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

Intervention

Characteristics

Outer Setting

Inner Setting

Individual

Characteristics

Implementation

Process

Adaptation of the Care Certificate

Portability; Accreditation of prior learning;

Quality assurance

Logistics; Peer support; Completion & recognition

Motivation to learn; Literacy; Prior experience

Size and infrastructure; Organisational support;

Scope; Recruitment

Qualitative Themes on Barriers and Facilitators

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?

What examples

of good practice

can I share?

How can smaller care

organisations be supported to

deliver high quality Care

Certificate Training

Thank you for coming!