The Importance of Quality Training in Homecare

There is nothing more important in homecare than well-trained, compassionate staff.

Here UKHCA’s Learning and Development Specialist Jayne Easterbrook discusses how training has grown in emphasis and the support UKHCA can provide to both homecare organisations and their care staff.

United Kingdom Homecare Association Ltd (UKHCA) is the professional association of homecare providers from the independent, voluntary, not-for-profit and statutory sectors.

UKHCA helps organisations that provide social care (also known as domiciliary care or homecare), to people in their own homes, promoting high standards of care and providing representation with national and regional policy-makers and regulators. The Association represents over two-thousand members across the United Kingdom.

As the Learning and Development Specialist for UKHCA, I spend a lot of time discussing training issues with our members and reflecting on the best way to support them. Every provider will have slightly different requirements and I try to help them identify the level of training required, for their organisation and for individual staff training needs.

Homecare training needs to be specifically related to the sector, which is very different from residential care or health care. Homecare has a very particular set of requirements; staff require a unique skill set to enable them to provide care that meets a wide range of need.

To understand the need for high-quality training in the homecare sector, you need to understand the way the sector has evolved.

Back in the 1970’s older people received support from home helps supplied by the local council. Their role was to do light housework, with expressly no window cleaning, carry out a bit of shopping, collect the pension and provide cups of tea/sandwiches. Staff had minimal training, very few checks, certainly no DBS. The person receiving the service would tell the home help what they needed; there was no care plan or risk assessments. The service was not regulated until 1985 when the Social Services Inspectorate in England was set up as a professional division of the Department of Health.

In fact, the whole landscape in health and social care was different then, with healthcare both in hospitals and the community carried out by auxiliary nurses, enrolled nurses and staff nurses. Many of the tasks carried out by the auxiliary nurses and enrolled nurses are now part of the role of the social care worker. If an individual was no longer able to carry out the activities of daily living, the family would step in or the person would go into residential care. Thankfully, people now have more choice, and many choose to remain in their own home until the end of their life, with homecare support where needed.

By the 1980s and 1990s, with the advent of community care, homecare began to look more familiar with support with personal care, the preparation of food and drink, and continence care regularly delivered in the person’s own home. The local authorities initially continued to provide this service, but over the following years the majority of care was outsourced to private providers, initially many of the nursing agencies expanded to take on the work, quickly followed by the setting up of homecare specific organisations.

At this time, homecare regulation was on the horizon and the required training for careworkers was the induction and foundation standards that were first published in 2001, by the Sector Skills Council.

The Care Standards Act 2000 set out how the regulation and inspection of social care services would be carried out against Domiciliary Care Agency Regulations and the National Minimum Standards (NMS).  The regulator was to be the National Care Standards Commission (NCSC).

The National Minimum Standards set a target that by December 2005, in domiciliary care, 50% of all personal care by the provider was to be delivered by workers who were NVQ qualified. This target was planned to be achieved by 1st April 2008. There was funding provided to enable this (Train to Gain and European Social Fund) and although many staff completed the qualifications, the target proved difficult to achieve, from a workforce with few formal qualifications.

In April 2004, the Commission for Social Care Inspection (CSCI) became the independent inspectorate for all social care services, with a broader remit than NCSC. It was created by amalgamating the government’s Social Services Inspectorate (SSI) with the NCSC, and the Audit Commission. Standards of care were set; this included a list of mandatory training that would be required by frontline care staff. Local authorities were very robust with delivering this training to their own staff, but in the wider sector, the quality of training could vary a great deal.

In 2006, the induction foundation standards were replaced by the common induction standards, followed in 2009 by the Care Quality Commission replacing CSCI, to regulate and inspect both health and social care services in England.

Along with other changes, including the Care Act 2014, new legislation on safeguarding, data protection, health and safety and best practice, it is no wonder there was confusion as to what training was best.

Jump forward to the present time, where homecare provision has evolved into a highly skilled provision, which offers a range of care from companionship to complex care. There are more and more people requiring care, along with far less money available in state-funded care, and higher eligibility thresholds. individuals who do not meet the eligibility criteria are now paying for all or part of their care privately.

For busy providers, keeping up with the constant changes is a challenge. UKHCA provides members with information via email alerts and updates, if the changes affect the homecare sector. Members can also find detailed guidance from the many resources available on the UKHCA website and in the Homecarer magazine sent out to members. There is lots of other guidance in the public domain, but this is not necessarily homecare-specific.

The great thing now is people have more choice, and can stay at home instead of moving into residential care, but to enable this, a highly skilled workforce is required to deliver complex care and support.

Some providers specialise in providing specific types of care, for example, dementia care, end of life care, mental health or childcare. Therefore, the training that is right for one provider would not necessarily be right for another provider.

With the change of government in 2010, the targets for NVQ qualifications in the sector were finally scrapped, and the majority of current funding is now allocated to apprenticeships.

Frontline staff are no longer required to have an accredited qualification, although there are still vocational qualifications available such as Diplomas through the Regulated Qualifications Framework (RQF) and apprenticeship routes).

For homecare staff, the minimum training requirement is currently the Care Certificate. The Care Certificate came about following the Francis Inquiry into the Mid-Staffordshire NHS Foundation Trust. Times Journalist (now Baroness) Camilla Cavendish was appointed to undertake an independent review into healthcare assistants and support workers across health and social care. She found the quality of training and support they received in both health and social care varied greatly between organisations. So she recommended successfully that there should be a Care Certificate, which is a set of standards common to both health and social care, to standardise training across both sectors.

For many providers, there is far more essential training needed before careworkers are able to carry out their role competently. It is essential that homecare frontline staff receive training that will give them skills and confidence as many work alone, and often need to make decisions in unexpected circumstances. The manager and office staff, such as the care coordinator, need to be able to manage change and respond to challenging situations. Staff also need to be familiar with the policies and procedures of the individual organisation, in addition to generic training.

So exactly what training is required? Unfortunately, there is not a tick list for providers. Every organisation and member of staff is different.

Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 applies to staffing.

To meet this regulation, providers must provide sufficient numbers of suitably qualified, competent, skilled and experienced staff to meet the needs of the people using the service at all times and the other regulatory requirements set out in this part of regulation 18. Staff must receive the support, training, professional development, supervision and appraisals that are necessary for them to carry out their role and responsibilities. They should be supported to obtain further qualifications and provide evidence, where required, to the appropriate regulator to show that they meet the professional standards needed to continue to practice.

The training that is required, to satisfy the regulation, very much depends on the service provided. For most homecare providers training is required in addition to the Care Certificate to enable frontline staff to provide support that is safe, effective caring and responsive. This generally will include more in-depth training for medication, moving and handling, first aid, condition-specific training and much more.

For the homecare sector, providing effective training is often a challenge. There are several reasons why homecare providers face more challenges than residential providers. Firstly, logistics are a huge problem, with a dispersed workforce, just getting staff into the office for face-to-face training, whilst still covering the work is a challenge. There is also the challenge of meeting the cost both of the training and additional cover to ensure clients’ needs are met, at a time when funding for social care is at crisis point.

Unfortunately, the sector has a high turnover of staff, so the cost of continually training new staff is a burden on providers.

UKHCA has taken these challenges into account with the training we provide. For example, our train the trainer packages are a very cost-effective way to run in-house training and can be used multiple times at no additional cost. We have focused on training that members will need to ensure staff have the skills to deliver care, such as medication, dementia care and end of life care, which differ in homecare to other sectors in many ways. UKHCA also partner with Skills for Care to deliver the workforce development fund, a retrospective funding stream which enables providers to claim back some of their costs for qualification’s competed by their staff.

We also focus on ensuring key organisational staff have the support to lead the organisation effectively. This type of one-day workshop covers issues such as how to comply with CQC requirements, leadership, recruitment, and care coordinator responsibilities. All training is homecare specific.

As mentioned previously, the homecare sector is in a state of constant flux, so we also run workshops when major changes occur. These are often run for a set period until providers are familiar with the change and what it means for them. Previously, we have run workshops on the Care Certificate, Care Act 2014 and tendering for local authority contracts.

We also have a group of commercial members that supply training and consultancy. These members have a special interest in homecare, and understand the sector.

Some top tips for both UKHCA members and others who are planning training are:

• Your team are your greatest resource, providing training should never be an afterthought.
• Make the training meaningful. Don’t just do “refresher training” by repeating the same training to the same staff. Think about how you can develop the team.
• Check in your local area for additional resources you may be able to access (it does vary from area to area to area). Some local authorities and CCG’s provide free of charge or very reasonably priced training for providers who deliver care on their behalf.
• See what resources are available online. Often charities have resources available. (Alzheimer’s Dementia Friend scheme is free to join.)
• Remember homecare is ever-evolving, so it is vital to ensure you keep up to date with legislation changes, and new guidelines published (for example, by NICE).
• If you are using external training companies, make sure they understand the sector. Check out their credentials and ask for references. Word of mouth from other providers is a good way to find good training

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