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.

Shift from Care Service to Customer Service

I am fairly certain that you, like me, have been to a restaurant at some point in time where the staff rushed you through your meal and that you, like me, found it irritating and uncomfortable. I am also pretty certain that you, like me, would think twice about using that restaurant again and that many people who experienced that would, like me, probably tell any number of people about that bad service.

Now transpose that scenario to social care.

The now infamous 15 minute care visits are just one aspect of this, longer visits may equally involve care staff having to rush around leaving the individual who needs the service bemused and bewildered at the very least. At the worst it will leave the feeling a burden, someone in the way while the care staff do what they have to before shooting off to the next person. Add to this the times when the individual never knows who is going to turn up to help as staff rotation is based on the needs of the provider rather than continuity for the individual.

Of course this is not limited to home care, many care homes I’ve seen have a task-orientated culture where staff rush around trying to get jobs done and individuals merely become another box to tick on the endless ‘to do’ list and in the worst cases, as demonstrated on the Fiona Phillips’ Panorama programme last year (http://www.bbc.co.uk/programmes/b01gybn7) sometimes staff even fail to acknowledge the individual when they are undertaken their jobs.

The crucial issue here is that the person who needs the care service cannot just suddenly stop using the service because they are unhappy with it and if they are left feeling like a burden to the care service then they are unlikely to complain anyway and, equally, there may be a lack of opportunity for them to mention the bad service to anyone else.

Unfortunately we do not look upon those who need care services as customers. Look at the terminology, ‘service-user’, ‘client’, ‘resident’ or even ‘patient’.

Could you honestly imagine sitting down with your bank manager and having a ‘co-production’ meeting about your finances?

People who need social care services are getting a service and, as such, should be treated as customers no matter how that service is paid for. In many instances of course they are paying directly for that service.

We need to become a customer focused service which starts with acknowledging the individual as someone who has the right to be treated as a paying customer. Social services departments need meet the needs of customers rather than ‘commission’ services and regular reviews should not be just about immediate care needs but should also focus on customer care and the level of customer service that goes with the tasks being provided.

The needs to be a culture change in social care with a shift from task based commissioning to real customer service and customer service skills need to be high on the training list for all staff of undertake services for their customers. Personalisation must mean the customer comes first and what we want as customers will always vary. Some may like short sharp visits just so they can get on with their lives without strangers getting under their feet, many others will prefer visits that include a chat about what’s happening in the world, especially if they are isolated and unable to leave home. Whatever they want though it should be at the top of the list of services provided, after all, the customer is always right.

Let's Change from ‘Being in a Home’ to Being ‘at Home’.

Do we pay enough attention to the ‘home’ part of care home?

Take a moment to think about what ‘home’ means to you, after all a home is more than just a dwelling place – e.g. house, flat etc. – it is about you. It is the place where you, hopefully, can retreat to, a place filled with memories, a place decked out in the style you like and filled with your things. It is not just a building but a fundamental part of your character and both sociologically and psychologically an important part of your life.

When we go into another person’s home we look around and make judgements about their character, their life, their likes and dislikes etc. and then make judgements on how we feel we will get on with them by making comparisons to our own home.

Yet if it becomes necessary to move a vulnerable person into a care home is there enough thought about the human aspect of a home rather than it just being a ‘placement’.

And what of moving into a care home?

It is well documented that one of life’s greatest stresses is moving home, yes there are the stresses of mortgages, solicitors etc. but the psychological change also creates stress, e.g. how do I create my home in this new house? How do I make it so I am comfortable here?

When a vulnerable person is moved from their home into a care home, for whatever reason, how much thought is given to that transition especially given the additional stresses involved that have forced the need to move in the first place.

Age UK have said that care homes are damaged by a culture of negativity (http://www.ageuk.org.uk/latest-news/care-homes-damaged-by-culture-of-negativity/) and this is certainly true in terms of reports of abusive behaviour and the general perception of care homes as places of ‘last resort’ and while I whole-heartedly agree with the Age UK recommendations I would, perhaps, suggest that we need to add to this the aspect of it being the person’s home and that it is vital that any individual feels ‘at home’.

We can have the most professional, caring staff, but if a person does not feel ‘at home’ there is always going to be difficulty in adjusting to their life in the care home. This may lead to depression, challenging behaviours or just a general malaise and dissatisfaction with life.

How would you feel if you had to live in a place you did not feel comfortable in? Many people have had to because of abusive relationships etc. but for the majority of us can we really comprehend what it is like to have to spend day after day in a place where we did not feel ‘at home’.

There is a need for care homes in the social care system and, in one sense, they should be the ‘last resort’ choice and only consider when it is a danger for a person to live alone and there are no other care alternatives possible. But when it is necessary care homes should not be merely a placement but a real home alternative. Many care homes provide this homely atmosphere yet many do not. Equally those that do may not be the type of home that appeals to the individual and every care should be taken to make sure that the choice of home reflects the individual’s needs, traits and characteristics to ensure the best possible outcomes in their new life.

We need to work to change attitudes, we need to create a new culture of care, we need to change from ‘being in a home’ to being ‘at home’.