Advisory or Mandatory?

When is mandatory training not mandatory?

Apparently when it applies to the social care sector.

There’s something a bit wishy washy about labelling training as mandatory when there is no actual requirement to complete said training. Or worse still, when there is a stated ‘requirement’ to do the training (by the CQC) but there are no real consequences when the training is not completed. Unless you count a slightly lower inspection rating as a real consequence. Is it just me or is it slightly baffling that there is no legal requirement to complete any training in the delivery of social care?

Care providers themselves determine whether a training course is mandatory or not. Some will deem it mandatory while others will consider it optional. While the CQC may require that a service trains their staff to a minimum standard, this is not legally binding. It seems training is a ‘should do?’ rather than a ‘MUST DO!’

The training of care workers in the new Care Certificate is advisory rather than mandatory. The Care Certificate which is promoted as the basic or minimum entry level course is not actually a qualification as we understand the term.  It is not on the National Qualification Framework (NQF) but it is considered a Continuing Professional Development (CPD) course. This is a fantastic introduction to the world of care work and is indeed a minimum requirement for care workers. It is not, alas, mandatory unless deemed mandatory by the care provider.

We have a long way to go before we have a professionalised and regulated social care workforce. There are many reasons why it is important to achieve this. First and foremost is the quality it will bring to the care of the growing number of elderly and vulnerable people in our society. Secondly it will attach a greater value to this incredibly important work and allow carers to follow a career path with pay scales that reflect the importance of this work.  Is it the case that the current status of care work is an accurate reflection of how we as a society value care work? That is, not very highly. We are quick to jump on stories of poor care and express horror and outrage when people are abused and otherwise mistreated but when we scratch the surface a little and look at the way workers are trained and what they are paid, it is clear that the explanations for these behaviours cannot be simply dismissed as the actions of ‘rogue carers’.

Better pay will in turn attract and hold on to the right calibre of person needed by this growing social care sector. The resulting lower turnover of staff will add to the stability of the workforce which, again, will benefit the end users.

A better trained workforce with professional status will help care workers achieve something approaching parity with their health sector counterparts. This in itself will go a small way to greasing the wheels on the journey to an integrated health and social care system. The disparity in training, pay and conditions does nothing to facilitate the team spirit needed when workers are required to work across professional and organisational boundaries in the pursuit of an integrated health and social care system.

There’s an old adage that ‘Ignorance is no defence in law but training is’. I’m sure the day will come when training is, itself, a legal requirement. 

Integrating Health and Social Care

Integration of health and social care has been on the agenda since the turn of the century and has been talked about for a good deal longer. Will we still be talking about it at the turn of the next century or will someone actually be doing something about it?

Is your organisation doing something about it or are you, like the majority, merely paying lip service to what is, admittedly, a noble cause?

The logic is faultless but the application seems to be a good deal more complicated than some would have us believe. We know it’s desirable but is it really possible to bring two systems together to work seamlessly in the delivery of care? It can be difficult enough to get professionals of a similar discipline to work as a team when managing complex health and care packages. When we ask them to work across professional and organisational boundaries we’d better make sure the infrastructure is there to support them. But what is this infrastructure? What does it consist of and who is going to take responsibility for maintaining it? Are the differences in culture so different that we will never truly have an integrated system?

Multidisciplinary teams already exist to manage complex needs. We only need to look at the cases of NHS continuing healthcare to see that it is possible for decisions about health and social care to be made coherently and it is a credit to many of those teams that they can unpick the myriad of needs affecting patients and put together packages of care that meet the needs of the whole person and indeed the needs of those around them. It strikes me however, that it is not so much the decision-making or the ‘design’ but the implementation of those decisions and designs that is the real challenge of integrating health and social care. I wonder whether the fundamental differences in a)culture and b)training for clinicians in healthcare, as opposed to those in social care,  are such that there will never really be a genuinely integrated health and social care system. This sounds defeatist from the outset but I think it highlights just two areas (and there are many more), that need to be addressed if we are going to achieve this holy grail of a truly integrated health and social care system.

It’s worth shining the spotlight on some of the most complex cases requiring input from health and social care services. The provision of NHS continuing healthcare, by definition, applies to people with long term health and social care needs where the dominant need is deemed to be a ‘health care need’ as opposed to a ‘social care need’. So here’s the thing, what is the difference between health and social care? When does one begin and the other end?  As with many other things, it is the boundary, the borderline, the areas that are most difficult to define, where clarity is needed. It is at these professional and organisational boundaries where problems arise and where problems must be resolved in order for integration to occur.

We will consistently be returning to the questions of infrastructure and health versus care culture. It is surely a given that training will be key to any integrated system of health and social care. It is clear that joined up working can only be enhanced by joined up training. It is not entirely clear to me at present which organisations are really taking the lead in this integration of health and social care at a local level. NHS organisations and Local Authorities certainly have responsibility to design such a system but where is the guiding light? Where is the beacon that shows that people are receiving a genuinely joined up, integrated health and social care system? Is such a thing possible?