Training & Supervision

On this page we discuss current issues around training and supervision in care work. From here, you can navigate to tables in which we identify relevant laws in England, Scotland and Wales.

Minimum training requirements for care workers are set out in regulations and guidance. We regard these regulations as important indicators of the status that is formally afforded to the skills and roles of care workers. As we have noted elsewhere, care workers must demonstrate a broad range of skills, including practical and quasi-medical skills for ensuring the health, safety and welfare of service users, as well as less tangible qualities around ideas of integrity and honesty. But in spite of the complexity of the care worker role, training is inconsistent across the sector, with care workers receiving varying levels and types of training. Our comparative approach to the analysis of social care regulations has found significant differences in training and supervision requirements between England, Scotland and Wales. For example, unlike the other nations, England does not require care workers to join a system of professional registration.

That said, we are also aware of similarities at work in care settings across the UK. In all three nations, care workers are required to work with a growing proportion of disabled and older adults with complex care needs, and across the UK we see an increased emphasis upon personalisation of care. While personalisation includes many aspects of care, this principally means that individuals have choice and control over the shape of the support they receive in care settings. While the ethos of personalisation is an important aspect of ensuring services users’ human rights, this shift in the way in which care is delivered serves to complicate the care worker role, with the potential to fundamentally change the nature of care work. For example, care workers may be required to take more of a lead from service users in directing their roles, rather than prioritising their own or their employers’ beliefs on how care should be delivered. The personalisation of care might also raise ethical dilemmas where a service user wishes to undertake an activity which might be considered dangerous or risky to their health (Hayes et al 2019). For example, Galligan et al (2015) studied the fire hazards arising from at-home oxygen therapy for service users who smoke. The researchers found that workers were exposed to serious fire and explosion hazards. One care worker participant noted the following:

I have a client that is on oxygen and she smokes while she has it on. She doesn’t want to stop, she has had social workers, nurses, everybody you can think of going in there to tell her to stop. I actually see sparks on her nose.

Other examples of the ways in which personalisation might interact or conflict with a duty of care might arise around diets and food choice, or activities which might carry the risk of injury or a fall.

All this to say that contemporary care work and the ethos of personalisation give rise to a range of training requirements, and the need for care workers to develop a complex and constantly evolving skillset in line with individuals’ dignity, choice and control, as well as their ongoing care, health and safety.

Training

In spite of the importance of the care worker role and the broad range of skills care workers are expected to possess, training in the sector is hugely variable and some reports suggest a dangerous lack of vital training. The Kingsmill Review reported that a fifth of health and social care apprentices receive no training at all, while nearly a third of care workers receive no regular ongoing training. The same report found that over 41% of care workers do not receive specialised training to help deal with their client’s specific medical needs, such as dementia and stroke-related conditions. Given the increasing complexity of care worker roles, this raises serious concerns regarding the wellbeing of care workers and those they care for.

In terms of the types of training care workers receive, research shows that this tends to be a combination of formal and informal, ‘on-the-job’ training, the latter consisting of undertaking ‘shadow shifts’ as part of their induction training in order to learn, for instance, the practicalities of delivering hand-on care, the names and preferences of individual service-users, and organisational routines. More formal, ‘off-the-job’ types of training is more often recorded by employers in official reports and records. It appears that the most popular areas of formal training received by care workers mirror areas of regulatory priority, covering topics such as health and safety, moving and handling, the protection of vulnerable adults, and infection control.

However, as noted above, the types and quality of training delivered varies across different regions, employers and care settings. Training is characterised by localised, rather than nationalised, delivery, which means there is little the way of consistency across the sector. It is also important to recognise that, though important, training cannot make up for longstanding issues emerging from years of underfunding, such as insecurity, low pay and understaffing. No amount of training can compensate for these deep-seated structural problems in the care sector.

Supervision

Alongside training, supervision is an important aspect of care work, both in terms of job quality and quality of care. Effective supervision which involves frequent communication between management and care workers is essential to meeting regulatory requirements. This includes laws around safeguarding, health and safety, and record-keeping. Ongoing and periodic supervision can help to ensure care workers are competent in their role, and are receiving necessary guidance, as well as ensuring workers receive appraisal and any relevant training opportunities.

However, in spite of the importance of supervision for maintaining good quality care delivery, there are a number of areas in which this is lacking in the sector. Care work can involve a great deal of autonomous or lone working, and some care workers have very limited contact with management. The time and workload pressures in care work can mean contact time with colleagues is scarce as workers are under pressure to complete their tasks during their shifts. Researchers have noted how this can impact upon the quality of communication around important issues such as medication, and health and safety (Moriarty et al 2019).

Galligan, C. J., Markkanen, P. K., Fantasia, L. M., Gore, R. J., Sama, S. R., & Quinn, M. M. (2015). A Growing Fire Hazard Concern in Communities: Home Oxygen Therapy and Continued Smoking Habits. NEW SOLUTIONS: A Journal of Environmental and Occupational Health Policy, 24(4), 535–554

Hayes, L. J. B., Johnson, E., and Tarrant, A. (2019). Professionalisation at work in adult social care: Report to the All-Party Parliamentary Group on Adult Social Care. Available at: https://www.gmb.org.uk/sites/default/files/Professionalisation_at_Work_0309.pdf

Moriarty, J., Norrie, C., Manthorpe, J., Lipman, V., & Elaswarapu, R. (2019). What makes a good handover in a care home for older people? Working with Older People, 23(3), 167-176.

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