Skilled staff to meet people’s needs

Recommendation 7 (workforce)

In our Out of sight report, we highlighted that the workforce needed investment to ensure that people were supported by staff who had the right training and qualifications and who felt valued in the work that they did. We therefore made recommendations to support workforce development.

If this recommendation was fully implemented, people would:

• have enough staff to support them, with the right skills and competencies to provide high-quality, person-centred care to enable people to lead the lives they would like
• be supported by staff in health and social care who understand their needs
• never be restrained, unless absolutely necessary, and only by staff whose training in the use of restrictive interventions would be certified as complying with the Restraint Reduction Network training standards as required by the Mental Health Units (Use of Force) Act 2018
• have sensory assessments, communication plans and other reasonable adjustments made in line with the Equality Act when they are in inpatient units or using adult social care services
• not have their human rights breached, because staff have the right knowledge to recognise when this may be happening, and leaders would take action to ensure that this is challenged and changed
• be involved in the recruitment process, including staff interviews, to ensure the right staff are recruited to be able to meet their needs.

Has recommendation 7 been achieved?

We consider that recommendation 7 has not been achieved

Rather than an improvement in the workforce, we have seen a staffing crisis develop, partly due to the impact of COVID-19. Although significant work has been carried out to implement Oliver McGowan training and introduce human rights training to child and adolescent mental health services, the impact of the training is yet to be fully realised.

Action needed:

• The government needs to ensure that further urgent investment is made in the workforce to improve pay and ensure that staff have the right skills and knowledge to support people to lead the lives they want to lead.

What we are seeing and hearing

Rather than seeing an improvement in the recruitment and retention of the workforce, we have seen a deterioration in the numbers of staff in health and social care and an increase in the use of bank and agency staff. This has partly been because of the pandemic. We have reported on these issues in our State of Care report, where we said, “Health and social care staff are exhausted and the workforce is depleted”. There have been calls for the government to urgently review the needs of the workforce through qualifications, additional training and pay increases.

This was further evidenced in feedback from 12 senior managers in health and social care roles across eight local authority areas and a meeting with representatives of hospital and adult social care providers to get their feedback on what progress they felt had been made towards the Out of sight recommendations. One of the common areas of concerns raised was staffing levels. It was noted that services are struggling with recruitment and retention of staff and there was anxiety about staff leaving care jobs for higher paid, less demanding roles and the impact this would have on people using services.

Provider representatives talked about the need to have more funding for staff and a model that invests in workers and retains experienced and skilled staff. There is also concern within social care about the number of staff who left the profession due to the mandatory vaccination regulation and how this has affected the workforce.

Training

Training of staff was also raised as a concern by providers, with issues such as the lack of consistent training across the system. Providers spoke about the difficulties of keeping training up to date. It was noted that in some services, having one training session on a topic such as autism is still considered sufficient.

Oliver McGowan training

For people with a learning disability and autistic people, it is vital that staff have the right level of training to be able to provide high-quality support. This includes understanding the importance of ensuring that people’s sensory, cognitive and communication needs are met. We highlighted these concerns in our Out of sight report. Our Mental Health Act reviewers have reported concerns that the lack of staff with the skills to understand and meet people’s needs had been worsened by the pandemic.

Following the death of Oliver McGowan in 2016 and the 2nd annual LeDeR report published in 2018, the Government published 'Right to be heard', its response to the consultation on proposals for introducing mandatory learning disability and autism training for health and social care staff. It outlined strong support for ensuring that all health and social care staff should receive mandatory training in learning disabilities and autism, at a level appropriate to their role. This is currently known as ‘Oliver McGowan Training’. The Department of Health and Social Care invested £1.4 million to develop, test and trial the Oliver McGowan Mandatory Training with over 8,000 people in 2021. Pilots have been completed and a positive interim evaluation of the pilot training has been published, with a final report due in Spring 2022. The outcomes of this evaluation will inform the wider roll out of the training. There is strong support from government and all stakeholders, including CQC, to implement this training.

Human Rights Framework and Training

NHSE/I have told us that the children’s taskforce has commissioned the British Institute for Human Rights (BIHR) to deliver human rights training to over 2,000 staff. This training is bespoke to inpatient children and young people mental health, learning disability and autism services and supports providers’ wider commitments to reducing restrictive practices.

The training provides organisations and staff with a common framework for assessing human rights. Four hundred and seventy staff have attended the training to date. This will continue to be implemented until the end of 2022.

Other training in social care

The latest Skills for Care workforce data shows that 46% of social care staff have a record of training on equality, diversity and human rights. While more than half (56%) of social care staff have a record of training on the Mental Capacity Act and deprivation of liberty, only 8% have recorded training on mental health. Only 10% of social care staff have a record of training on autism, while only 9% have recorded training completed on learning disability. It should be noted that completing training data is not mandatory in the workforce data collection.

Restrictive interventions training

If our recommendations had been met, we would hope to see that people were never restrained, unless it is absolutely necessary for their safety or other people’s safety, as all staff know how to de-escalate and avoid restrictive interventions. However, as reported above, the rate of reported restrictive interventions in October 2021 was nearly five per adult and 20 per child. There are also more people in long-term segregation now than there were in 2018.

Training in trauma-informed care was seen as positive in supporting staff to understand the experiences of people they care for, and the effect trauma had on them, rather than just seeing their behaviour.

Provider representatives told us about staff needing to feel supported and confident to challenge when restrictive interventions are used. They spoke of the importance of having visible leadership that demonstrated a positive and open culture.

The latest Skills for Care workforce data shows that only 10% of social care staff have a record of training on physical interventions.

Use of Force Act training

Implementation of the Mental Health Units (Use of Force Act) 2018, also known as Seni’s Law, was delayed and will now come into force on 31 March 2022. The statutory guidance accompanying the Act, which applies to mental health hospital inpatient settings, describes what providers should include in their policy on the use of force. The policy should set out the plan or approach the provider will take to reduce the use of force within their mental health unit(s). This should include:

• the provider’s commitment to minimising the use of force
• the preventative action the organisation is taking to minimise the use of force
• information on how the risks associated with the use of force will be managed.

Providers will also have to ensure that their training for staff in the use of restrictive interventions is certified as complying with the Restraint Reduction Network training standards. Complying with the training standards will:

• protect people’s fundamental human rights and promote person-centred, best interest and therapeutic approaches to supporting people when they are distressed
• improve the quality of life of people and greater understanding of people’s needs from those supporting them, therefore reducing restraint
• reduce reliance on restrictive practices by promoting positive culture and practice that focuses on prevention, de-escalation and reflective practice
• increase understanding of behaviour as communication, such as of emotions or needs, which if unmet can result in distress
• where required, focus on the safest and most dignified use of restrictive interventions including physical restraint.

Next page

Ensuring people have the right local services

Previous page

Improving people’s rights