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Case Study: How the Care Certificate Elevated Healthcare Quality

In 2013, a public inquiry was set up to investigate alarming abuse and neglect cases at Mid-Staffordshire NHS Trust. The inquiry and the resulting report is known as the Cavendish Review.

The Care Certificate was a recommendation from the Cavendish Review, which made suggestions on how to improve the quality of care provided by health and social care support workers. The review stated that “all healthcare assistants and social care support workers should undergo the same basic training, based on the best practice that already exists in the system, and must get a standard ‘certificate of fundamental care’ before they can care for people unsupervised”. The Care Certificate is now a recognised standard within the health and social care sector which the Care Quality Commission (CQC) considers to be the benchmark of induction into the sector.

By standardising skills and knowledge and prioritising compassionate person-centred care, the Care Certificate provides employers, regulatory bodies, patients and their families with assurance that those who have successfully completed the Care Certificate possess the requisite requirements to provide competent, quality care and supports their ongoing professional development.

Understanding the Care Certificate

The Care Certificate was developed jointly by Skills for Health, Health Education England and Skills for Care. It was introduced in 2015 by the UK Department of Health and is based on 15 standards that care practitioners must adhere to:

  • Understand your role
  • Your personal development
  • Duty of care
  • Equality and diversity
  • Work in a person-centred way
  • Communication
  • Privacy and dignity
  • Fluids and nutrition
  • Awareness of mental health, dementia and learning disability
  • Safeguarding adults
  • Safeguarding children
  • Basic life support
  • Health and safety
  • Handling information
  • Infection prevention and control

The certification process involves a combination of training and assessment components. Caregivers undergo comprehensive training to understand the core standards and then undergo assessments to demonstrate their practical application. Assessments are conducted by occupationally competent assessors who evaluate the caregiver’s competency in applying the core standards in various care scenarios. Individuals need to complete all of these in full and be able to demonstrate their competence before they can be awarded their certificate and be deemed capable to work unsupervised in their role.

By setting clear standards, the Care Certificate plays a fundamental role in standardising the skills and knowledge and in ensuring the consistency in performance that is essential for safe, compassionate, high-quality care and support. Standardisation reduces the risk of variation in the quality of patient care thereby improving patient outcomes and safety. The Care Certificate contributes to the ongoing professional development and quality of care provided by healthcare and social care workers.

Whilst there is no legal requirement for individuals to complete the Care Certificate, it is often a regulatory requirement, ensuring that caregivers meet the established standards set by regulatory bodies in the healthcare sector. It is also an expectation of the CQC that all health and social care employers provide their employees with suitable training for the Care Certificate or an equivalent, that will provide individuals with the requisite skills and knowledge to meet the standards.

Training is important in health and social care, to ensure safety for everyone involved in delivering care and for those receiving it and to maintain the highest levels of care quality. The Care Certificate is designed to give everyone taking it, and their employers, the confidence that health and care professionals have the same introductory skills, knowledge and behaviours to provide compassionate, safe and high-quality care and support in their own particular workplace setting. This boost in confidence can contribute to higher job satisfaction for those working in the care sector, ultimately benefitting both healthcare professionals and the patients that they care for.

The Case Study

The following has been adapted from a case study featured by Skills for Care:

Caring Ltd is a small local domiciliary care agency based in a semi-rural part of Sussex. The organisation is a preferred provider of the local authority, which accounts for 30% of the business; the remaining 70% is made up of private packages. The majority of the packages are for older people with a variety of conditions, including dementia, physical disabilities, stroke and Parkinson’s. There are also packages for younger service users with multiple sclerosis and learning disabilities.

The team consist of the registered manager, deputy manager, two care coordinators and 15 carers. The deputy manager Lynn is responsible for planning and delivering training, including induction, health and safety, equality, safeguarding, stroke awareness and dementia training. The care coordinators also deliver training on communication skills, record keeping and infection control. Moving and handling training and first aid training are delivered by external training providers.

Prior to the Care Certificate, the organisation delivered the induction following the common induction standards (CIS). Staff who were responsible for the delivery of the CIS went on a one-day training course to help them understand the requirements of the Care Certificate so they could plan how the organisation would then deliver it.

Before the implementation of the Care Certificate, organisations such as Caring Ltd may have experienced issues with inconsistent training standards, particularly when recruiting carers trained in other organisations. There was a lack of standardised training across the sector for healthcare and social care workers. Different organisations and settings had varied training programmes, leading to inconsistencies in the knowledge and skills of healthcare professionals.

Many of the training programmes available before the Care Certificate had insufficient focus on core competencies, so some healthcare workers may not have received adequate training in key areas such as infection prevention and control, safeguarding, privacy and dignity or communication. Lack of effective communication skills, for example, can lead to misunderstandings, errors and compromised patient care, and other so-called soft skills included in the Care Certificate competencies, such as empathy and compassion, may not have been consistently emphasised in previous training programmes. These skills are crucial for building positive relationships with patients and providing holistic, person-centred care.

The implementation of the Care Certificate aimed to address these challenges by establishing a standardised set of expectations for training and competency in key areas across the whole sector. Employers would be able to appreciate and accept the level of training that a healthcare worker had previously received if they had undertaken the Care Certificate.

Implementation of the Care Certificate

A structured and comprehensive process is needed in order to implement the Care Certificate into an induction and training strategy for staff. This ensures that healthcare and social care workers receive standardised training, skills practice and assessment in essential areas.

Obtaining commitment and endorsement from leadership in the care setting is essential to support the implementation of the Care Certificate. It also requires engagement from key stakeholders, including staff and managers in the planning, application and decision-making processes. For example, time for staff to participate in meetings, training and assessments will need to be agreed and prioritised to ensure that training programmes stay on track.

Many organisations will implement the Care Certificate as part of the induction process for new employees; however, participating in the training and assessment can also be of benefit to existing staff who may not have already acquired a certificate in Care. It is useful to carry out a training needs assessment to identify the specific training needs of healthcare and social care workers within the organisation to clarify the existing skill levels, and to identify knowledge gaps and any unique challenges that may be present. This will provide relevant information in order to develop a comprehensive training programme based on the Care Certificate standards. There may also be potential to incorporate existing training initiatives into the Care Certificate programme, rather than to reinvent the wheel.

The units in the Care Certificate can be delivered and assessed in whatever order that the setting deems appropriate, allowing those responsible for the training to prioritise topics to suit their individual setting. The next stage is to identify and develop learning materials that can support the learning, and to develop a programme of learning, skills practice, feedback and assessment. Whilst assessments are usually carried out by occupationally competent staff at the setting, there may be some elements, for example basic life support, where a specialist assessor may be needed to be used to assess that standard. Workplace assessors need to be familiar with the Care Certificate standards and fully understand the principles of assessment.

Care settings should also develop a programme evaluation process to monitor and quality assure the programme and its outcomes, and this includes the impact of the training on the quality of workplace practice and care given. Each employer must have a named responsible person (in social care this would be the registered manager) who is responsible for the Care Certificate programme. They oversee the assessors and sign off the quality of assessments; they will also sign the Care Certificates.

As with any learning programme, the effectiveness of the Care Certificate should be regularly reviewed and adjustments made to the programme based on changing needs, feedback and emerging trends in health and social care.

In our case study, the Care Certificate delivery was planned to use the Care Certificate workbooks to evidence the knowledge and a variety of training methods to deliver the underpinning knowledge including:

  • Face-to-face training
  • Handouts
  • Videos and e-learning
  • Demonstrations
  • Work shadowing
  • Practical training, on-the-job training
Group of people attending health care training

Additional support such as team training and staff meetings, regular meetings with a mentor (a senior carer), feedback and support sessions, and access to a resource library for additional information were also scheduled.

A programme for the Care Certificate was set out over 12 weeks of the new employees’ probation period as follows:

Week 1:

  • Organisation induction
  • Overview of the Care Certificate
  • Attend team meeting
  • Meet with mentor
  • Shadow mentor on shifts (as appropriate)
  • Review organisational handbook, policy and procedure book

Delivery of Standard 1 “Understand the role”

  • Face-to-face discussion (with mentor)
  • View video (from resources)
  • Care Certificate workbook (free resource)

Introduction to Standard 3 “Duty of care”

  • Face-to-face discussion (with mentor)
  • View video (from resources)
  • Care Certificate workbook (free resource)

Week 2:

  • Attend team meeting
  • Shadow mentor on shifts (as appropriate)
  • Feedback on standard 1 UPK evidence

Delivery of Standard 2 “Your personal development”

  • Meeting with deputy manager to plan and discuss development plan
  • Care Certificate workbook (free resource)

Unit will be delivered over a number of weeks, to allow for development.

Delivery of Standard 4 “Equality and diversity”

  • Face-to-face discussion (with mentor)
  • View video (from resources)
  • Care Certificate workbook (free resource)

Week 3:

  • Attend team meeting
  • Shadow mentor on shifts (as appropriate)
  • Feedback on Standards 3 & 4 UPK evidence
  • Attend in-house dementia training (this training is relevant to the following standards: 3,4,5,6,7,8,9,10)

Delivery of Standard 5 “Work in a person-centred way”

  • Face-to-face discussion (with mentor)
  • View video (from resources)
  • Care Certificate workbook (free resource)

Delivery of Standard 10: “Safeguarding adults

  • Face-to-face discussion (with mentor)
  • View video (from resources)
  • Care Certificate workbook (free resource)

Week 4:

  • Attend team meeting
  • Feedback on Standards 5 & 10 UPK evidence
  • Shadow mentor on shifts (as appropriate)
Team Meeting

Delivery of Standard 6 “Communication”

  • Project
  • Discussion with Deputy Manager
  • Care Certificate workbook

Delivery of Standard 7 “Privacy and dignity”

  • Group discussion, during team meeting
  • Care Certificate workbook

Week 5:

  • Attend team meeting
  • 1-2-1 supervision meeting
  • Feedback on Standards 6 & 7 UPK evidence
  • Attend in-house infection control training
  • Shadow mentor on shifts (as appropriate)

Delivery of Standard 13 “Health and safety”

  • Face-to-face discussion (with mentor)
  • View video (from resources)
  • Care Certificate workbook (free resource)

Delivery of Standard 15 “Infection prevention and control”

  • Handouts on handwashing and PPE
  • Care Certificate workbook (free resource)

Week 6:

  • Attend team meeting
  • Feedback on Standards 13 & 15 UPK evidence
  • “Double-up shifts”

Delivery of Standard 14 “Handling information”

  • Demonstration and explanation by mentor
  • Care Certificate workbook (free resource)

Holistic observation 1

  • Undertaken during double-up shift, assessed by mentor. Logged to all units requiring observation that competency has been achieved.

Week 7:

  • Attend team meeting
  • Feedback on Standard 14 UPK evidence and observation
  • Double-up shifts

Delivery of Standard 8 “Fluids and nutrition”

  • Project
  • Care Certificate workbook (free resource)

Week 8 :

  • Attend team meeting
  • Feedback on Standard 8 UPK evidence
  • Start single shifts with appropriate service users
  • Shadow senior carer who supports service user with a learning disability

Delivery of Standard 9: “Awareness of mental health, dementia and learning disability”

  • Review previous in-house training
  • Care Certificate workbook (free resource)

Holistic observation 2

  • Undertaken on shift with service user, observed by assessor. Logged to all units requiring direct observation as appropriate.
Health care Training Observation

Week 9:

  • Attend team meeting
  • Feedback on Standard 9 UPK evidence and 2nd observation
  • Attend team first aid (includes practical on resuscitation Annie)
  • 1-2-1 supervision meeting
  • Double-up shifts with senior carers & single shifts with appropriate service users
    Delivery of Standard 12 “Basic life support”
  • Care Certificate workbook (free resource)

Week 10:

  • Attend team meeting
  • Feedback on Standard 12 UPK
  • Attend team first aid (includes practical on resuscitation Annie)
  • Double-up shifts with senior carers & single shifts with appropriate service users

Delivery of Standard 11 “Safeguarding children”

  • Care Certificate workbook (free resource)

Week 11:

  • Attend team meeting
  • Feedback on Standard 11 UPK
  • Attend team moving and handling training
  • Double-up shifts with senior carers & single shifts with appropriate service users

Holistic observation 3

  • Undertaken on shift with service user, observed by assessor. Logged to all units requiring direct observation as appropriate.

Week 12:

  • 1-2-1 supervision meeting
  • Feedback on observation 3
  • Sign-off of full award if appropriate / further planning to enable sign-off if required
  • Complete Standard 2 “Your personal development”
  • Care Certificate workbook (free resource)

The underpinning knowledge for units was delivered as planned; however, the final sign-off took 14 weeks, but this was well documented in the portfolio, ensuring transparency around the delivery.

Holistic observations enabled several standards to be signed off at the same time. This was motivational for the trainee. It also enabled them to begin working with service users who required a single carer.

Results and Impact

One area of improvement in care settings that has been notable following the introduction of Care Certificate training programmes includes infection prevention and control. Healthcare-associated infections (HCAIs) are infections that patients get while receiving medical or surgical treatment, or from being in contact with healthcare services. The emergence of new infections can pose a significant risk, and, as a result, infection prevention and control is a key priority.

The availability of statistics to make a comparison between the prevalence of HCAIs prior to and following the implementation of the Care Certificate is sparse; however, anecdotal evidence suggests that health and social care professionals have demonstrated increased adherence to infection prevention protocols, by consistently following proper hand hygiene practices and using PPE in accordance with guidelines. Patients are experiencing more hygienic and secure healthcare environments.

There is evidence to show that the take-up of the Care Certificate by health and social care workers is mixed. Skills for Care carried out an evaluation of the impact of the implementation of the Care Certificate on take-up, and they found that:

  • Over two thirds (70%) of care workers who started in the sector after January 2015 had engaged with the Care Certificate.
  • Just under half of the direct care-providing workforce (44%) held a qualification at Level 2 or higher in 2020/21.
  • The most popular areas of training received were within the categories of ‘Moving and handling’ (76%), ‘Safeguarding adults’ (75%), and ‘Infection Control’ (68%).

Although the Care Certificate is available to all, the main demographic it is aimed at is workers who are new to social care as part of their induction programme. 47% of all filled posts had achieved or were working towards the achievement of the Care Certificate. Around half (53%) of all filled posts hadn’t started or weren’t engaged with the certificate.

The Care Certificate appears to have had a positive impact on staff and organisations who have implemented the initiative, for example:

Hampshire and Isle of Wight Integrated Care System (ICS) developed a specific career framework for ex-airline cabin crew who wanted to make the most of their customer service and first aid experience by joining the NHS. Following initial mandatory training, either face-to-face or using e-learning for healthcare’s cabin crew patient care module, staff can be deployed as HCSWs. After completing the Care Certificate, they can progress to nurse associates and onward to registered nurses, or equivalent, with further training.

When asked, “How do you think the Care Certificate benefits the organisation?”, a Personal Nursing Assistant at Hilton Nursing Partners responded, “The Care Certificate is laid out so clearly and is well organised, that it is easy to understand. Learning the sections within the training certificates ensures that we, as personal nursing assistants, conduct our role well, and with professionalism. We work safely and become excellent listeners to our patients. The Care Certificate training plan ensures that we do not become open to litigation, and avoid putting our organisation into disrepute. We protect the business and build up trust between patients and other services.”

Employers in the healthcare and social care sectors value the Care Certificate as a mark of professionalism and adherence to best practices. Completion of the Care Certificate is often a prerequisite for employment in these fields, as it attests to an individual’s competence and commitment to high-quality care.

The significance of high care standards goes beyond just ensuring adequate care, it shapes patient care outcomes. This includes rates of morbidity, mortality and complications. By adhering to high standards such as those in the Care Certificate, health and social care providers can improve the overall quality of care and optimise patient outcomes.

When inspecting health and social care providers, the Care Quality Commission continues to expect providers to induct, support and train their staff appropriately, and this includes using nationally recognised good practice, such as the Care Certificate standards. Implementation of the Care Certificate meets compliance with the CQC ‘Regulation 19, Fit and proper persons employed’, and will impact the quality rating applied on inspection. Regulation 19(1)(b) says that: “Persons employed for the purposes of carrying on a regulated activity must have the qualifications, competence, skills and experience which are necessary for the work to be performed by them.” The guidance for providers as to how they can comply with Reg 19 states that: “It is expected that providers that employ healthcare assistants and social care support workers should follow the Care Certificate standards to assess their competence

Lessons Learned

Independent research was commissioned and funded by the NIHR policy research programme to evaluate Care Certificate implementation across a variety of health and social care settings, a total of 401 settings. They conducted a national telephone survey with staff who have responsibility for training or induction of care staff in care organisations. Further in-depth evidence about the implementation of the Care Certificate was collected through semi-structured interviews and focus groups at ten care sites.

The key findings/outcomes included:

  • Of the 401 organisations that took part in the telephone survey, 352 (87.8%) had implemented the Care Certificate into their routine induction for new care staff and the uptake was significantly higher for health service organisations than for social care organisations.
  • The uptake of the Care Certificate has been good, and it is widely welcomed as providing a standardised approach to improving the skills of those new to care, enabling staff to feel better prepared to provide high-quality care. However, there is a proportion of smaller organisations where it has not been implemented, largely due to lack of resources and capacity.
  • There has been considerable variation in how the Care Certificate is delivered, ranging from group-based programmes combining teaching and activities, to short online courses completed individually. This inconsistency has undermined the credibility and portability of the Care Certificate, and its use as a transferable qualification supporting the movement of staff between organisations was not widely reported. Furthermore, when organisations employed new starters who had an existing Care Certificate, 21.3% required these care workers to fully repeat the training within their organisation and 28.5% required these staff to partially complete the training. The need to repeat the Care Certificate was frequently reported to be due to perceived inconsistencies in implementation and uncertainty about the quality of the training in other organisations.
  • The majority of organisations perceived a positive impact of the Care Certificate on the care organisation, care staff and care recipients. However, health organisations consistently reported more positive responses than social care organisations. Managers reported a number of perceived positive outcomes for care workers including being better prepared for their role, providing a sense of achievement and confidence boost, and benefitting from peer discussions and reflections on their role and practice.
  • The main challenges to implementing the Care Certificate identified through the telephone survey were lack of interest from care workers, lack of resources (funding, time and staff for backfill) and the need for relatively high levels of literacy.
  • Foremost among barriers to implementation is the time commitment imposed by the Care Certificate which disproportionately affects smaller organisations, and acts as a disincentive to both prospective trainees and care managers. Successful implementation could be achieved through planned and comprehensive integration of the Care Certificate across the organisation, which was supported by existing organisational infrastructure and organisational leaders. Mentoring, buddy systems and group teaching were identified as mechanisms that facilitated learning and development on the Care Certificate.
  • One care manager reported logistical problems in planning observations and supervisions for the Care Certificate training due to the peripatetic nature of home care workers’ work. He feels that the Care Certificate has been a generally positive development as it has made people more aware of the fundamental components of good care, although he feels that there should have been more guidance from Skills for Care in the process of implementation. On the whole, the care manager felt that the Care Certificate training works well for the organisation.

Highlighted in this evaluation of the implementation of the Care Certificate are a number of challenges to successful implementation including:

  • Low take-up by smaller care settings
  • Difficulties scheduling observations
  • Time and resource commitment
  • Lack of funding
  • Lack of portability of the Care Certificate due to inconsistency in delivery methods and quality assurance

These challenges are not insurmountable; however, many need external intervention to overcome them. In 2021 the government published a White Paper People at the Heart of Care: adult social care reform. This led to a review and update of the content of the current Care Certificate to meet the standards of a Level 2 qualification.

In March 2023, Skills for Care was commissioned by the Department of Health and Social Care (DHSC) to develop a specification for the development of a new Level 2 Care Certificate qualification based on the existing Care Certificate standards to enable better consistency in portability and standardisation in how the current standards are delivered, achieved and assessed. This new qualification is backed by £50 million in funding. The qualification will be accredited to ensure its quality and will be recognised by employers when care workers move roles, reducing the costs and burden of repeat training.

Further details on the rollout of the qualification for training providers and the sector will be shared by the Department of Health and Social Care over the coming year.

Department of health and Social care

Conclusion

Since its introduction in 2015, the Care Certificate has provided a standardised framework for the induction and training of health and social care workers, many of whom had previously not received this fundamental training.

Unfortunately, there was a missed opportunity to accredit the award of the Certificate towards gaining a qualification when it was introduced; however, that is now being rectified with the introduction of the new Level 2 Care Certificate qualification. This initiative will build upon the positives of the current Care Certificate and become the very beginning of the training and development journey in a new national care career structure, with defined roles and ongoing professional development.

The new career pathway for care workers will support people to gain the right knowledge, skills and expertise needed to deliver excellent care, giving clear differentiation between roles based on the level of expertise people should have and expect to develop. The government has said that it will fund around 116,000 training courses and qualifications, 34,000 Care Certificate qualifications from June 2024 to the end March 2025, and continuous professional development for around 35,000 eligible care professionals.

Investment in the training and development of workers in health and social care is crucial to maintain and build upon quality care. Caregivers benefit from increased job satisfaction and confidence, while care recipients experience improved well-being and satisfaction with the care provided.

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About the author

Liz Wright

Liz has worked with CPD Online College since August 2020, she manages content production, as well as planning and delegating tasks. Liz works closely with Freelance Writers - Voice Artists - Companies and individuals to create the most appropriate and relevant content as well as also using and managing SEO. Outside of work Liz loves art, painting and spending time with family and friends.



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