The Evolution and Future of the Care Certificate

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 Cavendish Review found that the training and development of healthcare assistants and adult social care workers was often not consistent or good enough. 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 was developed jointly by Skills for Health, Health Education England and Skills for Care. It built upon and replaced the earlier induction programmes, that is social care’s Common Induction Standards (CIS) and health’s National Minimum Training Standards (NMTS).

The Care Certificate was introduced in 2015 by the UK Department of Health. It is an agreed set of standards that define the knowledge, skills and behaviours expected of specific job roles in the health and social care sectors, 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

All new staff are expected to undertake the Care Certificate, usually as part of their induction. This includes staff who are new to care and employed as:

• Healthcare assistants
• Assistant practitioners
• Care support workers
• Support to clinical roles where there is direct contact with patients
• Adult social care workers, providing direct care in residential and nursing homes or a hospice
• Home care workers
• Domiciliary care staff

Other social care roles that can benefit from undertaking the Care Certificate include:

• Caring volunteers
• Porters
• Cooks
• Drivers with direct contact with patients / service users

The Care Certificate applies across the health and social care sectors, is portable between sectors and organisations and is an assessment of both knowledge and competence. Each standard has associated learning outcomes and assessment criteria.

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.

The Care Certificate is 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. 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.

Origins and Early Adoption

Following its introduction in 2015, the Care Certificate was adopted by health and social care providers and employees who recognised that it provided a comprehensive and consistent approach for care worker training, and it was able to quickly gain acceptance across the health and social care sectors.

Skills for Care’s annual report published in September 2019 entitled “The state of the adult social care sector and workforce in England” showed that:

• 60% of new care workers have engaged with the Care Certificate.
• 70% of new senior care workers have engaged with the Care Certificate.
• Engagement was highest in domiciliary care services, where 75% of care workers had achieved, were in the process of completing, or had partially completed the Care Certificate.

The Care Certificate is regularly reviewed to ensure that it reflects changes in the health and social care sector, and that it remains relevant and effective. For example, the COVID-19 pandemic offered valuable learning and amendments were made to some unit content of the Care Certificate as a result. Since the launch, some standards have been updated where there have been changes to legislation, for example, the introduction of GDPR, and changes have been made to the resuscitation guidelines.

In 2021, however, it was agreed that a refresh review of all the Care Certificate standards should be completed to ensure that they continued to reflect current best practice. A recent renewed focus on the recruitment, induction and retention of healthcare support workers (HCSWs) across the NHS in England, Health Education England (HEE) in partnership with Skills for Health and Skills for Care has undertaken an in-depth review of the Care Certificate. This review has been carried out to ensure that the Care Certificate continues to offer a structured practical induction programme for new support workers to make sure they are effectively prepared for their role across all health and care settings.

As part of the review, feedback was sought from providers, education teams and frontline staff from both health and social care across England, who use the Care Certificate as part of the induction process for their workforce. This has led to recommended updates and improvements to some of the standards, and as a result, awarding organisations are now developing the Level 2 Adult Social Care Certificate qualification which is due to launch in June 2024, and they are currently making the relevant updates to their learning resources. This new qualification is aimed at those who enter the social care sector without a qualification.

Overall, this review established that the Care Certificate continues to be fit for purpose as a robust induction programme for support workers across health and social care settings and has recommended that employers should continue to use the existing standards and resources until the updated resources are available.

The CQC updated its position statement regarding the Care Certificate on 5 December 2022, which states that it continues to support it and expects to see the Care Certificate being used by providers across Health and Social Care.

Many of the updates and amendments made to the Care Certificate have been made to the resources to support learning and to the guidelines for assessment. These updates have reflected changes in the health and social care sector and to wider regulatory and legislation changes. For example, the implementation of GDPR in 2018 means that patients, service users and service providers now work more closely together, leading to an improvement in relationships.

The 2020 COVID pandemic created new ways of working to combat and control infection, leading to a heightened awareness of hygiene principles, the requirements of PPE usage and how carers’ own health or hygiene might pose a risk to the individuals that they support or work with.

In order to improve the quality of care provided to patients and service users, scenarios used in the Care Certificate resources have over time been reviewed and updated to better reflect specific care settings and are based on the typical duties that a Care Certificate student is asked to perform.

The Role of Technology and Innovation

Employers can choose how the Care Certificate is delivered and assessed in their setting, Elearning, workbooks and films can all be useful approaches to cover some parts of the Care Certificate learning. Technology and other innovative approaches started to become more prevalent during the COVID pandemic when face-to-face training was more difficult to arrange, and it appears to have become an established practice.

However, it is not possible to complete the Care Certificate using just e-learning or technology-based simulations. A blended approach to learning is essential and that requires on-the-job training, and staff need enough time to learn and practise their new skills. Assessments can encompass a mixture of all approaches but must also include skills assessments that must be assessed in the workplace.

In 2018, Health Education England elearning for healthcare (HEE elfh) launched five new scenario sessions to support the application of the Care Certificate Standards. The scenarios take place in a range of health and social care settings aimed at broadening learners’ experience and to provide learners with the opportunity to apply the standards within a setting similar to their own, as well as to see how the standards are applied in other care environments. HEE have continued to add new scenarios since, in order to enhance workplace knowledge.

New content was added in 2020 to the Care Certificate elearning programme by the HEE elfh and made accessible to learners via smartphones. This enables learners to access learning at times to suit them and their role commitments.

The use of technology in delivering the Care Certificate can capture learners’ interest and enhance learning. It provides trainers with the ability to create immersive learning experiences. Learners have access to various educational tools tailored to their specific learning styles, enabling them to actively participate in, for example, virtual simulations, engage in online discussions or webinars with colleagues and/or subject experts, engage in research, and much more.

Adaptive learning platforms and intelligent tutoring systems can identify learners’ strengths and weaknesses, providing focused feedback and individualised learning plans. This personalised approach ensures that learners can learn at their own pace, boosting their self-confidence and improving overall learning outcomes.

It can, however, be challenging for trainers to effectively incorporate technology into their training methods, and many health and social care providers may not have the financial resources to take full advantage of the technology available. Learners working in the health and social care sector may not have the proficiency in technology needed to participate in this form of learning, or may not have access to the equipment required.

The prevalence of technology in the learning environment can have both positive and negative effects. Whilst it provides access to a wealth of knowledge, it also poses the risk of information overload and distractions. There are also security risks and privacy issues to take into consideration. Protecting staff privacy and ensuring data security is a top priority.

The Future of the Care Certificate

The Care Certificate established a standardised approach to care worker induction training. At the start of 2024, the Government announced the care workforce reform package. This includes the first version of a Care Workforce Pathway (‘Pathway’) and a new Care Certificate qualification. Both developments will be essential in supporting learning and development opportunities for people who work in adult social care, as well as boosting recruitment and retention, which are persistent challenges for employers. They have also launched the new Adult Social Care Training and Development Fund. Eligible adult social care (ASC) employers can claim varying levels of reimbursement from this fund, for spend on upskilling the adult social care workforce in England.

There is up to now no consistent career structure or clear articulation of the level of knowledge, experience and skill required to deliver high-quality, personalised care and support. The Care Workforce Pathway aims to address this, with the Care Certificate providing the foundation level. Developing the Care Certificate into a recognised, transferable qualification is a welcome move that recognises the value and professionalism of foundation level staff to the care sector, and provides a robust induction process.

As a framework, the Care Certificate currently has the capability to provide flexibility in the type of setting that the unit criteria are applied. However, moving forward, should the Care Certificate be adopted across all diverse care environments and settings, there may be a requirement to adopt a similar approach to that of other competency based qualification frameworks and define a number of mandatory core units together with a selection of elective units that focus on nuances in settings, roles and patient/service user profiles. This might allow for specialisation at a foundation level in, for example but not limited to, specialisation in paediatric, maternity, mental health or eldercare. It may also allow for the adoption of the Care Certificate as an induction training option by a wider range of health and social care providers such as in dentistry, physiotherapy, etc.

International Perspectives and Global Adoption

The European Care Certificate (ECC) is a Europe-wide qualification that has been developed to cover the basic knowledge that is required for an individual to work in a health and social care setting. The ECC Certificate tests and verifies that a worker has covered the Basic European Social Care Learning Outcomes (BESCLO) which are recognised across the ECC partner countries. In this way, the ECC establishes a comparable base for knowledge of entry level care staff across Europe and provides an accessible and transferable certificate for workers and employers.

Whilst the ECC has similar aims of the qualification, providing a foundation induction for staff new to the care sector, it differs somewhat in units and content from the UK Care Certificate. The ECC provides training/knowledge in the following main areas:

• Values of social care
• Promote life quality for the individuals you support
• Working with risk
• Understanding your role as a care worker
• Safety at work
• Communicating positively
• Recognise and respond to abuse and neglect
• Develop as a care worker

Canada – the Personal Support Worker (PSW) Certificate provides the knowledge and practical skills to work as a care provider in a range of healthcare settings. After graduating, a Personal Support Worker works under the supervision of Registered Nurses and/or Registered Practical Nurses in:

• Retirement homes
• Long-term care facilities
• Home care agencies
• Hospitals

USA – the Certified Nursing Assistant (CNA) training programme. Individual US states issue CNA credentials, so prospective nursing assistants must enrol in a state-sanctioned training programme and pass a state certification exam. Certified nursing assistants provide important basic care services, including feeding, bathing and grooming patients, and taking vital signs.

Australia – Certificate III in Individual Support. The qualification comprises core and elective units. To achieve this qualification, the candidate must have completed at least 120 hours of work as detailed in the Assessment Requirements of the units of competency. Core units include:

• Provide individualised support
• Facilitate the empowerment of people receiving support
• Support independence and wellbeing
• Recognise healthy body systems
• Communicate and work in health or community services
• Work with diverse people
• Work legally and ethically
• Apply basic principles and practices of infection prevention and control
• Follow safe work practices for direct client care

Elective units include:

• Provide support to people living with dementia
• Work effectively in aged care
• Deliver care services using a palliative approach
• Contribute to ongoing skills development using a strengths-based approach
• Support community participation and social inclusion
• Work effectively in disability support

Many of these international care qualifications share similarities with the UK Care Certificate, although they do all differ in scope. What is clear is that, internationally, care is being seen as a professional career option worthy of qualification status. It also highlights the requirement for recognised standards of care.

Conclusion

Since its formulation in 2015, the principles and framework of the Care Certificate have altered marginally. However, it is the learning content, delivery methods and assessments that have evolved to meet the needs of an ever-changing health and social care environment and to encompass innovations both in healthcare and in training delivery and assessment.

Continuous improvement in health and social care is a systematic, sustainable approach to enhancing the quality of care and outcomes for patients, and it is crucial that health and social care training plays an active part in this. Training content, resources, methodologies and assessment methods need to be continuously evaluated to ensure that they not only meet the learners’ needs but that they also are forward looking to meet the ever-changing needs of the sector.

The advent of the Care Certificate gaining qualification status is a positive aspect of the care workforce reform package as it will help the Care Certificate to be viewed more positively amongst health providers and staff. This will improve the adoption of the qualification as an induction standard across the sector. With £53.91m being provided by the Department for Health and Social Care (DHSC), there are 37,000 fully funded places available for people in direct adult social care roles to complete the qualification between summer 2024 and March 2025.