This will help give you a more accurate picture of how your organisation is functioning and take account of changes in staff and service users.

For those seeking to use digital surveys, there are a range of online providers. SurveyMonkey is one of the most popular and has a free option.

 

Carry out mock inspections

CQC inspectors will not just interview you. They will also interview your staff to ensure they are aware of your organisation’s policies and procedures and of their responsibilities as carers. Carrying out mock inspections will get them used to questioning and help you identify where there are gaps in staff knowledge. It will build confidence, meaning that you and your staff will be able to talk about how great your services are with more authenticity.

You should not, though, prepare a ‘script’ for your staff. CQC inspectors will be able to see through it. It will also have long-term negative consequences, creating a culture of mistrust in your organisation. If your organisation is well-led and has a mission to deliver excellent care, you should largely be able to trust your staff to show off how good you are.

Again, staff surveys will help you an insight into carers’ awareness of their responsibilities and how they feel about your organisation. A people-oriented organisation will regularly solicit staff feedback to help improve its services.

You can carry out the inspections yourself, have a senior member of staff do it, or procure outside help. There are now a number of organisations that can carry out mock audits and inspections. Get in touch with us to find out who we recommend.

 

Ensure all staff training is up to date

Staff training is one of the easiest things to fall short on. All your care staff should be up to date on their mandatory training, including health and safety training, fire training, and all the mandatory care subjects. You must ensure that records are kept of all the training, including copies of the certificates.

Innovative care organisations will look beyond the bare minimum, of course. Outstanding providers will have development plans for members of staff. This will not just help the CQC inspection but also improve staff retention and morale. They will also be able to demonstrate an ongoing system of staff training that highlights when a training need is likely to emerge. Advantage centres use our accreditation portal to help keep track of training needs and records.

Getting your training or training systems accredited demonstrates a commitment to quality, consistent training. Click here to find out how Advantage Accreditation may be able to help you with this.

 

Be aware of limiters

Even if you perform well against the ‘well-led’ KLOE, you may be unable to reach an outstanding rating under certain circumstances. These ‘limiters’ are:

• If the setting has no registered manager when it should have, or if there have been insufficient attempts to hire one
• There is another condition of registration that has not been met
• You did not alert the statutory authorities about a relevant event
• The provider has not completed a PIC request

You should also be aware that, in some cases, the CQC will not be able to give a rating. This is only likely if it is a brand new organisation, if there has been a significant change in operations or ownership, or if there isn’t enough evidence.

 

Now for the inspection …

Provided you have done your preparation and planning, the inspection itself will go a lot smoother. Here’s some tips though that may help you:

• Shout about your successes – act as if the inspector is a potential client
• Smile, and get your staff to smile too
• Highlight anything you do that is innovative to stand out from other settings
• Don’t lie and don’t be afraid to say if you don’t know the answer – trying to cover your tracks will only come back to bite you later

If you are a truly outstanding organisation, then you won’t need any tricks or shine. Hopefully this guide will help you put a plan in place to ensure that your greatness really shines through!

If you need any more advice, get in touch with the Advantage Accreditation team.