The unregistered health and social care workforce plays an increasingly crucial role in care provision, and its ability to respond appropriately to clients’ needs greatly influences the quality of care. In recognition of this, the Department of Health and Social Care (DHSC) recommended that, from April 2015, all newly-recruited care workers in England should undertake Care Certificate training. On average, this training takes 12 weeks of blended learning, covers 15 fundamental topics in health and social care, and is intended to provide care workers with transferable skills to take between care organisations.
To investigate whether the Care Certificate is having the desired impact of improving the training, competence and career development of care workers, a national evaluation has been undertaken, involving a partnership between the University of Nottingham and Nottinghamshire Healthcare NHS Trust. This took 18 months and was funded by the NIHR Policy Research Programme. It aimed to evaluate the effectiveness of the Care Certificate and its implementation.
Collecting the data
A national telephone survey was carried out, speaking to people who had responsibility for the training or induction of care staff. The care organisations surveyed were randomly selected from the CQC database.
The survey questions focused on the approaches and challenges of implementing and delivering the Care Certificate training and its impact on the organisation, care workers and service users.
Further in-depth evidence about the implementation of the Care Certificate was collected through qualitative studies of ten care organisations, including NHS Trusts, care homes, and domiciliary care providers. These organisations had been identified as being able and willing to participate in a site visit. Interviews and focus groups with care workers, trainers and managers at these sites were used to explore their experiences of the training as well as potential barriers to successful implementation and outcomes.
Care Certificate implementation
Of the 401 organisations that took part in the telephone survey, 352 had implemented the Care Certificate training for new care staff. Most respondents (65%) felt that the Care Certificate had led to a positive or very positive impact on their organisation. As such, it was widely welcomed as providing a standardised approach to improving the skills of those new to care, better preparing them for their role and enhancing their sense of confidence and achievement.
There was considerable variation in the way that the Care Certificate training was being delivered, to whom, and over what period. Some organisations chose to train their staff to assess care workers undertaking this training, as well as providing regular training updates to all their staff, while others did not.
Most organisations used a variety of training methods, combining computer, classroom, and clinically-based approaches. These mixed methods were felt to be particularly effective as they allowed participation and enabled care workers to network, reflect and learn from the experiences of colleagues. Some organisations also chose to adopt a broad approach in the delivery of the training, aiming it not just at newly-recruited care workers but also a broader cross-section of their workforce.
This diversity in patterns of training delivery reflects the flexibility of the training itself, allowing the adoption of a bespoke and site-specific approach. However, the inconsistency between organisations in the training’s implementation could undermine the credibility of the Care Certificate, as well as its use as a transferable qualification to support the movement of care staff between organisations. This has led to calls for greater regulation and standardisation in Care Certificate training.
As a result of scepticism about the quality of any prior training and the lack of external validation of this training, most participating organisations surveyed required new recruits who had completed their training elsewhere to repeat some or all of it.
Organisation size, leadership, capacity and resources were all major factors in determining the effectiveness of Care Certificate implementation, with health organisations reporting more positive responses than social care organisations.
Where organisations had significant resources to devote to the training, it was also more likely to be perceived in a positive light. Many larger organisations spoke of the way in which the support of a training team facilitated the development of the training and its assimilation into their existing induction programmes. Conversely, smaller organisations, such as independent care homes and home care providers, were more likely to struggle, either not implementing the Care Certificate at all or facing issues such as a lack of capacity, resources and leadership to support implementation.
The research drew a number of recommendations about the implementation of the Care Certificate. It found that Care Certificate training appears to be most effectively delivered when it involves regular updates and assessor training. This helps to promote the quality and credibility of the training and its sustained impact. Furthermore, the adaptation of existing materials in order to meet Care Certificate standards helps to avoid the duplication of work and promotes a seamless transition from one mode of training to another.
Care staff should be encouraged to ‘own’, value and be aware of their continued professional development through such things as Care Certificate presentation ceremonies. To facilitate the transfer of learning, confidence and competence, training should allow for peer support, mutual reflection and mentoring and incorporate participatory and experiential approaches as well as practical and classroom components.
A similarly broad approach can also be beneficial when selecting team members to train, including not just newly-recruited care staff but also longer-established staff, health professionals and care leaders within each care organisation. This will help to promote the awareness and credibility of the training and its impact on workplace culture.
Guidelines on the Care Certificate, such as those developed by Skills for Care , should be updated to incorporate greater clarity on its delivery and implementation. Support and guidance should be particularly targeted at smaller care organisations through such things as the development of local workshops, networks and mentor schemes.
The Care Certificate was formally introduced in England in April 2015 as a means of assuring fundamental skills in front-line care and to improve the quality of this care. This national evaluation of the Care Certificate has shown that the training has been widely adopted throughout care organisations and generally welcomed as a positive development. This adoption has often involved the adaptation of existing training materials, easing the process of transition, and has tended to take a flexible approach, helping to meet the specific needs of different care organisations.
However, greater guidance and support is required to facilitate implementation and to promote the credibility and transferability of the Care Certificate.
This summary is based on independent research commissioned and funded by the NIHR Policy Research Programme (Evaluating the Care Certificate). The views expressed in the publication are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health, ‘arms’ length bodies or other government departments.
Acknowledgement is made to the contribution of the research team in the performance of this evaluation including Louise Thomson, Elaine Argyle, Zaynah Khan, Justine Schneider, Antony Arthur, Jill Maben, Heather Wharrad, Boliang Guo and Julian Eve.
Further information about the evaluation can be found on the Institute of Mental Health website.