Award Not Enough

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

• A summary of the
  findings from the thesis The Effectiveness of National
  Vocational Qualifications in Residential and Nursing Homes: An
  Inquiry into the Potential for NVQ to Improve the Quality of
  Care and the full document are available from the PSSRU at the
  University of Kent from Lesley Cox on 01227 823963 or by mobile
  telephone on 07979 706323.

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

• 
  A Bebbington, Care Homes for Older People, Vol 2,
  Admissions, Needs and Outcomes, PSSRU, University of Kent,
  2001
• 
  Brown J and Harvey R, Fair Assessment in Vocationally-related
  Qualifications and NVQs, Qualifications and Curriculum
  Authority, 2001
• 
  Dalley G and Denniss M, , Centre for Policy on Ageing,
  2001
• 
  Nazako L, , second edition, Blackwell Science, 2000
• 
  Topss England, Quick Start to NVQs in Social Care,
  2003

CONTACT THE AUTHOR

Marion.Witton@ofsted.gov.uk