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.

Improve Dementia Care Sooner Rather Than Later

Dementia is a disease, or rather the generic term for a group of diseases that are classified as degenerative diseases of the nervous system. The World Health Organisation classifies these diseases, Alzhiemer’s Disease, for example, is listed as “a primary degenerative cerebral disease of unknown etiology with characteristic neuropathological and neurochemical features. The disorder is usually insidious in onset and develops slowly but steadily over a period of several years” in the WHO International Statistical Classification of Diseases and Related Health Problems 10th Revision, more commonly known as ICD-10.

Given that the various types of Dementia are a disease it seems surprising, yet deeply disturbing, that the NHS is failing to provide adequate care for those who have dementia http://www.bbc.co.uk/news/health-16206169

One of the reasons could be that care for those with dementia in the UK falls under the social care remit rather than the health care one. Therefore the expertise in supporting people with dementia is detached from front line health care.

The problem is, perhaps, exacerbated by the fact that few people access hospital services because of their dementia. The reason for being hospitalised is for other health reason, yet it has to be born in mind that these reasons can be related to the dementia, for example a cut or burn could be the result of failing to remember something, so true, holistic care needs to take into account all aspects of the persons health.

One of the answers being touted is training for NHS staff, while this can only help it may not be enough to solve the problem. Training imparts knowledge but that is all, how that knowledge is used in practice is a completely different matter. To ensure that the knowledge gained through training is used effectively their needs to be both good staff development and effective leadership at all levels of the NHS. And to achieve this, managers and supervisors, at all levels, need both effective leadership and communication skills along with a knowledge of dementia themselves.

An additional area highlighted was communication between hospital staff and relatives of the person with dementia. This is an important area to be addressed. Dementia is a disease that can have a great impact on a family, the worry about a loved one can be tremendous, along with the guilt of feeling inadequate in caring for them. If this is made worse by a) poor care & b) poor communication then it is not only the patient that the hospital is failing.

Again the solution is better knowledge, better practice and better communication skills.

Perhaps it is now time to take a fully integrated approach to health and social care. Why not have social care specialists on elderly wards? Why not recognise that social care is best placed to provide the support for people with dementia in hospital. This is particularly important in ensuring there is sufficient after care when the person leaves hospital, especially if they are returning to their own home.

The numbers of people with dementia are predicted to rise sharply and unless action is taken soon the situation will only get worse, so let’s hope we get action sooner rather than later.