University Hospitals Bristol and Weston NHS Foundation Trust

University Hospitals Bristol NHS Foundation Trust Monitoring visit report

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Name of lead inspector: Richard Light SHMI

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Type of provider: Independent learning provider

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Address:

Upper Maudlin Street Bristol BS2 8AE Monitoring visit: University Hospitals Bristol NHS Foundation Trust 5–6 December 2018

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Context and focus of visit

From October 2018, Ofsted undertook to carry out monitoring visits to all newly directly funded providers of apprenticeship training provision which began to be funded from April 2017 or after by ESFA and/or the apprenticeship levy. This monitoring visit was undertaken as part of those arrangements and as outlined in the ‘Further education and skills inspection handbook’, especially the sections entitled ‘Providers newly directly funded to deliver apprenticeship training provision’ and ‘Monitoring visits’. The focus of these visits is on the three themes set out below.

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Context and focus of visit

University Hospitals Bristol NHS Foundation Trust (the Trust) started delivering apprenticeships in May 2017. At the time of the monitoring visit, there were 186 apprentices enrolled on six different standards-based apprenticeship programmes. Nearly two thirds of apprentices follow a healthcare support worker route at level 2 or senior healthcare support worker at level 3. Other apprenticeship routes offered are operational department manager at level 5, customer service practitioner at level 2, dental nursing apprenticeship at level 3 and team leadership at level 3.

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The delivery of apprenticeship programmes by the trust is not leading to substantial gains in knowledge, skill and understanding for many of its apprentices. Ineffective strategic leadership, weak systems to secure trust-wide delivery and an absence of a clear understanding of what constitutes an effective apprenticeship training programme have combined to expose serious weaknesses in the apprenticeship programme of the trust. Trust leaders have not demonstrated the capacity to deliver high-quality apprenticeship training, particularly in healthcare. They have been too slow to establish a trust-wide strategy that ensures that the delivery of training is of high quality. Processes to monitor and evaluate apprentices’ performance lack coherence and rigour. As a result, education managers do not know how well apprentices are progressing in their training. The trust board members have not obtained findings

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from monitoring activities. This hinders their ability to target where improvement and remedial action is required. Consequently, the quality of training and apprentices’ achievement is too variable across the different programmes offered. The trust’s strategic plan does not prioritise the urgent need to check the impact of training on apprentices’ gains in knowledge and skill. Despite requests for the appointment of a quality manager, trust leaders have not invested in sufficient Monitoring visit: University Hospitals Bristol NHS Foundation Trust 5–6 December 2018 quality-assurance resources that would enable the head of education to analyse patterns of achievement across different training routes. Apprenticeship programme leaders do not routinely share approaches to delivery, feedback and how apprentices’ progress can be checked. Therefore, not all staff are learning from the stronger practice, such as in customer service. Such weaknesses in leadership stymie the

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development of a coordinated approach to improve the quality of experiences for all apprentices. This inertia is indicative of the trust’s limited capacity and illustrates their lack of understanding of what is and what isn’t working well in order to make things better. Leadership and governance of the trust’s management structure is hampering its ability to bring about the changes required. Systems and procedures to support successful apprenticeship delivery, which were absent when the delivery model was established in May 2017, remain in their infancy now, nearly 18 months later. Trust leaders have been too slow to develop a strong culture for the effective delivery of education and training. A small number of staff members who spoke to inspectors expressed their frustrations at the lack of action by leaders, for example to establish clear procedures that ensure that all healthcare apprentices receive the 20% off-the-

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job training to which they are entitled. The strategy for the growth in the apprenticeship offer places a strong emphasis on the recruitment of staff, particularly in specialist areas. A strong values-based approach to recruitment is helping to attract more apprentices onto the right courses and meeting the trust’s core values. Apprentices are identified with the right personal qualities and are loyal to the trust; they want their training to make a difference. Useful analysis by leaders is helping to meet the recruitment needs of the trust. Staff retention rates are increasing year on year, even though the national trend is a decline. The head of education demonstrates a good understanding of the requirements for good quality apprenticeship delivery. Developments in operational procedures, accountability structures and an ambitious vision for the future delivery of new apprenticeship routes are evident. Despite efforts to engender a cultural change with

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the trust, the head of education has been very much a lone voice in this endeavour.

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Too many assessors, mentors, tutors and managers do not fully understand the requirements and full entitlement of an apprenticeship training programme. As a result, too many healthcare apprentices do not receive sufficient off-the-job learning activities. The arrangements are often ad-hoc, poorly planned or do not supplement the core training well. In a small number of cases such as on the level 3 team leadership route, apprentices report that off-the-job training is not occurring at all. Other apprentices report having to come in at weekends to complete work or taking ‘whatever time they can’ during the working day. Too many managers do not plan shifts that enable apprentices to attend off-the-job training regularly and gain new Monitoring visit: University Hospitals Bristol NHS Foundation Trust 5–6 December 2018 knowledge and skills. As the training requirements of the apprenticeship are not fully

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understood by staff, many apprentices wrongly believe that attendance at English and mathematics sessions is considered as off-the-job training. Leaders acknowledge the subcontracted provision for the delivery of functional skills requires closer monitoring and improvement. The current delivery model, which offers apprentices the opportunity to ‘drop in’ and receive one-to-one support from a tutor once a week, does not enable leaders to check the progress apprentices are making in English and mathematics. Currently, leaders are unable to talk with any confidence about who has attended, the progress that apprentices are making in developing their English and mathematics skills or the quality and impact of this service. Internal assessors lack sufficient knowledge of the apprenticeship requirements, such as in healthcare, and therefore are unable to provide apprentices with clear feedback on the progress they are making. Tutors delivering study days for the level 3

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leadership and management programme do not have the skills or knowledge to challenge apprentices sufficiently. Too many apprentices do not know how much progress they are making in developing new skills and knowledge, whether they are on track to pass their qualifications or not; they do not know the requirements of their end-point assessment or when it will take place. In addition, too many apprentices do not receive helpful advice and guidance at the start of their apprenticeship or when preparing for their next step. As a result, many are unaware of their potential routes for employment or future training. Some tutors do not have up-to-date or relevant qualifications to deliver high-quality training to apprentices. For example, two thirds of the small cohort of tutors supporting apprentices to improve their skills and achieve the functional skills qualification, only have GCSE English and mathematics qualifications. Tutors in these

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subjects focus too much on passing exams and use workbook and worksheets as their main teaching strategy. Targets and feedback provided to apprentices are often cursory. As a result, too few apprentices enjoy attending these ‘drop-in’ sessions. Reviews with assessors do not place sufficient emphasis on apprentices’ progress from their starting points. The timings and frequency of such reviews are often irregular for healthcare apprentices. Consequently, they do not receive timely or pertinent points for their development. When the reviews do occur, assessors place an insufficient focus on apprentices’ development of behaviours, attitudes and employability skills. These aspects of their apprenticeship are currently not tracked by staff. Healthcare apprentices gain some useful practical skills and knowledge while working on wards with medical staff. However, the design of the training programme at the

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trust does not expect apprentices to apply or extend the theory learned in a structured or coherent way. Therefore, assignments completed by apprentices are often only on the standard expected, while many are capable of more. Where strong management of programmes exists, there is often a marked difference in apprentices’ performance and outcomes. Training provided in operational delivery, dental nursing and customer care is well planned, thorough and motivational. Managers have a strong grasp of the course requirements. They check apprentices’ Monitoring visit: University Hospitals Bristol NHS Foundation Trust 5–6 December 2018 progress carefully and provide incisive, thoughtful feedback that prompts apprentices’ further learning and development. Apprentices on operational delivery can cite specific examples of using their new knowledge of project management to plan and deliver external careers workshops with public sector companies and the

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Leaders and managers have ensured that all safeguarding arrangements are fit for purpose. Policies and practice keep abreast of government legislation and procedures. Staff attend update training regularly so that they are vigilant and mindful of the potential dangers to staff and apprentices. Staff and apprentices are aware of the procedures for passing on concerns. Meetings between key members of staff and monitoring of safeguarding matters, keep everyone up to date and informed of any issues. Close links and proactive work with other professionals, such as social workers, ensure that referrals for more specialist support are managed well. The strong commitment to apprentices’ safety is demonstrated in the way matters were followed through by staff when they came to light during the inspection. Apprentices feel safe at work and they know who to contact if they have a concern. Strong networks exist between apprentices, which they use to support each other.

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Checks to ensure that recruitment processes and records are kept in accordance with the government’s guidance are well established. The managers responsible for safeguarding have had recent training. However, some managers do not have a sufficiently well developed understanding of the recently published guidance on ‘Prevent’ for work-based learning. Most apprentices’ understanding of the threat of radicalisation is sufficient, although their deep knowledge and understanding British values is rather limited. Monitoring visit: University Hospitals Bristol NHS Foundation Trust 5–6 December 2018 the guidance ‘Raising concerns and making a complaint about Ofsted’, which is available from Ofsted’s website: www.gov.uk/government/publications/complaints-about-ofsted . If you would like Ofsted to send you a copy of the guidance, please telephone 0300 123 4234, or email enquiries@ofsted.gov.uk . Learner View Learner View is a website where learners can tell Ofsted what they think about their college or

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provider. They can also see what other learners think about them too. To find out more go to www.learnerview.ofsted.gov.uk .

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Employer View Employer View is a website where employers can tell Ofsted what they think about their employees’ college or provider. They can also see what other employers think about them too. To find out more go to www.employerview.ofsted.gov.uk .

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regulates and inspects to achieve excellence in the care of children and young people, and in education and skills for learners of all ages. It regulates and inspects childcare and children’s social care, and inspects the Children and Family Court Advisory and Support Service (Cafcass), schools, colleges, initial teacher training, further education and skills, adult and community learning, and education and training in prisons and other secure establishments. It assesses council children’s services, and inspects services for children looked after, safeguarding and child protection. If you would like a copy of this document in a different format, such as large print or Braille, please telephone 0300 123 1231, or email enquiries@ofsted.gov.uk . You may reuse this information (not including logos) free of charge in any format or medium, under the terms of the Open Government Licence. To view this licence, visit www.nationalarchives.gov.uk/doc/open-government-licence , write to

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the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gsi.gov.uk .

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T: 0300 123 1231 Textphone: 0161 618 8524 E: enquiries@ofsted.gov.uk W: www.gov.uk/ofsted

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