Richard Griffin provides a case study of engagement in a vocational training programme for care workers in London

From Wolf to Whitehead, the last few years have seen a steady flow of reports, studies and think pieces highlighting the challenges inherent in delivering vocational education and offering a range of solutions. To put it mildly, L&D professionals have not been short of advice on what they should do. Indeed, I have commented on many of these reports in my blogs and articles for TJ over the last few years and have pretty much agreed with most of what has been written. Vocational education is too complex and too often not led by employers. There is a need for education providers to be more outward-facing and for more partnership working. Quality assurance approaches do not pay enough attention to the outcome of learning (sadly the list of issues is long and enduring).

It is, though, one thing to write about what should be done, it is quite another to try to actually do it yourself but that is exactly what I, as part of a team, have been doing since April 2014. We have been given a unique opportunity for a year to consider how skills and knowledge strategy should be developed for more than 20,000 employees in London.

First, some context. We have been working with health care employers in North West London (NWL), the part of London which begins in Victoria and goes right to the edge of the capital in the boroughs of Hillingdon and Harrow. Wembley Stadium sits in the middle of the area. Nearly two million people live in the region’s eight boroughs. In total 51,900 NHS staff are employed in 11 hospital trusts and around 400 general practice surgeries. Around £268 million a year is spent training and developing staff, mostly on training new doctors, nurses, midwives and other professional staff. The focus of our project though has been 23,000 health care support staff. These include roles such as health care assistants, physiotherapy assistants, receptionists and porters. While comprising a little under half the workforce, these employees deliver the majority of face-to-face contact with patients in hospitals.

The catalyst for the project was the publication of the first dedicated NHS national policy for health care support worker learning and development (L&D) and the vision of the local NHS education commissioners who wanted to approach vocational education in an innovative way. Training funds in the NHS are largely managed through 13 Local Education Training Boards (LETBs), all part of an organisation called Health Education England.

While L&D in the NHS may seem to many TJ readers a specialist area, the truth is the challenges employers face whatever sector they work in when seeking to invest in vocational education also exists in healthcare settings. For example, a review of support staff in learning and development carried out in 2013 by the associate editor of The Times Camilla Cavendish and commissioned by the Prime Minister, roamed across health and social care providers. While it found good practice, a range of issues were also identified including:

• Unequal access to education among staff
• Confusion about vocational qualifications leading, among other things, to a lack of transferability and recognition of learning between employers
• Under utilisation of employee’s skills
• Variable and sometimes poor quality education delivery
• Limited career progression opportunities.

Sound familiar? The NHS Talent for Care policy published last October is in part a response to the Cavendish report. The NWL project seeks to address these issues and national priorities but also local training and development needs. Behind the approach is a belief that investing in the education and training of health care assistants and other support staff is a root to delivering safe, productive and effective care.

The NWL project specifically focuses on the following deliverables:

1.       Introducing a new national enhanced competency-based induction system for all new staff called the Care Certificate

2.       Increasing the number of apprentice starts

3.       Addressing quality assurance of vocational education

4.       Designing and delivering employer-led training programmes, including widening access to degree programmes. For example, for existing staff who may wish to train to become a registered nurse or midwife.

The project provided the opportunity to think about how to deliver real change. It was a chance to reread the various reports and studies that have been published in recent years. In particular, the planning of the project was influenced by Nigel Whitehead’s 2013 review of vocational qualifications, the findings of the business and skills department’s ‘Employer Ownership of Skills’ pilots along with the principles of ‘design thinking’. While the project embraced multiple employers and other agencies across a large geographical area, the insights and principles could easily be applied to smaller skills collaboratives – perhaps a single university or further education college and single employer, or within one organisation. Effective vocational education, whether at national, industry, regional, employer or departmental level, always requires
partnership working.

The design thinking

The project was based on the following principles:

End-to-end and comprehensive (whole systems)

While the project has distinct deliverables such as increasing the number of apprentices locally, it embraced the whole vocational education landscape from pre-employment activity through to higher level skills and support for staff who wished to apply for nursing degree courses. Joining the various L&D strands together and aligning them with service/business needs helped avoid unintended consequences and outcomes and aligned the strategic focus of the project. Too often, approaches to vocational learning
are fragmented.

No unnecessary burden

We were keen not to add unnecessary burdens to employers and other stakeholders as a consequence of delivering the project. In practice, this meant, where possible, building on and sharing existing best practice and collaborating. We tried also to be resource sensitive, taking the decision to focus effort on a couple of deliverables initially, recognising, if successful, that insights from these could be applied elsewhere. We have also tried to ensure information, advice and guidance is simple – no mean feat as anyone who has tried to explain vocational qualifications will know!

Partnership working

The project is founded on partnership working. We have bought together employers, education providers and others on a monthly basis to help guide and implement the project. Complementing and supporting this has been a small team – some drawn from my university’s institute, others from the education commissioners and others seconded from employers (all vocational L&D specialists). The commitment and quality of the team has been a key factor for success.

Employee engagement

The very first thing we did, even before the project started, was organise a series of discussion groups in a number of hospitals with staff who would be affected by the project. It is important that the support workers had a voice, could raise issues and felt that policy was being implemented with them not to them.

Quality assurance

Collectively, we have been working to design a quality assurance framework that establishes common principles stakeholders can sign up to. We are aiming to not only focus on educational attainment but also outcomes, asking the critical question: “what difference has the training made?” Quality assurance needs to be the golden thread throughout vocational education design and delivery.

Innovation

Let’s be honest, a lot of the reason things happen as they do is the result of habit. Breaking out of fixed ways of thinking can be really challenging. This is as much the case for L&D as for any other activity. One of the things we wanted to do was think differently. That is where using design thinking came in. Rather than having a predetermined answer about what would work, we tried to generate as many different ideas as possible. Engaging with end-users (including the staff) was important here too. Furthermore, partnership working also provided an opportunity for different ideas to come forward as well as building shared understanding, another key design thinking principle.

What have we learnt?

We have already been able to identify successes – partners wish to continue to meet once the project is finished in a new NWL healthcare skills collaborative. Apprenticeship starts are beginning to grow, an employer-led quality assurance framework is being designed, there is greater connection between employers and education providers such as the local further education colleges, resources are being shared and innovative programmes designed. The independent evaluation report from King’s College London this spring will provide robust feedback.

The need for ‘systems integrators’

Vocational education can be heterogeneous and fragmented, cluttered and complex. A recent review of employability strategies by McKinsey, Education to Employment, suggested that one factor contributing to schemes that were successful was the creation of  ‘system integrator’ roles, whose job it is to “work with education providers and employers to develop skills solutions, gather data and identify and disseminate positive examples. Such integrators can be defined by sector, region or target”. The creation of the team allowed this role to be undertaken and proved invaluable.

Too much information can confuse

While the publication of The Talent for Care is very welcome, the new national policy has many elements. These are on top of local priorities. A decision was taken to share as much information as possible with stakeholders. There was a lot of it! On occasions we risked information overload and confusion. Careful consideration needs to be given to how information is promulgated particularly to non L&D experts.

Partnership works but it is not straightforward

A potential fault line in vocational learning is the disconnect between employees, employers and education providers (in health there is a longer list of stakeholders that includes service commissioners, sector skills councils and trade unions/professional bodies). We were lucky because we have been able to build partnerships early in the life around tangible projects such as the Care Certificate. Working together on activities with defined outcomes has a lot of benefits including the opportunity to use limited resources more effectively. For example, by standardising curriculum or sharing good practice, but there were challenges particularly with multiple partners.

Building collaboratives and the trust and sharing, they are based on take time and effort. It was impressive how quickly and generously employers were willing to work together. Focusing on specific outcomes helped, as did having a clear and shared agenda. The team was also able to work between agencies and settings. Successful collaboratives are those that are clear on what they are trying to achieve and the impact that they want to have. Despite this, we did have limited examples of partners promoting their own agenda or limiting their engagement because there was not something (funding) immediately available to them. Partnership requires give and take.

As Dawn Grant, team member from the Chelsea and Westminster Hospital neatly summarises: “Shared working and purpose across North West London has been one of the greatest successes of the project. All who are involved in the large agenda for support workers have similar sticking points and so coming together to work through those was positive for the project team as well as individual trusts and most importantly in the long run the patients who receive care from our
support workers.”

The long run

Vocational education organisation and delivery in the UK is like healthcare – largely shaped by government policy and funding. In an ideal world, we would have policy and organisational stability. Organisations would not merge, services restructure and policy shift. They do, though. This is something we have to learn to live with. Again, partnerships help – individuals may come and go but there is collective focus that transcends the complexity and instability.

Conclusion

The various reports on vocational education published in the last five years including most recently UCKES all point to the need for change. This need for innovation is likely to be even more pressing post-election as central resources become even more constrained. If there is one thing above all else that I have learnt in the last year, it is that Everett Rogers’ (author of Diffusion of Innovation) insight that innovation is essentially a social rather than technological or procedural process is right. Lots of time has been devoted to face-to-face communication within the team and amongst stakeholders. L&D is about people. Changing how we deliver L&D has to be about people too. Working together can deliver real change.

Acknowledgements

Thanks are due to all those involved in the project: Kathryn Jones, Louise Saul, Therese Davis, Dawn Grant, Loo Blackburn, Maggie Orr, John Bateson, Gaynor Phillips, Fran Nairk and Goretti Dowdican-McAndrew