NHS apprenticeship providers face Ofsted pressure
Why have several NHS employer providers of apprenticeships struggled when Ofsted calls?
The NHS is in the midst of one of its most challenging winters on record. A surge in patient demand and Covid-related rises in staff absence have combined to put health services under extreme pressure. Amid rising delays to A&E and non-urgent care alike, NHS leaders have insisted the health service is up to the task.
Central to the challenges facing our health service is the availability of skilled staff who can deliver care in often-challenging circumstances. NHS staff shortages appear significant, amid reports of almost 40,000 nursing vacancies, resulting in consequent reductions in service capacity.
Faced with these pressures, NHS trusts have increasingly turned to apprenticeships to recruit new staff and develop the skills of existing employees. Last year, around 2200 learners started a Registered Nurse apprenticeship in England. Over 3000 people enrolled as a Senior Healthcare Support Worker apprentice. And almost 4200 started a Nursing Associate apprenticeship. Apprenticeship starts were registered in 64 different health and care occupations in 2020/21.
This growth in apprenticeship activity is welcome and comes at a time when the NHS has rarely been more in need of the skills that apprentices bring. However, a troubling pattern of weak Ofsted inspection reports has emerged amongst NHS Employer Providers (EPs). As the sector continues to navigate unsteady terrain, we must examine what is impacting the quality of training available, how this affects our healthcare workforce and the quality of care they can provide.
Quality curriculums improve conditions for our Healthcare workforce
In our article Tackling the National Skills Shortage From Within, we discussed the value of opportunities for workforces to access relevant skills within the sector. We considered how workforce development relates to staff retention and quality of care. As organisations experienced in delivering training, NHS trusts should be well suited to becoming employer providers – where the employer of the apprentice is also the provider of learning and development (rather than a training provider, university or college).
But in September, Tees, Esk and Wear Valleys NHS Foundation Trust was graded as ‘inadequate’ in its first full Ofsted inspection for 13 years, resulting in the trust losing its place on DfE’s Register of Apprenticeship Training Providers (RoATP), meaning it can no longer deliver apprenticeship training. Ofsted’s report highlighted that many of their apprentices reported little to no guidance on their learning, minimum opportunity to develop new skills, and the apprenticeship merely reinforced the skills they already possessed.
A pattern of sub-par inspection performance
Unfortunately, TEWV is not the exception. Three years earlier, Walsall NHS Trust also received an ‘inadequate’ Ofsted rating, ending their employer-provider apprenticeship delivery. Meanwhile a clutch of foundation trusts delivering apprenticeships have been graded by Ofsted as requiring improvement. In late 2021, Guy’s and St Thomas’s NHS Foundation Trust and University Hospital Southampton NHS Foundation Trust both received ‘Requires Improvement’ Ofsted ratings, as did South Tees Hospitals NHS Foundation Trust in summer 2021. In 2020, Manchester University NHS Foundation Trust and Birmingham Women’s and Children’s NHS Foundation Trust were handed ‘Requires Improvement’ Ofsted reports, with the former’s subsequent 2021 Ofsted monitoring visit concluding that ‘insufficient progress’ has been made across the main areas for improvement identified in their full inspection report - putting the trust at risk of being downgraded to ‘Inadequate’ and losing the ability to deliver apprenticeships.
In all, out of 14 NHS trusts subject to a full Ofsted inspection in the past three years, half received a grade 3 ‘Requires Improvement’ result, five were judged ‘Good’ and two ‘Inadequate’. These results are well below par for apprenticeship providers, where typically each year around 1 in 4 inspection results are ‘Requires Improvement’, and under 10% are usually judged ‘Inadequate’.
Diagnosis and symptoms
So is Ofsted diagnosing similar problems among NHS apprenticeship providers? Each report identifies a different mix of challenges but common symptoms among grade 3 and 4 NHS trust apprenticeship providers do emerge, such as:
Weak prior assessment of apprentices’ knowledge and experience, leading to poor programme planning and target setting for learners
Poor coordination of apprentices’ on- and off-the-job learning (often partly the result of weak line manager engagement).
A lack of timely and accurate careers information, advice and guidance to apprentices
Difficulties ensuring that learners are supported to meet English and maths requirements
Weak oversight and monitoring of apprentices’ progress
Ofsted’s post-inspection monitoring visits offer providers clear feedback on the quality of their training provision; highlighting where sufficient progress has been made and what areas require improvement. Birmingham Women and Children’s Hospital NHS Foundation Trust was graded as requiring improvement in 2020. But their most recent Ofsted monitoring visit showed good progress in developing the quality of provision for apprentices. Ofsted highlighted that apprentices were developing significant new skills and knowledge within their workplace and leaders were actively engaging them in developing wider skills, including effectively carrying out procedures and working in intensive care.
The value of developing confident, supported, and engaged workers is significant to the care patients receive, especially as services continue to feel the strain.
Some providers in the sector get it right from the start, like Virgin Care Services Ltd, which was rated ‘Outstanding’ on their first full Ofsted inspection. But navigating the complicated landscape of apprenticeships, Ofsted guidance, and ESFA funding rules can prove difficult.
There are many advantages to becoming an employer provider, especially for large employers that can harness their facilities and expertise to deliver training that better meets their organisation’s requirements. In the healthcare sector, which faces a growing skills shortage and strain on services, such approaches are essential for its success.
Quality workforce development opportunities enrich the quality of care available for patients, improve staff retention rates, attract a wider scope of talent to the healthcare sector, and build a better working environment for our present and future labour markets.
Getting there might feel like a trek, but the hard work will pay off.
Find your Bearings
THINK can act as your compass as you make your way through the changing landscapes of apprenticeship training and workforce development. Our commitment to quality, accessible, and relevant education opportunities ensures our clients harness the potential of their organisation, driving increased capacity, performance and service resilience.
We help organisations to navigate the processes, systems, and quality requirements of sustainable apprenticeship programmes. We equip our client with the right tools to achieve excellence, empowering organisations to grow programmes that meet their changing workforce skill requirements.
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