Chelsea and Westminster Hospital NHS Foundation Trust

Chelsea and Westminster Hospital NHS Foundation Trust Monitoring visit report

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Name of lead inspector: Rebecca Jennings, Her Majesty’s Inspector

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Address: 369 Fulham Road London SW10 9NH Monitoring visit: Chelsea and Westminster Hospital NHS Foundation Trust, 21–22 April 2021

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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 ‘Monitoring visits’ and ‘Monitoring visits to providers that are newly directly publicly funded’. The focus of these visits is on the themes set out below.

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Context and focus of visit

Chelsea and Westminster NHS Foundation Trust (the Trust) is a teaching hospital in West London. They teach apprentices at Chelsea and Westminster Hospital and at West Middlesex Hospital. At the time of the visit, the Trust had 12 apprentices working towards the level 2 healthcare support worker apprenticeship standard. They started training apprentices as an employer-provider in February 2020. The Trust employs 180 apprentices who are trained by other independent learning providers.

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Context and focus of visit

COVID-19 (coronavirus) has had a substantial impact on the staff at the Trust. Many managers and apprentices have been deployed to different clinical areas and there has been significant disruption to the training of apprentices. Apprentices have remained on programme throughout. They continue to learn as they are taught how to work in different areas of the hospital.

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Context and focus of visit

The impact of COVID-19 has been taken into account in the findings and progress judgements below.

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Reasonable progress

Leaders have selected an apprenticeship standard that supports the workforce planning and development strategies of the Trust. The programme provides a sound route through which the hospital can recruit new, inexperienced employees, that adds real value to the work of the hospital. Apprentices are in the ideal environment, working in a variety of clinical areas, where they can acquire the skills they need to succeed on the programme.

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Reasonable progress

Leaders recruit apprentices onto a programme that closely matches their longer-term aspirations. Leaders offer excellent career progression opportunities for successful apprentices, who can become advanced clinical assistants, and then are able to progress to train as associate and fully qualified nurses. Monitoring visit: Chelsea and Westminster Hospital NHS Foundation Trust, 21–22 April 2021 Deputy directors support and challenge staff to develop the programme to better meet the needs of the Trust. For example, they add extra courses to apprentices’ programmes and make sure professional documentation is used in training sessions. As a result, apprentices receive meaningful training that helps them improve patient care. Managers use suitable quality assurance procedures which help them improve the quality of the programme. For example, they identify extra opportunities for apprentices to practise their skills.

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Reasonable progress

In the first cohorts, recruiting managers did not gain apprentices’ commitment to complete their programmes. Once apprentices demonstrated key competencies, they withdrew from the apprenticeship and moved into different roles in the Trust where they can use their prior knowledge and experience. This has been particularly prevalent over recent months due to the outbreak of COVID-19 and the pressure to have suitable staff in place.

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Reasonable progress

Leaders’ and managers’ plans for improvements have been delayed due to the disruption since the outbreak of COVID-19. Leaders do not monitor the progress of apprentices effectively enough. Leaders are implementing changes to improve their oversight of the programme, but managers are not clear when apprentices will expect to achieve their apprenticeships. Apprentices do not have a fully developed understanding of their final assessments.

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Reasonable progress

As the Trust is a teaching hospital, managers have a strong culture of continuous professional development. The Trust provides excellent opportunities for the apprentices to gain a rich variety of new knowledge, skills and behaviours in the workplace. Apprentices ask their colleagues if they are unsure about what they should do, or how to do it. All members of staff are highly supportive and provide clear guidance where required.

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Reasonable progress

Managers have developed a suitable approach to teaching the apprentices. Managers teach apprentices key knowledge and skills at the start of the programme, so that they care for patients effectively. Apprentices also quickly learn how to use the equipment associated with monitoring and recording observations on patients’ blood pressure, oxygen level and temperature.

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Reasonable progress

Staff who train apprentices are well qualified and hold high levels of clinical expertise. They teach and supervise apprentices well. Apprentices receive their entitlement to training time. Managers and tutors review apprentices’ progress and provide them feedback on their performance, which helps them to improve at work. Apprentices produce written work to a high standard. They understand how they apply their new knowledge, skills and behaviours to carry out their roles effectively. Monitoring visit: Chelsea and Westminster Hospital NHS Foundation Trust, 21–22 April 2021 Specialists, including dieticians, paramedics and nurses, teach different subjects, such as palliative care, dealing with dementia and dealing with stroke patients. The quality and content of taught sessions is good, informative and directly relevant to the work of the apprentices. Specialists teach more insightful modules as the programme progresses as apprentices work in each of the clinical areas. Staff

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Reasonable progress

provide emotional support if required, associated with the nature of the role apprentices perform, such as for those giving care to an end-of-life patient.

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Reasonable progress

A few apprentices and teaching staff do not fully understand the structure of apprentices’ final assessments. As a result, apprentices are not fully prepared for these. During progress reviews, managers do not evaluate apprentices’ wider skills development beyond the requirements of the apprenticeship standard.

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Reasonable progress

Leaders promote a culture of safeguarding for apprentices, staff and patients. Apprentices feel safe in the working environment. They have a sound understanding of safeguarding procedures. Managers provide clear guidance for apprentices to protect their own health, for example through safe working practices on the clinical areas associated with COVID-19.

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Reasonable progress

The designated safeguarding lead and their deputies are well trained. They take part in expert forums. For example, they feed into and use the Counter Terrorism Local Profile to help keep staff and patients safe. Safeguarding leads implement comprehensive policies for safeguarding and the ‘Prevent’ duty. Staff and adult apprentices are trained to at least level 1 when they start working for the trust.

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Reasonable progress

The lead is aware of issues that might affect apprentices joining the Trust, for example mental health or domestic abuse. The lead logs and follows up any concerns and signposts staff to relevant agencies who can offer financial support and safe housing. Monitoring visit: Chelsea and Westminster Hospital NHS Foundation Trust, 21–22 April 2021 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.

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Reasonable progress

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Reasonable progress

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Reasonable progress

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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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