It’s a given that healthcare assistants who want to become nurses need further education but there are also development opportunities for those who want to remain HCAs. However, both groups need supportive employers to enable them to continue working while they study.
UNISON has had a partnership with the Open University since 2004, which aims to widen participation. It has led to a range of opportunities for HCAs, starting with openings courses, which run four times a year in March, June, September and November.
These short, 10-credit courses assume no prior knowledge of their subjects, take about 20 weeks to complete and involve 6–8 hours of study. Topics include literacy and numeracy, an introduction to health and social care, and an introduction to psychology.
‘They’re to get people a foot in the door of studying and aim to develop confidence and learning skills,’ says Shirley Reveley, professor and dean of the university’s Faculty of Health and Social Care.
The Science Faculty offers level 1 courses worth 10 credits on subjects such as understanding diabetes and heart disease.
These allow people to enhance their existing skills and knowledge, and can be counted towards another qualification.
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The Faculty of Health and Social Care also offers level 1 courses, the main one being the 60-credit Introduction to Health and Social Care, also known as K101. Over 50,000 students successfully completed its predecessor, K100, Understanding Health and Social Care. The name change introduced an NVQ level 3 qualification, which is needed for entrance to nursing.
K101 includes English language enhancement for people whose first language is not English, and can help HCAs to develop the written, oral and IT skills they need to succeed in their studies. While K101 is the preferred route into the pre-registration nursing education, HCAs can instead opt for the foundation degree in health and social care. Level 2 courses are also on offer, and one of the most popular is about death and dying. All HCAs can take these courses to enhance their knowledge.
Those who want to progress to professional training can take a part-time, work-based pre-registration nursing diploma leading to registration as a nurse in either mental health or adult nursing. Once they receive their diploma, the Open University has a range of post-registration courses, including degrees.
The unifying theme for all the courses is that they can be taken through distance learning, which means students do not need to attend university lectures and therefore they have no need to give up work. Support is provided online and locally through UNISON union learning representatives and Open University associate lecturers.
When it comes to course fees, for openings courses and level 1 courses, some HCAs pay for themselves and can get a UNISON discount while others receive help from their employers, depending on individual and service needs. The Open University offers some financial support and it’s worth asking student services what help is available.
The pre-registration nursing programme is done as a secondment, so HCAs must be in practice. Their employers then pay for the course, and provide a mentor and study time to complete it. HCAs also need to be part of a cohort, normally 10–15 students from the same locality – either from one trust or a group of trusts.
Secondments are popular – almost 1,000 HCAs are on the pre-registration nursing course and both the retention and pass rates are high. Professor Reveley says the course could not operate without close partnerships with employers. ‘It is the partnership that makes it work. No nurse training can happen without that kind of support.’
Deciding a path of training and education will be linked to personal interest and service development need, says Professor Reveley. While some HCAs may want to become nurses, others want to become more effective HCAs. The two groups are not mutually exclusive and may take the same course but for different reasons.
‘I think that’s important because we don’t want people to keep thinking “they’re just trying to get us through into professional training”. But for those who do want to go on to professional training, there are opportunities for them as well.’
London South Bank University, another UNISON academic partner, has offered a part-time sponsored route into nursing education for HCAs since 1999, when it won a tender from the Department of Health to design such a course. The idea was that HCAs who showed promise could be seconded onto the course. They would remain employed by their trust, where they would do their placements, which would be audited to ensure they complied with educational requirements. It began as a four-year course but has since reduced to three-and-a-half, and leads to a diploma in higher education.
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Until two years ago about 70 HCAs took the course each year but this dropped by 60% when the DH cut training budgets in 2006. The DH was still able to pay university tuition fees but trusts could not afford to pay the HCAs’ salaries while they were on the course. David Sines, executive dean in the university’s Faculty of Health and Social Care, says: ‘The 2006–2007 year was the first time the whole thing was knocked off of the rails and that’s only just beginning to recover.’
Professor Sines says the secondment model is crucial for enabling HCAs to train as nurses. ‘It really rewards them for their expertise in practice and their commitment and confidence. The majority are mature candidates. For them to become unemployed for three years and go onto a student bursary would be impossible.’
HCAs are committed students and attrition is less than 6%. They are all based in London, which means they are more likely to stay at their trust when they finish the course.
For recruitment, some trusts tell HCAs how many places are available and ask who is interested, while others interview them before offering a place.
Those who wish to remain HCAs can take courses at NVQ levels 2, 3, and 4 on subjects such as care, leadership and management for nursing homes at London South Bank University.
The university’s foundation degree is primarily taken by band 3 HCAs and enables them to progress to band 4 and be called assistant practitioners. This two-year employment-based qualification is designed around the competencies needed to do the job. Each year students are released one day a week for 35 weeks and for a one-week study block. Assessment is also work-based, with workbooks and assignments rather than exams.
For assistant practitioners who want to become nurses, the foundation degree is worth 33% of accredited learning towards a nursing qualification, enabling them to do a shorter nursing course. Starting with a foundation degree helps built HCAs’ confidence and competence.
‘Most of these people have not been involved in learning for years and they’re not really able to demonstrate that they
can actually achieve the right level of learning to go straight into a nursing course,’ says Professor Sines. ‘But if we saw someone was really promising we would encourage them to step off at the end of the first year of their foundation degree, if their employer allowed it, to progress to the nursing course.’
UNISON has been developing its education work over the past six years and can help HCAs identify and pursue training opportunities. Joanna Cain is manager of its learning equality and diversity project, which focuses on developing union learning representatives (ULRs). The Employment Act 2002 gave ULRs statutory recognition, which means they have the same status as health and safety representatives or stewards and are entitled to time off to carry out their duties and attend training. Ms Cain says: ‘This was a really big step forward for unions campaigning to promote the idea that learning and training issues were trade union business.’
ULRs are UNISON’s first port of call for HCAs needing support in their learning – whether or not they are UNISON members. ULRs can offer advice and signposting to those who need to improve their literacy and numeracy skills, for example, and also negotiate with employers for time off to run courses at a trust. They are also often involved in negotiating with line managers.
Ms Cain explains: ‘Often there may be an agreement at an employer-union branch level to run a course but then the difficulty comes when the line manager is faced with trying to reorganise shift patterns to give time off to someone for learning. The ULR may be engaged at workplace level to negotiate with the immediate line manager and explain why the course will be helpful.’
ULRs can intervene in cases where HCAs are not receiving appraisals or personal development reviews. And UNISON runs workshops to help HCAs get the most out of the Knowledge and Skills Framework by using development review meetings as opportunities to get the training they want.
But in addition to information-giving, a crucial role for ULRs is to be a friendly ear. Ms Cain says: ‘Where line managers are saying “you need to get yourself on this training”, there is an element of fear and people are less likely to take that opportunity up, whereas ULRs are by definition employees doing similar kinds of work. Very often they have themselves been through learning programmes and they know the anxiety learners will have.’
Jane Reed, a healthcare support worker in outpatients at Neath Port Talbot Hospital, part of Abertawe Bro Morgannwg University NHS Trust, is a UNISON ULR. Her hospital has a network of ULRs, with herself in outpatients, a colleague on the wards, and so on. As a ULR, Ms Reed distributes information on courses available to healthcare support workers and other staff.
After taking the K100 through the Open University she mentioned the course to a fellow healthcare support worker, who has also taken it. Ms Reed now attends college in the evenings to brush up on her computer skills and rounded up a few nurses to join her.
She believes that further training can help HCAs consolidate what they do in practice. ‘You do things on a day-to-day basis and it’s just automatic,’ she says. ‘Training makes you think about what you do.’
And her role as a ULR is increasingly recognised. ‘One of the girls had her personal development review a few months ago. She had wanted to know about a course, and sister said to her “why don’t you ask Jane?”. So the word is getting out there that we can help.’
How Unison supports HCAs’ professional development