Health and Social Care Training: The Real Issues

“There is no minimum standard of training for healthcare assistants before they can work unsupervised, an independent report has found” http://www.bbc.co.uk/news/health-23246066

Actually that’s not true!

Back in March Skills for Health and Skills for Care launched the National Minimum Standards for Healthcare and Social Care workers – see http://www.skillsforhealth.org.uk/about-us/news/code-of-conduct-and-national-minimum-training-standards-for-healthcare-support-workers/ . In addition the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 state quite clearly the Health and Social Care providers must ensure employees are “appropriately supported in relation to their responsibilities, to enable them to deliver care and treatment to service users safely and to an appropriate standard, including by receiving appropriate training, professional development, supervision and appraisal” (Regulation 23)

So, the issue is not whether those standards are in place but how those standards are applied, implemented and inspected.

The first area that needs real scrutiny is the induction process.

Imagine that time when you first started in a new job, there is always an element of nervousness as you enter a new environment, have to learn new routines and adapt to working with new people. Now imagine how much information you are likely to retain when you are bombarded with DVD’s or reading material which is supposed to make you competent in the role you are about to undertake!

While we have, in social care, the Common Induction Standards, it has to be remembered these only form a part of the induction process. Induction must be as much about ensuring that new employees learn about the workplace, its routines etc. and how the induction standards apply to the workplace and the individuals receiving care and support there. A tick box approach to the induction standards will not work and there needs to be a greater understanding by managers and leaders in the home of the importance of mentoring new employees to ensure the induction standards are embedded in work practice.

Learning and development must not stop after a successful induction. Professional development is a regulatory requirement and continuous training is important. Even if you have been on endless health and safety courses the chances are going on another will spark something in your mind that you had forgotten or prompt you to think about a bad habit you have got into and encouraged you to change it. Training, aside for giving us new information, can also make us think about how we do things right now, it brings us into ‘conscious competence’, always a good thing to do on occasion.

Supervision and appraisal also serves the same purpose. It helps us question why we do things in certain ways and can make us consider better ways of doing our work. Too often supervision and appraisal are seen as a means to be critical of an employees work but they should be seen as a means of encouraging employees to think about their own role and how they perform it.  

The key issue is to ensure that those responsible to managing and leading staff are sufficiently trained themselves in staff development.

One of the vital areas of training, often overlooked, is the quality of training itself. Certainly I have stopped using training providers because of the negative feedback I had from staff (the usual complaint is ‘they were just reading from a script’ – how can a trainer engage learners when they a focused on reading their lines?) yet how many providers actually get feedback from staff about the quality of training. It is important that providers do this, not only to ensure the quality of training but also to ensure they are not wasting their money!

There are schemes in place which accredit training in social care the principle one being the National Skills Academy for Social Care, and whilst their list is somewhat small at the moment, it would benefit all those who provide social care training to apply for accreditation (here’s the link https://www.nsasocialcare.co.uk/training-providers ).

Given that standards and regulation already exists the obvious question is how are these actually regulated and inspected. If there are issues over training and development why are these not picked up in the inspection process? It can only be speculated that the inspectors themselves are receiving insufficient training into what to look for and what questions to ask about training and development. One of the proposals from the Care Quality Commission’s consultation on inspection is the introduction of ‘specialist’ inspection teams – personally I hope that includes specialist in training and development to ensure standards and regulations are adhered to.

The training and development regulations and standards are there, the issue is how these are applied and inspected, if we can improve this we can improve the general quality of care across the board.

Back to Basics after Winterbourne View: Social Care Training

The Governments final report on Winterbourne View says a lot about the need for staff training but within all of that there is an important phrase that applies right across the social care spectrum and that phrase is “properly trained”.

While there could be some debate about what ‘properly trained’ means it is essential that all care providers reflect on the standard of training that they are providing for their staff. Under the current economic climate it is quite possible that providers are focusing on the cost rather than the quality of training.

Skills for Care and Skills for Health are charged with producing minimum training standards by January but it is unclear as yet whether these will be tick boxes for providers or fundamental changes in the way training must be monitored or delivered yet in either instance care providers should take responsibility for the quality of the training they provide for their staff and this can be done in a number of ways.

Firstly talk to staff. How did they feel about the training, were they engaged with the training or was it just a chore that just had to be done? I know, from personal experience, have conversations like that are useful, once I was informed that a training session was pointless because the trainer just read everything from a book and obviously did not know much about the actual subject. Needless to say that training provider was not used again but without seeking that feedback in the first place the company would probably have continued using the same trainer.

Naturally it would be obviously more useful if care providers could have some assurance about the quality of training providers before they booked them. This is easy for certain courses such as First Aid and Food Hygiene where trainers are accredited by the Chartered Institute of Environmental Health but for other training the route to quality is much less clear.

Yet there is some help, the National Skills Academy for Social Care has started a list of endorsed trainers (available here) and of course word of mouth through local trade associations is a good way to identify recommended trainers. Hopefully the endorsement/registration of trainers in social care will expand to help providers in identifying trainers who can provide appropriately qualified trainers to meet the needs of their particular service.

It is also, perhaps, important that care training providers look at how they can improve their own service by , perhaps, ensuring that the model of care set out in the Winterbourne View report is embedded in any training they deliver and by seeking recognition from the National Skills Academy for Social Care so that providers can trust that they will receive quality training.

Care providers have further responsibility though. Ensuring staff are ‘properly trained’ is not just about what happens in the classroom setting, that training has to be turned into practice and that aspect is the responsibility of the management of the care provider. How aspects such as infection control, medication, mental capacity, adult protection etc. are applied to those the provider cares for can only be done at the point of care delivery and it is essentially vital the staff development activities work hand in hand with formal training.

Unfortunately, when the sector changed from the National Minimum Standards to the Essential Standards of Quality and Safety many of the training standards were lost as the new standards were required to cover hospitals, dentists, ambulance services etc. as well as social care but hopefully the new standards being worked will fill some of this gap.

There can be little doubt that training and the quality of training will be high in the Care Quality Commission inspection agenda and ultimately training provision is the responsibility of the care provider and it is essential that training provided for staff is high quality training that engages and leads to better outcomes for those they provide services for.