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Gaps in healthcare training for vulnerable groups revealed

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Training for healthcare workers on how to provide care for people from socially excluded communities is “underdeveloped”, with a “sizeable gap” having formed between education and the skills required to practice, a new report has found.

The government-commissioned year-long report focussed on people from vulnerable communities including those who are homeless, travellers, Roma, sex workers or migrants.

“Inclusion health is an area that is generally underdeveloped and the guidance provided to professionals and education providers varies enormously”

Mary Lovegrove

It noted that, while all universities offering healthcare courses reported teaching six key areas of health inequalities at undergraduate level, they were not all assessing them.

Even levels of assessment among specialist community nursing courses such as those for health visiting and school nursing – which provide the largest workforce in contact with vulnerable groups – were “relatively low”, said the report.

Called Inclusion Health: Education and Training for Health Professionals, it found only 38% of the 62 universities that provided these specialist courses were “confident” they assessed student nurse knowledge about how social determinants are distributed across society.

Meanwhile, only around half reported they assessed social and economic determinants of health as part of specialist community nursing courses.

A shortage of suitable clinical placements in the community for pre- and post-registration healthcare students was also identified, with the “vast majority” of undergraduates unlikely to come into contact with socially excluded communities.

“Higher education institutions need to ensure they have sufficient staff with the appropriate knowledge and skills to support the inclusion health agenda”

Mary Lovegrove

While third sector organisations help to address this problem, this approach causes concern for education providers on how to monitor the quality of learning, added the report.

Limited academic expertise in the sector was also identified, although it was unknown whether this was due to a lack of commitment to this type of training by universities or insufficient numbers of experienced practitioners.

Meanwhile, evidence from 12 healthcare sites across England, Scotland and Wales that work with vulnerable groups showed there was “variable” support for practitioners when in post, especially for loan workers.

Participants from the case studies noted several challenges in working with these communities, such as risking offending patients and potentially being attacked.

The report recommended the government draw up a national strategy for England to ensure healthcare professionals have the appropriate skills, attitudes and understanding of the issues facing vulnerable groups.

QNI Awards 2014

Queen’s Nursing Institute

Crystal Oldman

It also called for regulatory bodies to make it “explicit” in their standards of education that training on healthcare for socially excluded groups – known as “inclusion health” – should be embedded in undergraduate curriculum.

Universities should ensure they are assessing inclusion health learning and must also “urgently review” staffing arrangements, said the report.

Professor Mary Lovegrove, joint author of the report, said: “The study found that inclusion health is an area that is generally underdeveloped and the guidance provided to professionals and education providers varies enormously.

“Much of the existing education and training addresses only the health risks and healthcare needs of people who are homeless and make the assumption that the needs of this vulnerable group are readily transferrable to the other four groups,” she said.

“Higher education institutions need to ensure they have sufficient staff with the appropriate knowledge and skills to support the inclusion health agenda,” she added.

Crystal Oldman, chief executive of the Queen’s Nursing Institute, which contributed to the study, welcomed the report.

“[It] will be very helpful to nursing educators and employers who wish to enhance the capacity of community nurses to give high quality healthcare to the most vulnerable people in society,” she said.

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