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
    ,(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


    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


    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


    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


    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


    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.

    • 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
      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.


    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



    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.



    (1) Topss England, Modernising the Social Care Workforce – The
    First National Training Strategy for England
    , 2000



    • A Bebbington, Care Homes for Older People, Vol 2,
      Admissions, Needs and Outcomes, PSSRU, University of Kent,

    • 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,

    • Nazako L, , second edition, Blackwell Science, 2000

    • Topss England, Quick Start to NVQs in Social Care,


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