Scottish Government

7 PILOT OPERATION - VIEWS ON LEARNING AND ASSESSMENT

Introduction

7.1 This chapter explores stakeholder, healthcare support worker and workplace supervisor experiences and perceptions of the learning and assessment process. We follow the process through from setting up the initial meeting between HCSW and WPS, use of evidence of prior achievement, through the observation and oral assessments to being entered upon the occupational list.

7.2 In Chapter 5 we saw 71% ( 335) HCSW volunteers went on to have an initial meeting with a workplace supervisor and 61% ( 286) had completed at least the first observation element of assessment (Table 5.2). The large majority of HCSWs completing assessment were: clinical support staff, nursing assistants/ CSWs (71%, 206), allied health support staff (20%, 57) (Table 5.8).

Pilot site stakeholder perceptions

7.3 The monitoring data indicated that the large majority of assessments were, as expected, completed within two to three months. Delays appeared to be more about logistical issues than capability of the HCSW. Local Pilot Coordinators attributed slippage in the process to the combination of multiple reasons:

• Late and lost consent forms; issues with internal mail
• HCSWs starting other jobs, courses or opting out for personal reasons ( e.g. maternity leave)
• Service re-design causing relocation of staff and difficulties in linking HCSWs and WPS
• WPS prioritising other work responsibilities; not able to attend or missing arranged training sessions
• Difficulties in identifying an appropriate WPS
• WPS assessing HCSWs on a phased basis to cope with larger numbers of HCSWs
• Difficulties in getting meetings arranged between HCSW and WPSe.g. on opposite shifts; both being absent consecutively or sequentially (sickness, holiday); staff shortages

7.4 Stakeholders reported that the assessment burden was generally not excessive for HCSWs and that those undertaking the process had found it valuable and enjoyable. Partnership representatives had largely received positive feedback about the learning and assessment process - some HCSWs said they could see how the standards relate to the KSF outline for their post. However it must be noted that these comments applied largely to clinical support staff.

7.5 A small number of medical laboratory staff worked through the standards. The Workplace Supervisor tried to find ways of making some of the standards and criteria applicable. However it currently appears that for standards 1, 10, 13 and 14 it is not possible to provide evidence for these posts. It has also been found that it is possible to generate an oral assessment paper with criteria not of relevance to these posts.

7.6 Stakeholders considered the assessment paperwork sufficient but there needed to be some adjustments to consistency across documents and preferably a reduction in the amount of paperwork.

7.7 The Local Pilot Coordinators found that again at this stage there was a much higher amount of time-consuming administrative work than anticipated. On receipt of completed assessment papers the LPCs checked for completeness of data and might find they had to telephone the WPS for completion of missing dates or even missing questions and the form might need to be returned to the WPS. One LPC reported the WPS as saying they missed things because the assessment papers were wordy and repetitive.

7.8 Local Pilot Coordinators found that going back to the HCSW, once all the assessment paperwork was signed, to get the Code of Conduct Declaration form signed was yet another unanticipated time-consuming task. It could take a half-hour per HCSW to ensure the form was read, understood and signed, then photocopied and returned to the HCSW.

Healthcare Support Worker views on learning and assessment

Learning

7.9 At the time of the participant HCSW survey 90% ( 146) had a Workplace Supervisor in place (in Lothian at this point 26% did not). For over two thirds (68%, 111) the WPS was another member of staff in the HCSW's work section and this was true for 83% of Lanarkshire HCSWs. For a fifth (20%, 32) the WPS was their usual line manager. For 4% the supervisor came from outside the work section. In the majority of cases (80%, 132) there was no difficulty in arranging a Workplace Supervisor, but for nine staff there was some or a lot of difficulty. Most (81%, 133) felt their WPS, at the first meeting explained what was required very or fairly well.

Table 7.1 Evidence of previous achievement

* Percentages may sum to more than 100% as some HCSWs hold more than one qualification

7.10 Two thirds (66%, 109) had discussed taking prior achievements into account with their WPS. For most (65%, 106) there had been no difficulty in deciding which to take into account as evidence but for 7%, ( 12) there had been some or a lot of difficulty. Table 7.1 shows that inclusion of the range of prior evidence was certainly not automatic (some 11% had an SVQ2 which was not included). 40% ( 65) had discussed personal development needed to meet the standards. 34% ( 56) had this already planned or had carried it out.

7.11 The majority (62%, 102) thought they needed to do preparatory work before assessment (Table 0.20). There was a consistent pattern across the three sites in terms of perceptions of the balance between work time and own time required to prepare for the standards: less than one in five (15%, 24) reported doing the work all in their own time, a third (34%, 55) spent some of their own time, and less than a third (28%, 46) prepared all in work time but a quarter did not comment (24%, 39). The amount of the volunteers' own time spent preparing for the standards ranged from none to 10 - 15 hours over a several days or weeks. Around a fifth spent 2 hours and a third 3-4 hours on preparation but a tenth said they spent more than a day. Of those using their own time, most felt this was reasonable and only 11 individuals felt it to be unreasonable.

7.12 41% ( 67) felt they needed some help with the preparation process. Half (54%, 88) received this from their WPS plus some (8%, 13) from a senior manager; others (21%, 35) turned to another HCSW.

Assessment

7.13 The plans for approaching assessment varied: 28% did all the Observation assessment first as recommended; 16% did all the Observation and Oral together in one go; 32% did a few standards at a time, Observation and Oral together, (this perception came from facilities staff); a handful did all the Oral assessment first. Only two fifths had completed assessment elements when the survey was taken (40%, Observation; 33%, Oral) and a further 25% felt they were just getting started.

7.14 When asked about how easy or difficult they thought the standards were, two-thirds (64%, 105) thought they were about right, more than a quarter (29%, 47) were unsure. Few ( 11) felt they were too easy and only one person thought they were too difficult.

7.15 Half (52%, 86) thought that the standards were mostly applicable to them, while just under a quarter (24%, 39) thought they were only applicable in parts.

7.16 Most HCSWs found the time required to work towards the standards about right (63%, 103); a few thought it was too much (7%, 11) or too little (4%, 6); but a quarter did not know (27%, 44). Around half the HCSWs (49%, 80) expected it to take up to three months to achieve the standards; less than one month (23%, 37), two to three months (26%, 43). A few (8%, 13) thought it would take longer than three months but 43% (71) did not know how long it would take.

7.17 At briefing sessions HCSW's appeared appreciative of the overall presentation of materials ( e.g. plastic ring binders).

Table 7.2 The standards potential to affect HCSW's work

7.18 Over half (59%, 96) felt the standards had potential to affect the way they did their job but a quarter (25%) did not. Table 7.2 indicates that almost half felt undertaking the standards had the potential to improve their confidence (46%) and their knowledge (40%). Most importantly they felt they knew more about patient safety (44%) and felt more able to take action to keep patients safe (46%). Slightly less felt it might help their career or transferability to another Board. Overall the perceived gains appeared strongest in Ayrshire and Arran and weaker in Lothian. Some 10-15% in Lanarkshire disagreed with these statements but that is most likely because more were already qualified to a higher level before the pilot.

I enjoyed taking part in the pilot project. It was an exercise that certainly makes you more aware of your day to day work activities and how you carry out certain tasks to ensure patient safety.

(Radiography assistant, grade 3, hospital based working weekends, nights and 9-5 hours)

Fit with KSF and PDP

7.19 The evaluation surveys of HCSWs and WPS confirmed that there was a wide variety of experience of both PDPR and KSF across the three pilot Boards. The majority of HCSWs had heard of KSF (70%. 115) but interestingly a fifth (21%, 35) had not and the rest did not know. Half the HCSWs and three quarters of WPS had a KSF outline in place by summer 2008. At least two thirds had had a PDP in the last year. Just half the pilot WPS were also KSF reviewers. Three quarters (78%) of WPS saw potential for fit with KSF but far fewer HCSWs did at this stage (40%).

As a porter I have not yet started my PDP, which I have been told is to be soon. I have never had a one-to one with my line manager about any aspect of my job. But most of the porters think nobody cares how we get on with our job, even though we need to learn certain skills to do our job.

(Porter, 8 hour shifts and weekends).

7.20 Awareness of KSF and PDP varied across the sites. In Ayrshire & Arran 95% had heard of KSF, 78% had a KSF outline in place, 52% felt the standards would contribute to the KSF foundation gateway and 77% had had a PDPR in the last year. In Lanarkshire only 59% had heard of KSF and 46% had an outline in place. In Lothian 80% had heard of KSF but only 40% had an outline in place and only 54% reported a PDPR in the last year.

Table 7.3 KSF and PDPR

* Percentages may sum to more than 100% as they relate to different questions

7.21 The case studies confirmed the wide variation in knowledge of and experience of KSF processes. Some clinical supervisors clearly felt there was potential for the standards to fit together.

It should probably run side by side I should think.

( WPS, Senior OT)

With what we've done in the work and with what I've seen in the KSF, I can'nae see there being any problems. I don't know because I have'nae done it yet so I would need to wait till we've actually done it and then I can tell you.

( WPS, Charge Nurse)

7.22 One WPS and HCSW had found going through the pilot very helpful in preparing for the KSF review

I thought the course [pilot] would help and it did, we just sort of went through it, you know how you do it for Grade 3, I didn't have to do anything to get to the Grade 3, I was there and above.[…].we discussed all the KSF and what it meant and to go through the gateways, because we had already gone through this healthcare thing [ WPS] was satisfied that I was at it sort of thing.

(Community nursing assistant)

I think it was [helpful]. I think because you know how you sit down, you obviously agree with the person [ HCSW] what you're doing.. what their standards should be. If it's a, you know if its communication, then you should be looking at a '1'. Then you can sit down and say, "Well, you should be able to record things on FACE records or whatever. So the fact we'd already used it in the pilot study meant you were almost.. It was fresh in your mind, and you were always using the same examples.

( WPS, Charge Nurse)

7.23 At first interviews some HCSWs had not heard of KSF or were not sure what it was.

We did do something about this but I really cannot remember - is it to do with the mandatory courses we did, like Food Hygiene, Fire, and Handling courses?

(Domestic assistant)

7.24 Where roll-out was slowest one mental health nursing assistant had not heard of KSF at all. The WPS confirmed no one in the ward had a KSF outline as yet but she could see the pilot fitting in with ' the ten essential shared capabilities'. On occasion HCSWs and WPS had different understandings about whether an outline was in place - this might be because of unfamiliar terminology.

7.25 Where the WPS did not yet have a KSF outline in place for their own post or had not yet had the first KSF meeting they were not in a position to be KSF reviewers or to comment on how the induction standards might fit with KSF ( e.g. Domestic supervisor Band 2).

7.26 There were examples of the KSF reviewer being a different person from the allocated WPS for the pilot (possibly the WPS' own line manager). Any potential implications from this did not appear to have been discussed with the relevant line manager/ KSF reviewer.

7.27 Technical issues with the e- KSF computer system had slowed down the KSF process at some units

She [ HCSW] will have [ KSF outline in place] and sorry, I shouldn't laugh, everything is on line with this e- KSF, however for some reason anything to do with my e- KSF went pear shaped and they're trying to work it out why. The technology. I think if I actually know what the standards were for the Clinical Support Workers against you know, for the e- KSF, I could make a comment on that [how they fit together] but as I say I can't get in to get standards just now because of a technical hitch.

( WPS, Staff Nurse)

7.28 Many (37%, 61) of the participant returns had written general comments at the end (Ayrshire & Arran 20, Lothian 20, Lanarkshire 21). Seventeen HCSWs took the opportunity to comment on a positive and worthwhile experience and a handful of them praised their supervisors' efforts.

I feel it has been a worthwhile and positive experience. My Workplace Supervisor put in a lot of the time and effort for the pilot scheme.

(Nursing assistant, full time, working weekends and 9-5, hospital based)

7.29 Eleven staff commented that they were already operating at this standard and most of these felt the standards would be better for new staff at induction.

Felt the pilot scheme is excellent for new members of staff coming into post but not for staff that has worked for years in present post. Observation, excellent. Oral, felt the questions were duplicated quite a few times.

(Rehabilitation support worker, older people's services, working in community setting, part time (30 hours), ten years with Health Board)

7.30 An issue within Lothian was lack of support to know how to progress the pilot and - in some cases - get support from supervisors. Difficulty arranging the same shifts as the WPS was an issue for a few in Lanarkshire. The case studies confirmed this sense of frustration with not knowing what they should be doing or whose responsibility it was. They also indicated how some HCSWs felt relatively powerless to get things moved along and were waiting for someone to come back to them.

This is my first correspondence since completing the Disclosure Scotland form in February for this pilot. In completing this form I had/have no information on the questions and what they mean.

(Nursing assistant, mental health, works weekends)

7.31 This quotation confirmed pilot staff views that bank staff may not be supported by ward based supervisors.

I haven't started pilot, I feel that the Staff Nurses on the wards don't want to help or don't have the time because I am Bankaide staff. Maybe if I was in a permanent position on a ward things might be different.

(Clinical support worker, mental health services, Hospital based, full time, band 2)

7.32 Other issues - mentioned by a handful only - were the need to make the standards applicable to particular staff, to improve the paperwork, being too busy at work. Interestingly, there was one description of a minor past offence (unlikely to have impacted upon the post) and one protest at the pilot not being voluntary.

7.33 At the time of the survey 61% ( 100) had already signed the Code of Conduct Declaration. Most (96%, 147) thought the Code of Conduct was very (84%, 129) or somewhat (12%, 18) important for people in their job. Only 2 thought it was not important. Just half (52%, 84) were aware of the Complaints and Appeals procedure.

Certificate Presentations

7.34 Senior Board level staff presented certificates at special ceremonies thereby endorsing the HCSW participation in the pilot, and the role of the HCSW in the healthcare team. Ayrshire and Arran, being furthest ahead at an earlier stage, held multiple ceremonies in 2008 for smaller groups whereas the Lanarkshire and Lothian ceremonies were in early 2009 for larger groups of around forty-five HCSWs. Lothian planned a prize draw. Workplace supervisors also attended. The HCSWs appreciated the ceremony and the fact that presentations were by senior staff. They commented upon the catering, photographs and publicity in local newsletters. In some cases HCSWs brought partners along to the event.

7.35 There were three certificates ⁶⁶

• Certificate of participation ( HCSW volunteers partial completion)
• Certificate of achievement ( HCSW volunteers who completed all assessment)
• Certificate of acknowledgement ( WPS taking part in pilot)

7.36 Most HCSWs (85%, 140) thought it was very or fairly important to receive a Certificate. They saw it as proof of effort and something to show a future employer. Supervisors felt less need of a certificate for themselves as they mostly already had other qualifications or certificates.

Very important, to recognise, can go into the professional development like the rest of it [but] Its very difficult to keep using up time, you have got patients to see, takes time to get people to come at certain times, don't want to cancel things.

(Technical instructor, allied health)

It's proof that you have done the course, if you did move to another employer you've got that certificate to say you have done it.

(Community nursing assistant, mental health)

Well, I think that's a good thing because you've got proof that you know what you're doing, you know what you're talking about.

(Hotel services operative)

Oh yes, because it gives them something to work for and they have got something to show that they have done it.

(Domestic supervisor, band 2)

I think its important, in nursing, Clinical support workers, I feel under valued, because if there's any training that goes on within the ward it tends to be for staff nurses and senior staff, and they go away and they get their training courses and they get their nice shiny certificates and quite often I feel the clinical support workers look and feel left out, feel unvalued so I think giving them a certificate is a good thing, I think everybody likes that wee bit of paper.

(Staff nurse, band 5, hospital physical disability)

Well I don't know, the girls get certificates for everything these days and just probably put them in their domestic room and forget about them.

(Domestic supervisor, band 3)

Entry onto the occupational list

7.37 The questionnaire asked a general question 'Do you understand what the occupational list is?' Replies indicated that 'understanding' of the occupational list is patchy with a third (32%, 53) having only some understanding and rather fewer (29%, 47) feeling that they have a good understanding. Perhaps of concern, one in five (19%, 31) reported that they had no understanding, and a further (15%, 24) reported that they had little understanding. The majority 71% ( 117) were happy for their name to be entered on the list with the remaining respondents either not happy (8%, 13) or unsure (15%, 25) with nine choosing not to answer. However it should be noted that the question itself did not allow any differentiation between 'understanding the reasons' for listing and 'understanding the process' of listing. It is clear from the case studies that HCSWs had little understanding of the 'occupational list'.

Support for the aims of the pilot

7.38 The vast majority of HCSW participants supported the aims of the pilot and regarded it as important for HCSWs doing their job (82%, 135) and for different healthcare support jobs (79%, 129) to undertake the standards. Most (87%, 142) said that it was important that all Health Boards have the standards in place, and that it was important that all Health Boards have an occupational list in place (64%, 105).

The pilot scheme should become mandatory to your place of work and not optional as it is at the moment, as everyone connected with the same post as I'm in, but in a different Health Board, will receive the same training and support that they need.

(Mental health care assistant, hospital based full time, 12 hour shifts, weekends and nights)

I think this is a worthwhile course for all NHS Assistants. It can only lead to better patient care and more job satisfaction.

(Podiatry assistant, full time working across hospital and community bases)

Stakeholder views on the definition of 'healthcare support worker'

7.39 The pilot has attempted to test the employer-led model with both clinical and non-clinical groups and the local implementation experiences have helped to inform stakeholder and key informant opinion about the current definition of 'healthcare support worker', and thereby the definition of groups to be included in undertaking the standards.

7.40 Discussion has circled around three elements. Firstly, the principle of whether inclusion should be determined by the amount of direct contact and nature of risk presented by the role or whether every health worker should meet these basic threshold induction standards. Secondly, should inclusion be determined by the 'applicability' of certain standards or criteria to particular roles, the scope for workers to evidence criteria and whether different criteria should be generated. Thirdly, should inclusion depend upon the practicality of managing supervision and assessment.

7.41 There was consensus around the principle, applicability and practicality of applying the standards to nursing assistants and allied health professionals. There continued to be very varied views about non-clinical support workers for whom the standards were as yet untested. There was some support for inclusion of some non-clinical staff in particular roles in particular environments ( e.g. porters with unsupervised direct access), but a great deal of uncertainty about the inclusion of staff in other support roles ( e.g. domestics, catering, laboratory assistants).

• 'A lot of domestics clean wards and have patient contact, catering don't. Still got a huge group where it (the standards) might not be fine'
• 'some domestics only go into a theatre in the evening to clean it, only work two hours per evening, the supervisor covers the whole of (X hospital unit) and if someone was off sick or a crisis then she wouldn't be able to meet them''
• 'My view is all of them, admin and clerical as well'
• 'a lot of staff don't have the same potential to get close to patients and so should not have the same responsibility placed on them'
• Porters are in and out of the wards all day, they don't have a lot of dealings with the patients but they will come into contact, particularly the care of the elderly wards… delivering mail, linen, patient's personal clothing

7.42 The medical laboratory assistants who took part in the pilot did not have direct patient contact. The NHSQIS learning and assessment quality assurance exercise and evaluation case studies found that some standards (1, 10, 13 and 14) may not be applicable to this group where there was no direct patient contact or delivery of direct care. If these latter groups are to be included, it was deemed crucial that the standards be made relevant and attainable. If this could not be done, then those groups should not be included in this model of regulation. Phlebotomists were not included in the pilot (due to an ongoing Agenda for Change related dispute); this skill, requiring direct patient contact, is provided by a range of staff. One job title from the prescribed list 'mortuary attendants' did not appear to have been sufficiently addressed by any site during the pilot.

7.43 There was a strong view from some respondents that many administrative and secretarial staff have as much (or more) direct contact with patients and the public as support staff and that they would like to see them included in the definition of healthcare support worker. The evaluation has discovered that a number of support workers hold both administrative and support worker roles, perhaps two part-time jobs or a split role ( e.g. ward clerk/support worker). The role of administrative staff is being covered by an NHS Education Scotland workstream ( Annexe J).

7.44 By the end of the pilot, Ayrshire and Arran considered the outcome with the sample of domestics to be disappointing but their focus was on NES funded work with the local college. In hindsight, Lanarkshire expressed some regret that non-clinical support staff had not been approached earlier as some staff had since expressed interest in the pilot.

Views on non-clinical groups

7.45 The evaluation team contacted Facilities staff at a national and local level and obtained views from non-clinical support workers via the case studies and surveys. Several potential reasons for the pilot's lack of success in engaging with non-clinical staff emerged.

7.46 There were clearly issues of communication at all levels. At a national level, there were very varied perceptions of communication between Health Facilities Scotland, SGHD and NHSQIS. At a local level the pilot was seen as not being 'sold' to these groups (para 6.17). Recognition of the title 'healthcare support worker' was an issue (it is noteworthy that the evaluators received calls from staff, asking why they had been sent the questionnaire as they were not healthcare support workers). The very fact of being 'voluntary' was reason enough for catering staff, in and out of site on short shifts to cover mealtimes, to not take it up. For those on short shifts, perhaps juggling with caring responsibilities at home, further (unpaid, development) obligations would take up too much time. These support workers may also have been put off the pilot because of fears concerning literacy requirements and assessment (Para 12.41).

7.47 Existing commitments also took priority ( e.g. mandatory training for fire safety, moving and handling, and hygiene ⁶⁷). Health Facilities Scotland was in the process of implementing a number of National Education and Training Frameworks for facilities staff across Scotland and consideration had already been given to how these mapped to KSF. The Framework for Domestic Services (2007) ⁶⁸ and the mandatory Domestic Assistants/ Housekeepers Workbook was already in place. In Ayrshire and Arran facilities managers were developing arrangements for the Workbook requirements to run alongside an SVQ with the local college.

7.48 A major problem in progressing assessment in domestic services was the low Workplace Supervisor to high support worker ratio and difficulties in freeing up sufficient supervisors to undertake assessment, particularly weekend staff (para 4.7).

Monday to Friday is not a problem as we have backfill, some domestics work in department offices only, so they can be pulled out to cover an hour for the questions and answers, for a domestic on the wards to do supervision. But at weekends we don't cover departments at all. All the people we have cover the wards, the patient services so that is going to be a slower process.

(Hotel services manager)

7.49 Management prioritised the completion of the Domestic Assistants Workbook which might require a couple of hours per week for experienced staff over four to five months.

If two hours for the domestic every week you are looking at three, three and a half per week for the supervisor because they have to prepare exercises.

(Hotel services manager)

7.50 Ayrshire and Arran was able to begin to explore, with a small number of domestic staff, how the standards fitted alongside the Workbook. Managers said that supervisors found the extra task to be a chore and that also only some supervisors, familiar with or interested in assessment, would wish to undertake it or be able to undertake it with sufficient confidence to be able to instil confidence in the support worker. There was duplication with the Workbook but a perception that they could link together.

7.51 The standards strengthened some areas not particularly covered by the Workbook

It take a very strong person to put forward a complaint and that standard in particular when its highlighted that everybody has a responsibility, it might give them that bit more confidence…I think the fact that you are going through the statements, about verbal and physical abuse, even just talking about it, there's more awareness to it.

(Hotel services manager)

7.52 However these domestic assistants from different pilot sites did not feel the standards applied to them

It is more for the auxiliaries and clinical support workers. It was talking about looking out for violent situations starting up and patients and relatives relaying information to me, and how you should tell a colleague, or whoever is in charge of the ward. That's not anything I'd come up against. I just get on with cleaning.

(Domestic assistant)

We're involved with the patients like as domestics on the ward. We speak to the patients but to me a lot is like for personal care with the patients and that doesn't involve me.

(Domestic assistant)

7.53 It confirmed the competence of domestics who undertook the standards, but for some there were concerns about paperwork and potential written work:

Staff themselves quite enjoyed it, they didn't realise that they were actually quite up to speed with the standards, I think they got a pleasant surprise, they didn't realise they were doing it on a day to day basis.

(Hotel services manager)

7.54 There were also concerns that ancillary services are often recruiting from a flexible or transient pool of staff. Such staff might find additional requirements off-putting ( e.g. Disclosure Scotland applications, induction preparation, potential payment for regulation) and may prefer to take up less demanding employment ( e.g. local supermarket).

Summary

7.55 Participating HCSWs (82%) supported the pilot aims. Undertaking the standards improved confidence, knowledge about patient safety (44%) and ability to take action to keep patients safe (46%). The certificates and presentation ceremonies made them feel valued.

7.56 HCSWs found that supervision arrangements and decisions about the relevance of previous achievements were mostly decided without difficulty, but for some these were both problematic. Half the HCSWS prepared for assessment partially or wholly within their own time (on average around two to four hours). Mostly (64%) the level of difficulty of the standards was 'about right'. Most (71%) were happy to be entered upon the 'occupational list' but many had little understanding of what this might mean. Half the HCSWs and three quarters of WPS already had a KSF outline but this varied across sites and posts; more WPS than HCSWs were aware of potential for the standards to fit with KSF.

7.57 As originally anticipated, assessment was usually completed within two to three months; slippage concerned logistical rather than HCSW capability issues. The level of assessment effort required was generally acceptable but paperwork needed to be reduced. It was not possible for non-clinical groups, who did not have direct patient contact, to evidence four of the standards.

7.58 Stakeholders expressed consensus about the principle, applicability and practicality of applying the standards to nursing assistants and allied health assistants, but there remained very varied views in relation to non-clinical groups. The lack of engagement of non-clinical groups with the pilot was attributed to: gaps in communication nationally and locally, other priorities in training, the high HCSW to low WPS ratio, lack of identification of this group of workers with the term 'healthcare support worker'.