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.

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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.

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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