Training and Induction for Care Staff: an update on the evaluation of the Care Certificate and next steps

Training and Induction for Care Staff: an update on the evaluation of the Care Certificate and next steps

Background to the Care Certificate

Unregistered Health and Social Care Staff Over 1.3 million unregistered health and social care workers in UK, predicted to rise to 2.2 million by 2020 Different sectors: NHS hospital wards, care homes, domiciliary care Variety of roles: washing, feeding, dressing, personal care. High turnover of staff - 14% NHS and 20% Social Care Francis Report (2013) recommended a registration system for care workers and national training standards Cavendish Review (2013) into HCAs and Support Workers in NHS and Social Care proposed a new common training standards a Certificate of Fundamental Care

The Care Certificate Developed by Health Education England with Skills for Care, Skills for Health and others Piloted in 29 sites, officially launched in March 2015 Designed to be a national training standard for unregistered care staff which: applies across health and social care; links to competences (National Occupational Standards) and units in qualifications; equips care staff with the knowledge and skills needed to provide safe, compassionate care; gives them a basis from which they can further develop their knowledge and skills as their career progresses.

15 Care Standards 1. Understand your role 2. Your personal development 3. Duty of care 4. Equality and diversity 5. Work in a person centred way 6. Communication 7. Privacy and dignity 8. Fluids and nutrition 9. Awareness of mental health, dementia and learning disability 10. Safeguarding adults 11. Safeguarding children 12. Basic Life Support 13. Health and Safety 14. Handling information 15. Infection prevention and control

Implementation of the Care Certificate Employers to implement with all new starters from April 2015 Priority to implement with new staff who are new to care Required to meet the standards before working unsupervised Completion within 12 weeks for full-time staff Materials freely available for employers to use via HEE Replaces other standards for care workers (CIS and NMTS) Employers are responsible for Quality Assurance

Evaluation of the Care Certificate

Study Aims Commissioned by NIHR Policy Research Programme to: Assess how successfully the Care Certificate meets its objectives to improve induction training and enable support workers to provide high quality care; Consider variations in implementation across health and adult social care organisations; Explore areas for improvement in order to meet its objectives better.

Study Methods Stage 1: Telephone Survey with Managers in 401 Care Organisations To quantify the uptake of the Care Certificate To examine patterns of uptake across settings To assess the impact on training provision offered To develop a taxonomy of implementation approaches Stage 2: Qualitative Interviews and Focus Groups in 10 Care Organisations, with 24 managers and 68 care workers To investigate the experiences of unregistered care staff To evaluate the impact on patient experience To identify the characteristics of successful implementation To explore barriers and facilitators to achieving Care Certificate objectives Consolidated Framework for Implementation Research (Damschroder et al, 2009) used as a theoretical structure to guide the qualitative analysis

Main Findings

Telephone Survey 401 responses, weighted according to stratification of CQC sample 87.8% had implemented the Care Certificate Main drivers for implementation: Perceived to be compulsory Positive influence on practice Pragmatic solution Reasons for not implementing Sufficiently trained staff / existing induction / no new starters Lack of capacity Puts new staff off joining

Positive benefits of Care Certificate Overall, the CC was positively received by survey respondents 65% - CC has had a positive impact on organisation 63.9% - CC has had a positive impact on staff 54.8% - CC has had a positive impact on patients More positive responses by health care organisations than social care Four qualitative themes relating to the positive impact of the CC A basic foundation for those new to care Greater confidence, knowledge and understanding Fostering empathy, compassion and reflective practice Career progression and standardisation

Challenges to the Care Certificate Variation in delivery of Care Certificate training 56.8% used a combination of different methods 22.2% used classroom-based delivery 9.7% used computer-based delivery only Care Certificate was not widely transferable 49.8% managers who had employed care workers with an existing Care Certificate said these new employees had to repeat part or all of the Care Certificate Need to repeat Care Certificate was due to: perceived inconsistencies in implementation uncertainty about the quality of the training in other organisations

Qualitative Themes on Barriers and Facilitators Intervention Characteristics Adaptation of the Care Certificate Outer Setting Portability; Accreditation of prior learning; Quality assurance Inner Setting Logistics; Peer support; Completion & recognition Individual Characteristics Motivation to learn; Literacy; Prior experience Implementation Process Size and infrastructure; Organisational support; Scope; Recruitment

Summary Where implemented, the CC has improved induction training and enabled care workers feel better-prepared to provide high quality care. The flexibility and adaptability of the CC means that it is being delivered in many different ways across settings and there have been considerable variations in implementation. Organisational size, leadership, capacity and resources were major factors in determining the effectiveness of Care Certificate implementation. Variation in CC delivery has led to uncertainty over the quality of training in other organisations, and in turn devalued the CC and reduced portability. There is a proportion of smaller care organisations where the Care Certificate has not been implemented, largely due to lack of resources and capacity.

Examples of Good Practice

Features of effective implementation Adaptation of the Care Certificate into existing training and induction programmes Blended, holistic, practical and participatory approaches to training delivery as outlined in the Care Certificate mapping document A broad scope of delivery, extending beyond newly recruited care workers to established personnel Peer support and mentoring for Care Certificate candidates Adaptation of materials and assessments to support care workers facing literacy or language barriers The provision of regular updates and assessor training

Features of less effective implementation A one dimensional approach to Care Certificate implementation and delivery that was inflexible and unsupported Didactic rather than participatory approaches to training delivery Lack of supervision and assessment of standards Lack of peer support and mentoring for care workers Inadequate resourcing, in terms of materials, assessors, care worker time and backfill for training

Next Steps

Next Steps Evaluation report was published in July 2018 Steering Group is now considering the findings Changing wider context of the new Regulated Qualifications Framework and trailblazer apprenticeships

Discussion

How can the portability of the Care Certificate between organisations be promoted? How can consistency in Care Certificate training between organisations be maintained? How can smaller care organisations be supported to deliver high quality Care Certificate Training What examples of good practice can I share?

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