Marion Witton is a qualified general nurse, mental nurse and health visitor. She has recently completed her doctorate researching the effectiveness of NVQs in residential and nursing homes. She has been head of the joint inspection unit in Barnet and has chaired the National Heads of Inspection and Registration. Currently she is divisional regional manager for the South East Region of Ofsted Early Years Directorate.
With an increasing number of much older people in residential homes with high dependency levels a better skilled and more numerous workforce is needed. The government has recognised this and requires 50 per cent of staff to attain a national vocational qualification in care level 2. This target, set as a result of the first national training strategy Modernising the Social Care Workforce,(1) did not take account of whether NVQs are actually effective in improving the quality of care to service users.
Where is this “qualified” workforce to come from when there are stubborn factors such as turnover of staff that inhibit it reaching adequate standards? Care is regarded as female-oriented work, so it tends to be seen as psychologically equivalent to the traditional care given by women at home and hence lacking professional status. But the requirements of residential care today cross the boundaries of health and social care. This can cloud the issues of who should do, or is capable of doing, such work, some of which was in the past carried out by qualified nursing staff.
I undertook a research project to determine whether the NVQ in care has the potential to create a quality workforce. Findings reveal that of the current care workforce, about 80 per cent have no qualifications at all, not even GCSEs or HNDs. And many still do not wish or feel capable of gaining qualifications of any kind. Indeed, many are fearful of the notion.
Their employers are often unsure of the benefits of helping staff
have their skills recognised, as qualified staff may leave for
better paid positions. Another obstacle is financial. There is no
single source for funding for social care education and training or
assessment.
The NVQ in care is itself largely misunderstood. Even the national minimum standards for care homes are misleading in assuming that a staff member holding an NVQ in care has been trained, or been required to attend an appropriate training course. In many cases, the conditions for learning are simply inadequate and it is common for NVQ candidates to have little concept of how to learn and to be given no help to discover how this necessary skill can be gained.
Achieving an NVQ in care is not dependent on being able to demonstrate competence in all aspects of care, as there is a choice of units for which candidates provide evidence. The extent to which the knowledge and skills of care staff are assessed and the standards of care that they provide in meeting the holistic needs of individual residents depends largely on the competence of the assessor. NVQ levels 2 and 3 in care are mainly concerned with personal care needs rather than the health care requirements of residents.
It is disturbing that contrary to the impression held by most people, even those with expertise and responsibility in the field of residential care, the NVQ does not include a training course.
Nor, in effect, does it train staff, many of whom struggle without proper support against the vagaries of the NVQ system, which must often serve to frustrate and demotivate them. Moreover there is substantial variation in the standard of assessment, which in itself lowers the real value of the NVQ.
So is the NVQ in care the answer to this set of problems? There are benefits to having a qualified workforce and there is, unquestionably if we are to raise the standard of residential or home care, a need for a qualification that recognises the skills of individual care staff.
But the qualification needs regular updating. At present, once an NVQ has been gained, there is no requirement for staff to update knowledge or skills. I would recommend that the NVQ should be updated every three years. There is also a clear need for national consistency of acceptable standards.
One way of moving toward this would be to make more NVQ units mandatory and fewer optional. Health care should be included in these mandatory units and the optional units should be more specific as to client group, for example dementia care. With the health care needs of older people growing in importance, the current assessed competence of staff through NVQ is not sufficient.
There should be a re-examination of the NVQ assessment process and the procedures for appointing assessors, how they are to be qualified and whether they should be line managers or externally appointed and verified.
There needs to be a determined, if longer term, project to encourage the understanding in the whole residential sector of the advantages of “professionalising” staff and raising their skills. The upgrading both in effect on standards of care and on public approval and support of NVQ would result in improvement in prospects for staff recruitment.
NVQs are assessment tools; they are not parts of a training course leading to a qualification. The government’s target for half of care staff to achieve at least NVQ level 2 in care focuses on an output measurement. It does not focus on the “outcome” - the effect on the quality of care through undertaking a qualification. Consequently, the contents of the units do not cover the holistic needs of older people.
As it is presently structured, the NVQ may be a red herring in
misleading many into thinking that those who gain it are trained
and qualified, when they may not be. It fails to satisfy the needs
of the residents, the purposes of the staff, the requirements of
employers or the aims of the government.
We have a duty, at least of moral force, to ensure that residents
of care homes receive the best possible care. This can only come
from a well-trained, properly qualified, appropriately assessed and
expertly managed workforce. A carefully-designed, well-structured
NVQ in care would contribute valuably to achieving this.
CC
ABSTRACT
The government had a requirement for 50 per cent of care staff to be qualified to at least NVQ level 2 in care by this year. The decision was taken with no evidence that the NVQ in care is the best qualification to ensure residents’ needs were met. This research is to determine whether the NVQ has the potential to improve the quality of care for these vulnerable older people.
ABOUT THE RESEARCH
Interviews were held with representatives of six training providers contracted by Kent Council to provide training and assessment to care staff undertaking NVQ level 2 and 3 in care. Interviews were also carried out with care staff working in residential and nursing homes, who were registered with the training providers.
REFERENCES
(1) Topss England, Modernising the Social Care Workforce - The First National Training Strategy for England, 2000
FURTHER READING
CONTACT THE AUTHOR
Marion.Witton@ofsted.gov.uk
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