Health Care Support Workers in England Response to HEE Consultation The Talent for Care Executive Summary This paper presents the Council of Dean s response to Health Education England s national consultation on its strategy to develop staff working in NHS roles banded 1 to 4. The paper identifies barriers and obstacles and makes proposals that cover recruitment, development of existing staff and, for appropriate candidates, progress into pre-registration programmes. In brief, they are: The concept of the Bands 1-4 workforce should take into account the diversity of roles and explicitly address the connection between health and social care. Funding for education and training should be consistent, transparent and wellsignposted. Workforce planning should be improved, including defining core healthcare support worker roles and responsibilities to allow the design of consistent and transferable qualifications. Support should be provided through the specific commissioning of bridging programmes to assist NHS staff that wish to apply to pre-registration programmes; this also requires work on the equivalence of qualifications. Introduction This paper sets out the Council of Deans of Health s response to Health Education England s national consultation on The Talent for Care, its strategy to develop staff working in NHS roles banded 1 to 4. The Council represents all UK universities engaged in education and research for nursing, midwifery and the allied health professions. Our members play a role in the education and training for the Bands 1-4 workforce in three main areas: Providing education and training for support workers, typically those in higher level roles, such as foundation degrees for assistant practitioners Bridging programmes and access into pre-registration education programmes Research into the education and training available to the support workforce 1
The Council welcomes the intention of The Talent for Care consultation to improve education and training for staff working at NHS roles banded 1-4. Under the national leadership of HEE there is an important opportunity to maximise the contribution of support staff in delivering high quality, safe patient care through consistent, high quality education and training. This paper draws on the Council s work in the past 18 months, including a study jointly published by the Council of Deans of Health and Skills for Health, The Higher Education Contribution to Education and Training for Healthcare Support Worker Roles and our 2013 Position Statement Health Care Support Workers in England: Five proposals for investing in education and development to deliver high quality, effective and compassionate care.1 2 Focus and Definitions (Question 4) Position: The Talent for Care should rework the concept of the Bands 1-4 workforce to take into account the diversity of roles and explicitly address the connection between health and social care. The use of the term Bands 1-4 workforce is problematic. Aside from the principle that staff groups should not be defined by their pay band, there is a risk that without distinguishing between the very different roles within these parameters, HEE s strategy will either be too generic to have significant impact, or revert to particular narrow areas by default without taking into account a broader agenda. The strategy should distinguish at a minimum between clinical and non-clinical roles and between roles at different levels, using career framework levels rather than pay banding. Members have suggested that clinical staff should be called Assistants and to be distinguished by clinical area and seniority e.g. Nursing/Midwifery/Therapy Assistant, Senior Nursing/Midwifery/Therapy Assistant, Advanced Nursing/Midwifery/Therapy Assistant. Given the significant transfer of staff across sectors and the policy imperatives towards greater integration of care, we also believe that it is unsustainable for the strategy to only take a healthcare focus and that it must explore the connection with social care. The development of The Talent for Care is an important opportunity to develop a common and appropriate language and shared approach to education and training across health and social care that should not be missed. 1 Council of Deans of Health (2013) Healthcare support workers in England: Five proposals for investing in education and development to deliver high quality, effective and compassionate care, http://www.councilofdeans.org.uk/wp-content/uploads/2013/07/codh-hcsw-5-proposals-for-investing-ineducdev-for-high-quality-care1.pdf 2 Council of Deans of Health and Skills for Health (2013) The Higher Education Contribution to Education and Training for Support Worker Roles, http://www.councilofdeans.org.uk/wp-content/uploads/2013/12/codhsfh-he-contribution-to-support- Worker-Education-Final-July-2013.pdf 2
Barriers and Obstacles (Question 1) Position: Funding for education and training for healthcare support workers is a significant barrier. Setting out plans to make this increasingly consistent, transparent and sustainable should be a priority for The Talent for Care As The Talent for Care notes, workers in Bands 1-4 make up 40 per cent of the NHS workforce and are responsible for an estimated 60 per cent of contact with patients. The lack of overall investment to support existing models of education and training, increasing costs and the lack of funding available to support CPD for the healthcare support worker workforce is a significant barrier. The changes in funding for 24 year old + and levels 3 and 4 vocational programmes introduced in 2013 has, for example, led some trusts to review continuation of advanced apprenticeship programmes. 3 Employers and employees therefore need alternative non-nhs vocational education funding to be sign-posted in clear, accessible ways. For courses delivered by or in partnership with higher education, increased uncertainty about funding poses a risk to higher level courses, including those that lead on to preregistration programmes. Faculties delivering healthcare support worker programmes argue that greater stability to funding streams is necessary to maintain appropriate staffing levels and to ensure the future sustainability of the programmes they deliver. Our joint research with Skills for Health in 2013 also found arguments in favour of a nationally agreed commissioning fee for particular types of courses, similar in concept to the benchmark price for pre-registration education. Inconsistencies in role design and qualifications are a second major barrier. The Talent for Care is an opportunity to set out a workforce planning strategy that addresses these. Effective workforce planning ensures the right numbers and mix (grade and skills) of staff to deliver safe and effective care to meet local health needs. Too often however, research suggests that healthcare support worker roles are poorly planned and designed. As a result support workers access a disparate, non-transferable and inconsistent range of formal and informal learning programmes, ranging from statutory training to Qualifications Credit Framework accredited qualifications such as diplomas and, for Assistant/Associate Practitioners, foundation degrees. Inadequate workforce intelligence and planning contributes to misunderstandings about roles, inappropriate delegation of tasks, lack of opportunities for support workers to progress their careers limited opportunities to access continuing professional development, inadequate education and training provision and the under-utilisation of skills. Variability in award titles also hampers the ability of some healthcare support workers to move between different employers. 3 http://skillsfundingagency.bis.gov.uk/providers/programmes/24advancedlearningloans/ 3
To overcome these barriers, the scope of practice of clinical and non-clinical support worker roles needs to be more clearly defined. We believe that this requires identifying the core tasks and attributes that apply to all support workers at each level, while allowing local flexibility to identify patient/client specific requirements. 4 For Assistant/Associate Practitioner roles, Foundation Degrees or Diplomas of Higher Education should become the standard qualification, given the complexity of the tasks performed by the roles and their degree of autonomy. There is also scope to explore the use of so-called Skills Passports. 5 Used as an integral part of formal education programmes, these can allow support workers to demonstrate their competence, which in turn, improves the confidence of registered staff to appropriately delegate tasks. Skills Passports also clarify the tasks support workers cannot perform, thereby addressing task drift. The Royal College of Midwives (RCM) has undertaken work on setting out the role and responsibilities of maternity support workers (MSW) and is an example of good practice in this field. Tasks have been identifies and given traffic lights as follows: green - tasks all MSWs can perform, amber MSWs can do with appropriate training and support, and red tasks MSWs can never perform. Support workers must also be given sufficient time off to attend education and training, and must be clear on the outcomes of courses they attend. With integrated care and community-led care major imperatives, The Talent for Care should take into account changing service needs and promote innovation in education programmes. With the imperative for greater integration between health and social care and calls for more community-led care, there is likely to be increased demand for healthcare support workers employed in the community and working across health and social care boundaries. The nature of these roles creates new challenges around education development and delivery. Our research with Skills for Health in 2013 found only a relatively small number of programmes focused on community services. The Talent for Care and other initiatives should therefore explicitly promote innovation in healthcare support worker education programmes with a community or social care focus, including considering expanding the use of simulation and e-learning. 4 Some progress has already made in this respect in regard of maternity support workers (RCM (2012) The Role and Responsibilities of Maternity Support Workers, RCM: London 5 Originally developed by NHS Education for Scotland and now used by a number of universities particularly for foundation degree programmes. 4
Supporting Progression (Question 3) Position: HEE s objectives on progression into pre-registration education need to look beyond nursing and must be based on the best available data The policy context around bridging has predominately focused on widening access for healthcare assistants into pre-registration nursing programmes and this is reflected in The Talent for Care. Whilst we support the continuation and further development of pathways into nursing preregistration programmes, clinical support workers roles, let alone those in the broader Bands 1-4 workforce are by no means solely focused on nursing care. Physiotherapy assistants, maternity support workers, occupational therapy assistants and emergency care assistants are examples of the many clinical support roles undertaken within the NHS. Investment in the interface between healthcare support workers education and preregistration programme must therefore not be limited to healthcare assistants becoming nurses but should be widened to support progression of across health and social care work into pre-registration programmes. The current narrow focus also means that the extent to which nursing programmes already offer a broad range of routes into higher education is widely overlooked (including the use of APEL and existing work-based routes). Any strategy must be based on the best available data on access rates into different pre-registration programmes and recognise existing good practice if it is to have wider stakeholder support. Strengthening the bridge between support worker education and pre-registration courses requires work on equivalence of qualifications and commissioning of specific bridging programmes. Healthcare support workers are increasingly taking on a broader and more complex range of tasks, and the Council has argued that this should be reflected in the continued and increased commissioning of education and training at higher levels, such as Foundation Degree (FD) or Diploma of Higher Education (DipHE). Although only a relatively small proportion of the healthcare support worker workforce will want to move on to pre-registration programmes, strengthening the bridge between support worker education and pre-registration programmes is important as it establishes a clear pathway to support the development of healthcare support workers. HEIs already play a key role in supporting the pathways from into pre-registration programmes, which enable support workers to become registered health professionals. 5
A Department of Health 6 document published in 2010 set out three educational models and one employment model that aims to widen access to pre-registration nursing programmes and set out careers pathways for healthcare support workers: Model A: Progression from foundation degrees to the relevant field programme of the pre-registration nursing degree course. Model B: Transition from the undergraduate pre-qualifying nursing programme to the foundation degree. Model C: National vocational qualifications (NVQ) level 3: transition into prequalifying nursing degree programmes. Model D: NHS clinical higher apprenticeships. The Council remains supportive of these models as a useful basis for discussions to address knowledge and skills gaps of healthcare support workers and allow staff to apply for entry to pre-registration programmes, including, where appropriate, to the second year. A HEE-led task and finish group should be established to work on the equivalence of qualifications (particularly functional skills) and to oversee the design, commissioning and implementation of specific bridging programmes. The proposed Higher Apprenticeship in Nursing leading to registration is an as yet untested approach, with an unclear case for its value over and above existing workbased flexibilities. The Talent for Care should exercise caution in advocating any single route above others. The Talent for Care specifically mentions a Higher Apprenticeship route into nursing in its example of entry routes that allow staff to remain in post whilst they study (Question 3). It should be noted that there are multiple routes that already allow this, notably secondments. Given that the inclusion of a pre-registration programme for nursing within an apprenticeship framework is as yet untested, both in terms of funding and in conformity with the NMC Standards for Education, it is premature to promote this as a route to registration. 6 Department of Health (2010) Widening Participation into Pre-registration Nursing Programmes, https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213867/dh_11665 5.pdf 6
Examples of Bands 1-4 Development (Question 8) Many universities have developed pathways to support access into pre-registration programmes, three examples of which are below: Example 1 - Middlesex University works closely with NHS partners to align their aims of values-based recruitment to the healthcare professions and widening participation of their clinical support workforce. They have introduced a new path to registration as a nurse. This enables those who do not meet University entry requirements for degree level study, but are currently employed within the NHS as a clinical support worker, to enrol on a one year certificate programme, which maps across to the first year of the pre-registration nursing programme, but at the same time provides enhancement of academic skills, including literacy and numeracy. Students who exit at this point have reached the level of knowledge and skill to move into a band 3 post. Students successfully completing the first year are eligible to enter year 2 of a Diploma programme at the end of which, they will be eligible to undertake a further 18 months to complete the pre-registration nursing programme. If they choose to exit at the end of year 2, they have the knowledge and skills to take up a band 4 Assistant Practitioner role. Example 2 - Canterbury Christ Church University has a foundation degree which supports the development of the AP role and is delivered in partnership with both acute and community sector with students learning together for a number of modules. Their local mental health trust have commissioned a Cert HE to support those who may wish to progress to nursing, however, this is not available for the assistant practitioner role at present. Example 3 working with the University of Southampton, University Hospital Southampton NHS Foundation Trust recognised the need for a Foundation degree for their staff to enable and encourage development of knowledge, skills and competencies relevant for access onto a number of health professions. Following a mapping exercise, the Faculty of Health Sciences at the university agreed a pathway from this Foundation Degree onto the second year of their BN (Hons) programme for those students who are interested in nursing as a career. This was because the content of their Foundation degree was exceptionally well suited to the BN programme. GCSE Maths and English at C grade is an educational requirement for all candidates when applying for the BN programme except for the students from this particular Foundation Degree. This is because there is an excellent medicines management module taught by practitioners providing relevance for the drug administration aspect of nursing, thereby removing the need for a further maths qualification. The Faculty will guarantee a place for the prospective student to attend an interview but not guarantee a place on the programme. Rachel Craine, Senior Policy Officer Rachel.Craine@cod-health.ac.uk 7