Impact of the Care Certificate

Four themes emerged from the data concerning the impact that the Care Certificate was perceived to have on care workers and care organisations.

6.3.1.1 A basic foundation for those entering the Care Sector

An important aim of the Care Certificate is to provide a basic foundation in care and an introduction to the employing care organisation. As such, most study sites regarded it as a positive tool for setting up care workers with the minimum standards to work within the health and social care sector, ensuring that they are delivering a high standard of care at all times:

‘‘I feel like it has made everyone more aware and conscious of requirements for care, the minimum standards shall we say. It is a benchmark now that we can measure not only new staff off but also existing staff.” (Study site 6- Stakeholder)

‘‘It captures everybody's learning styles that you've got, you know visual and they've got the workbooks to do so they've got revision and then you've got the practical stuff as well so it appeals to everybody's learning styles.’’ (Study site 5- Key Stakeholder) Participants usually acknowledged that while the Care Certificate can be important for staff with previous experience and knowledge, it is generally more valuable for those completely new to care. This can include staff from other countries who may be unfamiliar with care conventions in the UK.

I don't think it's been as impactful for the staff that we've recruited that have already got existing experiential knowledge and qualifications, but for the ones that are completely green, for want of a better phrase, I think it has been very helpful.’’ (Study site 8- Stakeholder)

This was echoed by care workers themselves, who felt assured that they were working to the standards set out in the Care Certificate, which provided a firm and comprehensive foundation for their work. Care workers who completed the Care Certificate appreciated its potential for generalising to other work domains:

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‘‘Yes, not only that, if you're going to work in the adult sector, you might come across a child visitor and they might need something, and you've been trained to cover all bases.’’ (Study site 7- care worker with the Care Certificate)

‘‘I think it's good because I feel like without it there wouldn't be a standard necessarily put in place. I think that immediately you get to know what's expected from the job and without it I think your knowledge would be limited.’’ (Study site 5- care worker with the Care Certificate)

Nevertheless, there was flexibility in its delivery depending on the levels of experience of care workers, with ‘self-assessments’ determining existing knowledge levels being

commonly used with new care workers before they commenced training, so that this training could be tailored to meet their specific needs. This was found to be useful by an employee who was new to the health and social care sector:

‘‘I made it clear that I'd never been in the industry before, so she went through a lot more in detail, because some of the others had been in the industry, so when they came in, they had more knowledge.’’ (Study site 1- care worker with the Care Certificate)

6.3.1.2 Greater confidence, knowledge, and understanding

The introduction of the Care Certificate was felt to have improved care workers

understanding of the care sector. Interviewees told us that it provided the care workers with an understanding of the bigger picture:

‘‘there seems to be an increased awareness amongst the support worker staff of rationales for carrying out certain therapeutic interventions with patients.’’ (Study site 8- Key Stakeholder)

Participants also told us that it increased care workers’ skills and confidence: ‘‘I think, from when we implemented the Care Certificate training in 2015, the confidence of people when they were leaving the training room … is higher now because they're going away with more tools in their box if you like.” (Study site 5- Key Stakeholder)

This confidence meant that care workers were not only able to apply their own skills more readily and appropriately, but were also able to challenge others if necessary.

‘‘They feel confident to challenge, to ask questions and most do feel very proactive in obtaining the Care Certificate and engaging managers about their development during that time.’’ (Study site 2- Stakeholder)

One of the biggest advantages of taking the Care Certificate expressed by care workers from the various organisations was the growth in knowledge which could be applied to different care settings and possibly developed further through additional qualifications:

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‘‘They've got a better knowledge of the standard of care that is acceptable, [they may] go on to... NVQ level 2 or QCS level 2s and 3s.’’ (Study site 6- care worker with the Care Certificate)

People who had completed the Care Certificate felt that the knowledge and understanding gained was immediately applicable to the working environment:

‘’It’s given me more knowledge, 100% and it’s made putting it into practice quite simple as well when I have actually gone to my placement where I work, putting into practices easily transferred from the training that I have just done.’’ (Study site 2- care worker with the Care Certificate)

This was true for people working with specific client groups, such as people with autism, as well as those working in a variety of other areas. This reflects how the Care Certificate training was adapted to particular settings, with nearly all sites reporting some adaptation of the Care Certificate format. For example, as a stakeholder stated on a social care and learning disability site:

“It is like the safeguarding unit, we deliver a full safeguarding training we don't sort of budget just to service the Care Certificate, we go into more detail than the Care Certificate is requiring to make sure that the needs of the new workers are fully met to meet our needs.’’ (Study site 2- Key Stakeholder)

6.3.1.3 Fostering empathy, compassion and reflective practice

Some participants felt that the knowledge and understanding gained through the Care Certificate fostered greater empathy in care workers. Thus one stated that they had “learnt people's different points of view.’’ (Study site 5- care worker with the Care Certificate) and another said:

“Well if you are more understanding to them they will kind of understand you more.” (Study site 9 – care worker with the Care Certificate)

Individuals who had not completed the Care Certificate could also see its potential benefits and its potential to broaden one’s understanding:

‘‘Because you can see from their perspective and put yourself in their predicament.’’ (Study site 1- care worker without the Care Certificate)

Compassionate care is an important objective, and there is some evidence from our interviews that the Care Certificate helped participants to understand what this means in practice:

“You just take your time and just do what you feel is best.” (Study site 9 – care worker with the Care Certificate)

Empathy is closely aligned with reflection and self-awareness. Reflection was explicitly encouraged by the approach to training and the assignments given in most sites. Consequently, care workers agreed that the learning process generated by the Care Certificate promoted a reflective approach to their practice:

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‘‘Just how you approach a situation, you might approach it the way you did before ... reflect on it …try it this way ... you develop as a support worker basically.’’ (Study site 3 – care worker with the Care Certificate)

This was endorsed by trainers on two social care sites:

“It may have made them think more, think, about how they do things, and what impacts on people, and the people who use our service.’’ (Study site 1- Stakeholder 1).

“I think the biggest thing that it provides, the people that I have taken through the Care Certificate, it really enforces reflective practice, so as they are going through things and they are looking at the standards and they are having to think about how these standards relate to the working practice within the service.” (Study site 2, Key Stakeholder)

6.3.1.4 Career progression and standardisation

We have already reported one participant’s view that doing the Care Certificate could

motivate people to undertake further training and development. We heard directly from some care workers that this was their ambition. For example, as a care worker with dyslexia said:

‘‘I did tell them that things are going to hold me back with the dyslexia, and the knowledge, but I will gain the knowledge from the training courses, and along the way, from other staff. So, as it stands now, I have been here a year and two months, that I'm a stand-in senior, and I'm a moving and handling instructor.’’ (Study site 1- care worker with the Care Certificate)

This quotation shows that taking the Care Certificate was seen as a springboard to further development despite a specific learning need, and its successful completion gave this individual the confidence to undertake new responsibilities at work.

Moving from the individual benefits to an organisational perspective, key informants recognised that the Care Certificate as could serve as a common currency in workforce training and qualifications:

‘‘It's about consistency isn't it, everyone's working ... the same.’’ (Study site 2 – Stakeholder)

It seems that the Care Certificate is also a mapping and assessment tool for key stakeholders to assess the competencies of their employees:

‘‘It actually provides a structure on which you can identify why they are not meeting standards.’’ (Study site 2- care worker without the Care Certificate)

Most of the participants from care organisations felt that the Care Certificate offers a minimum standard for workforce development. Therefore, its implementation ensures that there is a ‘‘benchmark of understanding’’ (Study site 8- Key Stakeholder) and the provision of uniformity in training standards and, ultimately, delivery of care:

“I think it is good that we are all going to be like held to the same accountability as well in the sense that each person will be following the same routine, the same

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procedures, the same practices rather than one carer might be, have their opinions on things and another carer might have their opinions, you all should be working from the same sort of thing.” (Study Site 2, care worker done CC)

Many felt that these characteristics were enhanced by participatory modes of training taking place in a classroom setting which allowed care workers to meet colleagues working in different settings and discuss relevant issues. Participants told us that it was also enhanced by the mixing of practical and classroom based approaches so that learning can be applied:

‘‘You have got two weeks training and then two weeks of shadowing and then you will be on your placement.’’ (Study site 2- care worker done the Care Certificate). Participants recognised the need for standards to be enforced, monitored and maintained, in order to be effective:

“Perhaps looking at an external body such as City and Guilds or Skills for Care, who would almost drop in and say 'I would like to inspect your Care Certificate records.” (Study site 2, stakeholder 2)

Therefore, our participants saw the potential of the Care Certificate to raise standards of care across the board. They largely welcomed its introduction and supported its purpose as a means to prepare the unregistered workforce to deliver good quality care with regard to the fifteen standards. Those participants with direct experience of undertaking the Care

Certificate reported positive outcomes for themselves and for their patients and clients. Some also regarded it as a springboard for career development. Few negative voices were heard. At the same time as seeing it as an overall improvement, there was recognition that the Care Certificate was not being delivered consistently by different organisations. In the next section, we turn to the reasons for this, by examining the barriers and facilitators to implementation.