‘What!’ I gasped. ‘You can’t be serious!’
‘Yes, that was it, half a day. But remember, I had had experience in caring, and I had done some home visiting, too. If I hadn’t, I suppose they would have sent me for a whole day, perhaps even two.’
So it is true.
Induction consists of three parts, which can be completed in a morning:
1. Fire drill, conducted by a fire officer
2. Moving and handling
3. Protection of vulnerable adults.
‘Moving and handling’ is instruction in how to use the winches, slings, pulleys etc., required for moving or lifting an immobile or helpless patient. Some of this equipment can be very complicated, and the company that makes these gadgets supplies a video instruction on the correct use. The purpose is to protect the employers and suppliers from claims of injury to nurses or care assistants from moving or handling patients incorrectly.
‘Protection of vulnerable adults’ is basically looking at different kinds of abuse, such as staff bullying or manipulating patients, or thieving. It is a video documentary, made by professional actors with advice and short, acted scenes of what can be done, and what one should not do. The purpose is to protect the employer from claims of malpractice. The video takes about forty-five minutes to run.
National Vocational Qualifications (NVQs) have been available since the 1970s. They are based on national standards of practical competence in a wide range of occupations (over 1000) varying from bricklaying to hairdressing to catering.
In 1988 the Healthcare Review Body (now the CQC) examined the position of carers, and, as a result, the NVQ training was started for prospective health care assistants. This is essentially a qualification in practical skills, and the training is on-the-job experience. There are three levels of achievement, trained, monitored and assessed by …
Question (from ‘Everyman’): … by whom?
Answer (from my research): It could be that the trust has a nurse-led training, followed by supervision of practice by a qualified assessor, and then both internal and external verification by an awarding body such as the City and Guilds.
Q: What is the training for care assistants in private hospitals or clinics or in nursing care homes?
A: This will depend on the organisation. In theory, a nurse on the staff should train and monitor care assistants. But, in practice, this is unreliable because some employers will take a carer after a day’s induction and there may be no nurse available to offer further training. There can be a wide difference between the training and supervision of care assistants in NHS hospitals and those employed privately.
Q: If the private establishment has no nurse to train potential carers, who does train them?
A: National Care Training Providers.
Q: And what training do they offer?
A: Telephone help throughout the day.
Q: So is it seriously proposed that basic nursing can be learned by telephone?
A: It is a telephone support line.
Q: Is this support line open at night?
A: No. Care assistants also have one-to-one contact with a specially trained NVQ Care Assessor.
Q: How often is one-to-one contact available?
A: By appointment, when it can be arranged.
I have mentioned my two nieces who are HCAs. The younger one is on NVQ Level 3, and her elder sister is on Level 4. I asked the younger why she did not take the Level 4 qualification. She replied: ‘I don’t see the point. I wouldn’t earn any more.’
‘But it says here in the syllabus that you would.’
‘It may say that, but I wouldn’t get it.’
‘What do you earn now?’
About £5.40 an hour. It might be £$.70 – I’m not sure.’
Her sister interrupted: ‘I was on £5 something an hour for years and years, even after I passed Levels 2, 3 and 4; it made no difference to the pay But now I get £8 something an hour because I have worked there for a long time. That makes a big difference.’
My nieces both work in nursing care homes, one in Reading, the other in Plymouth. I asked them why they did the work for such a pitiful wage. They replied, almost in unison, one echoing or agreeing with the other:
‘Because I love it.’
‘It is deeply satisfying.’
‘I love knowing that I have made a difference to some old person’s life who might be lonely or unhappy.’
‘At the end of the day, or night as it might be, you feel you have done something worthwhile.’
‘It’s very rewarding work.’
I looked at them with deep respect. I have always loved them both, but had no idea of the depth of their vocational commitment and unselfishness. Sue, the older sister, is a very thoughtful and impressive woman. She is a Jehovah’s Witness, which is a life-affirming religion, and she bubbles with laughter half the time, and radiates warmth, kindness and compassion, which she says, in a large part, has come from her faith. She sees it as God’s commandment that she should be a Witness by working for those in need. I am sure she would work for nothing if she did not have bills to pay.
I sent this chapter to them both for approval and had a letter in reply from Sue containing the following paragraph:
I have chatted with Jayne and we are both of the same mind, that maybe we gave you an unfair description of our training, which I must make clear is always ongoing throughout our working life in the units we are employed in. There are always updates in line with CQC and care standards. We are not nurses but care assistants who provide a vital role in the physical and emotional care of the people who for one reason or another find themselves in care homes or day centres such as ours.
This is the ideal standard, expressed by two ideal care assistants, and I know it to be true; the CQC, with support and advice from the RCN, is all the time striving to improve standards through on-going training. However, the stark fact is that a huge number of people working in private hospitals, clinics and nursing care homes have no training whatsoever, and do not stay long enough in the job to benefit from the training that may be on offer.
Nursing Care Home Managers are supposed to employ only people with NVQ Level 3 qualifications. However, a survey conducted for the End of Life Care report, issued by the National Audit Office in November 2008 (p.6, sub para 15) found that fewer than five per cent of nursing care home staff had this minimum qualification. Why, then, are they employed? The reason is because the managers are desperate for staff. They must have someone to cover the varying shifts over twenty-four hours, and night duty is the hardest to get anyone for. They could not function if they insisted on this Level 3 qualification.
An NVQ seems to be the minimum qualification that is obtainable. But it can be bypassed altogether. Agencies offer a bit of training that amounts to shadowing another carer for a few hours, and this is accepted as enough for someone to get a job.
It seems to me that care assistants fall into one of three categories:
1. Those who are wholly and selflessly dedicated.
2. Those who enjoy looking after people, but don’t want responsibility.
3. Those who can’t get any other job.
The last comment is certainly not meant in a derogatory way. A great many of those in the third group are newly arrived immigrants from middle European countries (the former communist bloc) who need a work permit to stay in the country, and who can get one by signing up to take the NVQ Healthcare at Level 1, and working in a care home. Many of these boys and girls are very good indeed, and I have met them. They are young, bursting with life and happiness, not afraid of hard work or getting their hands dirty. Also, having been brought up in a culture that does not exclude the old from family life, they are gentle and understanding.