Behaviour Matters

Archive for July, 2012

The Minefield of Training

With all the regulations, legislations, standards, quality inspections, information giving and Government departments any one would think that planning a training strategy and identifying training needs in health and social care would be quite simple.  This is not the case!


First we use at a little bit of common sense as a guide.  Health and social care, three key words that define what you do and so describe the sort of training needed to do the job. 


Health is obviously part of Health and Safety at Work Act 1974, so everyone working in the sector needs to have some health and safety training.  After all the Act does say something along the lines of every person is responsible for the health and safety of them selves and any other person in the environment.  But when you read the Health and Social Care Act 2008 (Regulated Activities Regulations 2010), you find that the “registered person must, as far as is practicably possible, ensure that persons…are protected against identifiable risk…”  So now who is to take responsibility, who needs the training and to what level?  We look to the Care Quality Commission, ‘What standards you have the right to expect from the regulation of your care home.’  In this leaflet it tells us that “you will not be harmed by unsafe or unsuitable equipment” and that you will be cared for staff who have the knowledge, skills and experience needed to meet your health and welfare needs.” Another anomaly,   the responsibility has returned to the staff member and not just the registered person.  Or is the registered person any person who delivers care?  Back to the Health and Social Care Act 2008 (Regulated Activities Regulations 2010) where we find that the registered person is “in respect of a regulated activity, a person who is the service provider or registered manager in respect of that activity.”  Still a little unclear but I understand that to mean that the registered person is the registered manager, not necessarily the owner or the staff member.  But ultimately I believe (although have no evidence to show) that in a conflict of legislation the HASAW 1974 always take precedence. 


All of that shows us that every person working in any environment needs to have some training in health and safety, but to what level? I will come back to that point. 


Next on the training list of common sense would be care.  Common sense would say that you need to provide training to ensure you can care effectively.  You would be right, and to be more specific the Health and Social Care Act 2008 (Regulated Activities Regulations 2010) part 4 says that you, the registered person, needs to

  • Take proper steps to ensure that each service user is protected against risk of receiving care or treatment that is inappropriate or unsafe…
  • Protect service users and others who may be put at risk against the risks of inappropriate or unsafe care or treatment…
  • Make suitable arrangements to ensure the service users are safeguarded against abuse…
  • Ensure that service users…are protected against identifiable risk of acquiring infection…
  • Protect services users against the risks associated with unsafe use and management of medicines…
  • Ensure that service users are protected form the risks on inadequate nutrition and dehydration…
  • Ensure that service users…are protected against the risks associated with unsuitable or unsafe premises…
  • Make suitable arrangements to protect service users…who may be at risk from the use of unsafe equipment…
  • Ensure dignity, privacy and independence of service users and that service users are able to make, or participate in making, decisions relating to their care or treatment…
  • Have suitable arrangements in place for obtaining, and acting in accordance with, the consent of service users…
  • Have effective system in place for identifying, receiving, handling and responding appropriately to complaints made by the service user…
  • Ensure that service users are protected against the risks of unsafe or inappropriate care and treatment arising from lack of proper information about them…
  • Operate effective recruitment procedures…
  • Take appropriate steps to ensure that at all times there are sufficient numbers of suitable qualified, skilled and experienced persons employed…
  • Have suitable arrangements in place in order to ensure persons employed…are appropriately supported in relation to their responsibilities…
  • Make suitable arrangements to protect the health, welfare and safety of service users…


Some of that is about safety, but part of caring is to ensure people are safe.  The CQC also mention that the quality of care you can expect will meet your needs.  So in all of that we can clearly see there is a need for some training here too.  


Looking a bit deeper into the job description of a typical care in a typical health and social care setting, there are a number of other jobs and tasks that would require specific training.


For example many individuals who are cared for will be on medication either short or long term.  There is another piece of legislation to cover this, in fact there are a few.  Medication can be covered by the Control of Substances Hazardous to Health 2002, Health and Safety at Work Act 1974, Health and social care act 2008 (regulated Activities) Regulations 2010, Care Standards Act 2000, Mental Health Act 2007, Capacity Act 2005, Human Rights Act 2000, are just a few. Not to labour the point too much but suffice to say that before you can even think about administering medication you need to have training.  All of these laws will tell you the same thing.  But the other main point to remember is that the person receiving medication must consent, even if it would be detrimental to their health, if they have the capacity to decide they should decide.


Manual Handling is another area where training is needed. All of the legislations listed above cover this activity as well.  I would go as far as saying that any activity you can think of, any task you may be asked to do, and any eventuality you can think of will be covered by legislation some where. 


We have all of these laws and guidelines and regulations but what do they actually mean for you as a manager or owner.  How much training is appropriate? Who can deliver the training?


To make it slightly easier to understand you can look at the training in two different areas; statutory and mandatory.  During my research on this topic I found a chapter of a book that explains the differences clearly.


“Statutory training is determined by legislation including the Health & Safety at Work Act 1974, the Employment Relations Act 1999 and the Race Relations Amendment Act 2000. Mandatory training includes skills and knowledge training for all staff (some specific to certain staff groups and disciplines) and this is determined by the organisation’s policies, government guidelines and sector specifications.” (


This still does not inform us of the level of training needed.  Do staff members need to be competent or have awareness? Do they need to prove knowledge by submitting a portfolio of evidence or sit an examination?  To answer these questions the legislations do not help.  We need to look at industry standards and Government policies. 


Care Quality Commission is the regulatory body for all health and care settings in the country (with the exception of child care facilities who are regulated by OFSTED).  It is there job to ensure that any care that is being provided meets the Government standards of quality and safety.  There are five standards; you should expect to be respected, involved in your care and support, and told what’s happening at every stage. You should expect care, treatment and support that meet your needs.  You should expect to be safe. You should expect to be cared for by staff with the rights skills to do their jobs properly. You should expect your care provider to routinely check the quality of their services. 


Surprisingly though there are no specific minimum entry qualifications for the role of a care worker in England, Scotland, Ireland and Wales may be different.  To comply with the Government standards and the legislation a potential carer will need to complete a Criminal Records Bureau check, and they may be expected to complete an industry standard induction.  There are many induction packs that can be purchased on line, some companies will design a setting specific induction, and it is also possible to complete an induction on line.  I am unsure of the quality and suitability of some of these forms of inductions, there may be little in the way of measuring understanding or validity, but they are acceptable.  A simple induction will give employees a level of awareness but not necessarily any competence.  So further training is required to ensure employers can meet the government standards of care.


Now I return to the health and safety training and task specific training.  What level of qualification is required?  If staff members are required to handle, or prepare or assist in storing of foods they need to have a minimum of entry level food hygiene that is designed to fill the needs of food safety legislation.  In fire safety the minimum requirement for a care worker is to demonstrate the required competencies of fires safety and evacuation, which are to prepare for emergency situations, report emergencies, react safely and evacuate.  As for moving and handling,  well we can now return to legislations; Health and Safety at Work etc Act 1974 (HSWA)[3], Manual Handling Operations Regulations 1992 (MHOR) (as amended 2002), [4]Management of Health and Safety at Work Regulations 1999[5], Provision and Use of Work Equipment Regulations 1998 (PUWER)[6], Lifting Operations and Lifting Equipment Regulations 1998 (LOLER).  All of the legislation tells us that before using any lifting machinery individuals need to be trained. Employers must reduce the risk of injury to staff and people using care services by:

  • avoiding      those manual handling tasks that could result in injury, where reasonably      practicable
  • assessing      the risks from moving and handling that cannot be avoided
  • putting      measures in place to reduce the risk, where reasonably practicable

Employees must:

  • follow      appropriate systems of work and use the equipment provided
  • co-operate      with their employer and let them know of any problems
  • take      reasonable care to ensure that their actions do not put themselves or      others at risk




In summary then the facts about training in Health and Social Care are


  1. You need      no qualifications to enter the profession
  2. You only      need minimum qualifications in all areas once employed as a carer
  3. Any      person can deliver the induction training (even a computer can do it)
  4. Some      training, as described in legislation, needs to be delivered by a      competent person
  5. Having      an understanding of a topic is enough.
  6. You need      to have a CRB completed


The Government standards are


  1. You      should expect to be respected, involved in your care and support, and told      what’s happening at every stage.
  2. You should      expect care, treatment and support that meet your needs. 
  3. You      should expect to be safe.
  4. You      should expect to be cared for by staff with the rights skills to do their      jobs properly.
  5. You      should expect your care provider to routinely check the quality of their      services. 


From this information I am unsure how the two can work together in keeping people safe and ensuring staff members have the right skills for the role they are undertaking.


I would expect a minimum of a level 2 qualification with an understanding that a level 3 is completed with in 2 or 3 years of service.


Training that is delivered by professionals who have an understanding of the industry due to experience. 


Training that is focussed on the service user being at the centre of the provision.


That carers are rewarded for meeting all training target and longevity of service.


Ultimately I would like to see a highly skilled workforce which is doing a fantastic job because they have compassion and empathy for it and not because it is a job that pays them a minimum wage, but better than not working.