25 / 10 / 2010
NHS Leeds Community Healthcare is a community care trust serving the needs of the 753,000 people who live in Leeds. This population is culturally diverse and there is a wide geographical spread encompassing both inner city and outlying smaller rural communities.
The trust offers a broad range of community based services and employs approximately 3200 staff from a wide range of professional disciplines including all branches of nursing, allied health professionals, medical and dental.
The project aimed to develop a comprehensive support and development programme for clinical support workers within the trust. The programme developed:
- a portfolio containing competency frameworks covering all aspects of their role
- an associated training programme to ensure consistency in preparation
- the opportunity to undertake the development programme in association with Leeds Metropolitan University and achieve a certificate level qualification.
The outcome was a robust framework which readily lent itself to developing roles further, and the opportunity for staff to achieve a recognised clinical qualification. Ultimately this resulted in improved patient care as staff knowledge and confidence increased.
What we did and why
The shift to community care provision is increasing demand on community services and there is a need to ensure staff are fit for purpose and the potential for roles is maximised by making best use of skill mix. It was recognised that there were inconsistencies in support worker roles across the trust, both in terms of role expectations and preparation for roles. While NVQ’s were offered these did not encompass all of the clinical competencies staff needed.
Once stakeholders agreed the appropriate role responsibilities and areas for the development of clinical support workers they were able to develop evidence based competency frameworks. To ensure appropriate delegation and accountability, protocols detailing under what circumstances support workers could perform clinical activities were also developed.
The result was an inter-professional competency portfolio containing all of the competencies relevant for their roles.
Along with the competency portfolio, a training programme is delivered to cover all aspects of the portfolio. This provides a baseline for the theoretical component of clinical care which is then assessed in practice.
The trust believed that it was important that the completion of the programme was formally recognised, both to acknowledge the contribution of support workers to quality patient care, and so that learning was transferrable outside of the trust.
The trust collaborated with Leeds Metropolitan University and achieved higher education accreditation for the programme. This offers quality assurance and provides the support worker with a recognised qualification on successful completion of the programme.
This initiative was initially rolled out across the district nursing service, and later to intermediate care teams with the expectation that ultimately all staff within the trust would use the competency frameworks relevant for their roles. This will provide a quality assured approach to patient care with the same high standard delivered in the same way across the organisation.
How we did it
The programme co-ordinator initially met with clinical support staff to determine what activities were core to the roles, where there were any discrepancies and what they felt they could do that was not already part of their current roles.
This information was then shared with the registered staff within the service to gain agreement on the areas identified and to take steps to eliminate the discrepancies.
A proposal then was presented to the Director of nursing to develop a competency based programme and portfolio for clinical support staff to ensure a robust and consistent approach to their development, and increase quality.
The initiative was then shared with managers and clinicians through existing team meetings and forums. Representatives were recruited to a working group to develop the competencies and these were agreed by the appropriate specialists.
When the programme was ready to launch the trust held a number of briefing session for managers, clinicians and support workers to explain the programme and competency framework and how these should be completed.
The education programme is delivered through a combination of formal teaching sessions developed and delivered by university lecturers in partnership with trust staff. This is supplemented by work-based learning where competence is assessed in practice against the relevant frameworks.
Each training event is evaluated at the end of each session and immediate adjustments made if necessary. In addition ,support workers are asked to complete an overall evaluation at the end of the programme. Feedback has also been sought from managers and registered staff through the programme co-ordinator attending relevant existing forums.
Results and next steps
The final evaluation has produced the following results:
- consistent expectations and development for staff leading to increased job satisfaction and quality patient care
- staff reported they felt both motivated and appreciated
- the programme was seen as a welcome development opportunity by staff
- support workers reporting increased confidence in their skills and abilities
- some staff reported that they found doing the academic work daunting but had been surprised with their achievements
- some of the support workers had been motivated to undertake further formal study, including pre-registration nursing courses
- as many of the support staff had not undertaken formal study for many years some reported they would have liked more support both from trainers and in practice
- evidence of competence means improved professional accountability and minimises risk for clinicians and the organisation by eliminating discrepancy and increasing consistency.
The trust plan to roll out the programme across the organisation and continue to develop new competencies in line with role and service development. In addition as registered staff roles are developing the same framework for developing competence will be used to help them develop these new skills.
Interest has been generated in the initiative through sharing the approach taken at a number of national conferences, with a number of organisations wishing to adopt the approach.
It is anticipated by using the framework to develop roles cost savings can be made. In the first year support workers delivering diabetes care in place of registered nurse, is estimated at saving of between £5,294 and £12,800 in the first year. This increases to between £8,500 - £16,000 in subsequent years as the cost of the initial support worker training is removed. The savings are dependent on the number of patients on caseload requiring intervention for their diabetes and if they are suitable for delegation to the support worker.
Tips for trusts
Ensure you engage both clinical support workers and registered staff at all stages of the project
- Ensure management support as it is vital to the success of the programme
- Be sensitive to the operational pressures on services and be clear how the investment of time will benefit the service, teams and patients
- Be sensitive to any resistance to the initiative, particularly where staff perceive an erosion of role due to role development of non-registered staff
Further information and contacts
Education, Training & Clinical Development Manager
0113 2208 540 firstname.lastname@example.org