Conclusions and recommendations of the evaluation of the Care Assistant Development Programme

Learning from early implementation – SCIE evaluation report for HC-One

In the first year of its implementation our evaluation findings paint a positive picture overall of a well-planned Programme that continues to be refined and developed. We found evidence of early successes where the Programme elements are performing well, as well as some challenges for HC-One to consider.

Launch events were seen to be an effective means of introducing the Programme, building awareness and equipping managers with the skills and knowledge needed to recruit candidates. The two greatest reported motivating factors that attract candidates to the role are a desire to improve skills and outcomes for service users.

Recommendation: Launch events or other face-to-face workshops are used as part of any future communication plan on nursing assistants and that the content of these events continues to be refined in line with new learning.

Recommendation: Future communications and adverts emphasise the opportunities the role affords to improve skills and resident care. Drawing on personal accounts and stories of the impact can be an important driver in encouraging others to apply.

The overall learning and development package is regarded as a key Programme asset and nursing assistants rate their training highly as preparing them for the role. The face-to-face training in particular was highlighted for providing a quality learning experience.

Recommendation: Ensure nursing assistants are supported to feel highly confident in all areas of practice such as through maintaining the nurse mentor relationship once in post.

The nurse mentor has an important role to play in ensuring nursing assistants are supported. There are challenges in some cases around coordinating time for trainees to practice skills under the guidance of a designated mentor. Overall, nursing assistants and mentors indicated they would welcome more time working together.

Recommendation: Set expectations for the hours per week that should be spent mentoring. HC-One and home managers should work together to overcome challenges in the rota.

Recommendation: Nurse mentors are provided with Programme content and complete mentor training prior to receiving a mentee. Encourage mentors to attend the training alongside their mentee. Give mentors dedicated time to go through workbooks and other mentor-related tasks.

Nurses play a significant role throughout this Programme and their positive engagement in the training and implementation of nursing assistants can be critical to its success. It was usual for some nurses to express initial concerns about the role, and so any concerns they have should be addressed at the outset and throughout the Programme.

Recommendation: Particular attention should be paid to communicating with nurses about the nursing assistant role, covering in detail the benefits it brings to them, and how they will be accountable working alongside nursing assistants.

Just over half of the residents and relatives surveyed had heard about the nursing assistant role, showing that whilst steps have been taken to inform residents and relatives, awareness is not complete. Most surveyed and interviewed residents and relatives would feel safe with the care provided by a nursing assistant. Where residents and relatives have concerns these can be addressed with information clarifying the rationale for the Programme, training content and role profile.

Recommendation: Further information is provided to relatives about the role and its impact. Our findings suggest that face–to-face communication by staff at all levels could be more effective than written communications.

Generally speaking, nursing assistants indicated they are enjoying their role, it is broadly as they expected it to be, and it can contribute to improved morale. Nursing assistants are undertaking a diverse range of responsibilities in their new role – though the exact scope and extent to which they are practising new skills is variable. In the early stages of implementation it may be necessary for home managers to monitor the working patterns of nursing assistants to ensure they are being utilised to their full potential.

Future aspirations for the Programme tended to centre on consolidating and building on the learning and development of nursing assistants. Nursing assistants have high aspirations for their future and it is therefore encouraging that HC-One is exploring ways for them to continue their learning journey.

Recommendation: Develop a plan for providing ongoing learning and support to nursing assistants to ensure that they feel supported and developed in their role such as periodic face-to-face events and training.

In these early stages of implementation the emerging impacts for residents has so far been positive. Impacts on the continuity of care look promising; the KPI data suggests an overall reduction in agency spend and the case studies show the benefits of staff continuity for person-centred care planning. Most commonly and consistently staff noted that the Programme can enable care to be delivered in a more timely way which will enhance residents’ experience of care. Most, but not all, staff feel that the Programme has increased capacity which should ensure the quality and safety of care across the board. The early emerging KPI data for measures of safety show substantial decreases in three key areas including medication errors, but smaller increases in two others (safeguarding and incidents), which should continue to be monitored across all homes.

This evaluation has explored the learning and impacts emerging from the early stages of implementation. It will be important for HC-One to continue to monitor the different elements of the Programme to ensure that it is working to meet markers of quality and safety.

Recommendation: Establish a programme of ongoing evaluation of the impact of the CADP for at least a further year which could include: continued monitoring of the Programme KPIs; periodic surveys of nursing assistants, residents and relatives; externally commissioned in-depth review of the impact of the nursing assistant role against adult social care inspection domains in a mixed sample of care homes.