How to improve health and social care unregistered staff’s education and development

Richard Griffin MBE is Visiting Senior Research Fellow, King’s Business School. (434 words)

I write a fair bit about the challenges and barriers support workers can face. Research by King’s College London and others has identified persistent issues such as poor job design, lack of funding for training, pay levels that too often do not reflect the extended nature of the roles and poor progression pathways. I thought though, particularly in the run up to the Royal College of Midwives’ annual Maternity Support Worker Week (23-27 November) and the Royal College of Nursing’s first Nursing Support Worker Day (23 November), I would set out my views of some of the ways these problems can be addressed in the NHS.

  1. Be clear about the roles and responsibilities support workers can – and cannot – undertake. This means listing clinical and other tasks.
  2. Establish the competencies (knowledge, skills and behaviours) support workers need in order to perform those roles and responsibilities.
  3. Agree the minimum entry-level qualification requirements needed at bands 2, 3 and 4 (or equivalent).
  4. Agree the minimum amount and type of experience required. For example, are new recruits expected to have some experience of working in a health or social care environment previously?
  5. Agree common job titles. The number of different titles for the same role continues to stagger me and must confuse the public.
  6. Map competences against apprenticeship standards but identify gaps in provision including steps into pre-registration degrees. Get these right and support workers will have access to a consistent national learning curriculum.
  7. Ensure best practice in respect of supervision and delegation.
  8. Create an expansive learning culture that is supportive of the whole workforce’s development.
  9. Leadership. Throughout the system leaders need to advocate clearly the contribution support workers make to care and that should start at the very top.
  10. Ensure consistent and sufficient funding for training and development (not just for apprenticeships).
  11. A feature of delivering these steps successfully is partnership working including with trade unions and professional bodies but also education providers, employers and the support workers themselves.

Are the above being delivered anywhere? Yes. Maternity, led by Health Education England, is leading the way nationally [1]. The approach taken to developing the Nursing Associate, albeit focused on a single role, is also encouraging [2]. There are signs other professions are beginning to systematically look at maximising the contribution of their support workers.

Richard Griffin MBE is Visiting Senior Research Fellow, King’s Business School.

Notes

  1. See: https://www.hee.nhs.uk/our-work/maternity/developing-role-maternity-support-worker/boosting-delivery-hee-national-maternity-support-worker which includes an economic evaluation undertaken by KCL of the return on investment on apprenticeships for Maternity Support Workers
  2. See: https://www.kcl.ac.uk/research/nursing-associates

Understanding the impact of COVID-19 on ethnic inequalities in health and social care – Have your say!

Introducing a King’s College London study examining inequalities experienced by people from racial and ethnic minority groups working in health and social care during COVID-19. (570 words)

Prof Stephani Hatch

Leading the study: Stephani Hatch, Professor of Sociology and Epidemiology in the Department of Psychological Medicine, King’s College London

We have launched a study to help improve working conditions and to tackle the inequalities experienced by people from racial and ethnic minority groups working in health and social care during the COVID-19 pandemic. Based at King’s College London, we are working in partnership with NHS England Workforce Race Equality Standard, NHS Confederation and the Royal College of Nursing. The study findings will be used to develop education and training materials (e.g. Virtual Reality training) available nationally to all staff, specifically to better support and improve the workplace experiences of NHS and social care staff from Black, Asian and minority ethnic groups.

COVID-19 pandemic

The pandemic has shone a light on existing inequalities that have a great impact on Black, Asian and minority ethnic communities. These communities are approximately 14% of the population in England and Wales, yet they have had greater exposure to the virus and are more likely to have poorer outcomes, including severe health complications and death. We have also seen that higher numbers of racial and ethnic minority health and social care workers have died from COVID-19. Despite making up 21% of the NHS workforce, 63% of those who died from COVID-19 were from racial and ethnic minority groups. What is less often known and discussed is that health and social care staff from racial and ethnic minority groups experience greater levels of workplace harassment and discrimination compared to other staff and these experiences have been compounded by the pandemic. This can have long-lasting effects on their health, wellbeing, and their ability to do their job. Continue reading

Evaluating the Nursing Associate Role: Initial Findings

Interim Report

Ian Kessler is Professor of International HRM at King’s Business School and Deputy Director of the Policy Research Unit in Health and Social Care Workforce (HSCWRU). Prof Kessler is lead author of the Interim Report and two case studies from the HSCWRU Nursing Associates study, published today. (1,624 words)

Film of webinar (23/11/20) where Prof Kessler discussed these findings.

We are conducting a survey of senior health and social managers on the use and management of the nursing associate role. The survey is open until 18 December 2020.

The introduction of the Nursing Associate (NA) role in England represents a decisive step towards changing the structure of the nursing workforce, with a view to improving the quality of health and social care. Originally proposed by the 2015 Willis report on nurse and care assistant education[1], as ‘a bridging role’ between the care assistant and the registered nurse, the NA has emerged in NHS England as a pay band 4 role, requiring a two-year level 5 qualification, registered with and regulated by the Nursing and Midwifery Council (NMC). The NA programme was launched in early 2017 in two waves 11 pilot and 14 ‘fast follower’ sites, respectively taking-on 1,000 Trainee Nursing Associates (TNA). There were subsequent waves, with 5,000 TNAs recruited in 2018 and 7,500 in 2019. It is a role which attracts interest given its capacity to address a variety of workforce and care management goals. However, as with the introduction of any new role, there are organisational challenges to be faced in ensuring that it becomes established at the workplace level and accepted by the various actors with a stake in it, including nurses, managers, healthcare assistants and service users. Continue reading

Grow your own – an idea whose time has come (again)

Richard Griffin MBE is Visiting Senior Research Fellow, King’s Business School. (869 words)

Back in 2010 I produced a paper for the Department of Health with the snappy title of Widening Participation Into Pre-registration Nursing Degree Programmes. Nursing was becoming an all degree profession and there was a concern at the time that this might narrow the pool of future recruits as vocational routes were closed. The document mapped pathways up to and into pre-registration degrees for existing support staff, including via the then current version of apprenticeships. It also set out the wider benefits of a “Grow Your Own” (GYO) approach to workforce development and recruitment. These included, not only securing future labour supply, but also helping ensure that the NHS workforce better reflected its local population, supporting diversity and reducing turnover.

Fast forward a decade and I’m having a conversation with an NHS Trust who had hoped to recruit from their existing support staff on to a degree apprenticeship. There is no shortage of candidates, but it appears the step up from support role to a pre-registration degree is too large for staff and the Trust is unable to recruit. The 2010 paper, which I repeated for Camilla Cavendish’s review three years later, made the point that GYO needs to be “end-to-end”, starting even before employment begins and delivering investment in the formal education of support staff at every level, creating clear pathways to mobilise what we called back then, the NHS “skills escalator”. GYO seeks to create progression steps creating horizontal and verticals career routes, avoiding the “gap” problem experienced by the Trust I was talking to. Continue reading

Fair Care Work: A Post COVID-19 Agenda for Employment Relations in Health and Social Care

Ian Kessler, Stephen Bach, Richard Griffin and Damian Grimshaw introduce their new paper, Fair care work. A post Covid-19 agenda for integrated employment relations in health and social care, published yesterday by King’s Business School. Lead author, Professor Kessler, is Deputy Director of the NIHR Policy Research Unit in Health and Social Care Workforce. (908 words)

The courage and sacrifice of the health and social care workforce have emblazoned themselves on the national consciousness as the challenge of COVID-19 continues. While classified as ‘key workers’, along with other occupations essential to the community in times of crisis, the distinctive contribution of frontline care workers, reflected in their direct and relentless engagement with the virus, has until recently been reflected in the Thursday night applause reserved for them. This public applause sits uneasily, however, with the treatment of over two million health and social care employees, mostly women, often from black and minority ethnic backgrounds, typically in undervalued, relatively low paid and insecure employment. In a new paper, we seek to kick start a policy debate on the development of fair care work, to stimulate discussion on a refreshed employment relations (ER) agenda which acknowledges and reflects the worth of care workers to our individual and communal well-being. Continue reading

International Women’s Day, 8th March 2020: Remembering the achievements for health and social care of some great women in South London

Caroline Green, who is NIHR ARC South London Post-Doctoral Fellow, reflects on the lives of prominent women figures in the health and social care context in South London. (838 words)

International Women’s Day is an annual celebration of the achievements of women and a day to put special emphasis on raising awareness of gender bias and taking action for gender equality. Women contribute significantly to England’s health and adult social care. The adult social care workforce is dominated by women, with 83% of the workforce being female. In 2017, 77% of NHS health workers were women. However, beyond “holding up” England’s health and social care system, women have revolutionized it at many points in time. This blog post looks back at some significant female figures in South London, who have shaped health and social care either directly or indirectly. This list is of course not exhaustive. Countless women with a diversity of backgrounds are driving today’s health and social care provision in South London and have done so for many years. Yet, the stories of the women below offer an indication of the rich female history of health and social care in this part of London:

Florence Nightingale (1820-1910)

Florence Nightingale is widely considered the founder of modern nursing and a social reformer of health and social care. She first gained prominence as a manager and trainer of nurses during the Crimean War, looking after wounded soldiers. In 1860, she established the nursing school at St Thomas’ Hospital in London, the first secular nursing school in the world, and now part of King’s College London. Many say that Nightingale here laid the foundation of professional nursing, with the International Nurses Day celebrated annually on her birthday. Nightingale’s social justice work extended to the abolition of prostitution laws, advocating for hunger relief in India and expanding acceptable forms of female participation in the workforce. Continue reading

Is the answer to the NHS workforce crisis right in front of its eyes?

Richard Griffin MBE,Visiting Senior Research Fellow, King’s Business School, today begins a series of guest posts on the healthcare workforce. He argues that, in the face of the widely acknowledged problem of shortages in this workforce, we should turn to current NHS support staff for part of the solution. (477 words)

Workforce is the biggest challenge facing the NHS. Not only is it short of 50,000 nurses, it also needs more podiatrists, midwives, radiographers and a host of other occupations. Total vacancies are approaching 110,000.

Whilst the government is committed to addressing this shortfall, a key question is – where will all those extra nurses, podiatrists, midwives and radiographers come from? Continue reading

A National Workforce Plan for Approved Mental Health Professionals

Stephen Martineau was at a day conference last week focusing on a new national workforce plan and proposals to introduce AMHP service standards as well as changes to the AMHP competencies. (1,030 words)

Recent empirical research at this Unit on the Approved Mental Health Professional (AMHP) workforce has focused on why so few in the eligible health professions are taking up the role. AMHPs are responsible for organising and undertaking assessments under the Mental Health Act 1983 (MHA) and, where statutory criteria are met, authorising detention under the Act. Traditionally a social worker role (they were formerly known as Approved Social Workers), it has been open to occupational therapists, learning disability and mental health nurses, and psychologists since November 2008. But about a decade since these professionals were enabled to become AMHPs, they still only make up around 5% of the AMHP workforce. Continue reading

National study starts of new nursing role

How can the new Nursing Associates help resolve some of the workforce recruitment and retention problems in health and social care? A new King’s College London-led study is finding out the answers to this question and it will also be seeking the views and experiences of patients and people using care services of these new staff. The study, funded by the National Institute for Health Research (NIHR) at the NIHR Policy Research Unit in Health and Social Care Workforce, will be the first to gather information, statistics and experiences of the new Nursing Associates in practice and from people supporting them. Continue reading

Promoting the importance of human relationships: hospital social work

Jo Moriarty, Senior Research Fellow at the NIHR Health & Social Care Workforce Research Unit, King’s College London introduces the new hospital social work report, which she wrote with Dr Nicole Steils and Prof Jill Manthorpe. World Social Work Day is on 19 March 2019 #WSWD2019 is the official hashtag. (602 words)

Mapping Hospital Social WorkThe theme for next week’s World Social Work Day is ‘promoting the importance of human relationships.’  In preparation for this we are launching our report into hospital social work, which was funded by the National Institute for Health Research Policy Research Programme at the request of the Chief Social Worker for Adults, Lyn Romeo.  Lyn has also kindly written the report’s foreword.

The origins of hospital social work lie in the decision made by the Royal Free Hospital in 1895 to appoint Mary Stewart as the first ‘lady almoner’. Her role was to interview people to decide who would be eligible for the free medical treatment that the hospital provided.  Other hospitals soon followed this example and by 1948, the Institute of Almoners had over 1000 active members.[1]  Written in the style of the time, Flora Beck’s textbook for almoners noted that their two key tasks were:

… to determine whether social problems are likely to have a bearing on the patient’s illness. The second is to make the patient feel that here is a person with whom he could, if necessary, discuss his personal difficulties; someone to whom he need not mind admitting any trivial misunderstanding which had been bothering him, and to whom he could reveal serious and confidential problems without embarrassment.[2, cited in 3] Continue reading