Chelsea and Westminster Hospital NHS Foundation Trust

Further education and skills inspection report

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Inspection of Chelsea and Westminster Hospital NHS Foundation Trust

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Inspection dates: 14 to 16 December 2022

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Overall effectiveness Requires improvement

The quality of education Requires improvement Behaviour and attitudes Good Personal development Requires improvement Leadership and management Requires improvement Apprenticeships Requires improvement Overall effectiveness at previous inspection Not previously inspected

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Information about this provider

Chelsea and Westminster NHS Foundation Trust (the Trust) is a teaching hospital in west London. It teaches apprentices at Chelsea and Westminster Hospital and at West Middlesex Hospital. At the time of the inspection, the Trust has 27 apprentices working towards the level 2 healthcare support worker apprenticeship standard. A further three apprentices are on a break in their learning. The Trust started training apprentices as an employer provider in February 2020. 14 to 16 December 2022

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What is it like to be a learner with this provider?

Too often, apprentices are not made aware of the significant commitment required at the start of their apprenticeship. This has led to many apprentices being frustrated, and a high proportion of apprentices have left the course without completing their qualification. Leaders have made improvements to the recruitment process; as a result, the apprenticeship team now clearly explains the components of the apprenticeship to new recruits. However, it is too soon to see the impact of these changes on current apprentices.

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What is it like to be a learner with this provider?

Apprentices do not benefit from structured opportunities to learn away from the workplace. They do not receive sufficient teaching sessions or guidance on the theoretical components of their programme, in order to complete their assignments.

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What is it like to be a learner with this provider?

Apprentices have a good understanding of how their work contributes to a healthy society. Despite the intense and often stressful nature of their work, they are proud of the contribution they make. Many who have changed careers describe high levels of personal satisfaction from the work they do.

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What is it like to be a learner with this provider?

Apprentices develop the professional behaviours they need in order to work in a healthcare setting. For example, they know how important team working is to ensure that patients receive the best possible care. Apprentices describe how their confidence has improved since the start of their training. For example, many apprentices are confident to deal with patients or family members who demonstrate more challenging behaviour towards them.

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better?

Leaders have not evaluated the quality of the programme well enough. Their resulting improvement plans lack clarity. They have not identified sufficiently all the areas for improvement. For example, they do not ensure that teachers give apprentices developmental feedback on their work or in progress reviews. The targets teachers set are focused on apprentices completing tasks rather than on what apprentices need to do to improve their knowledge, skills or behaviours. Consequently, apprentices are unclear about what they need to do to improve their work further.

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better?

Senior leaders and governors have recently expanded the apprenticeship leadership team, ensuring that leaders have the capacity to manage the quality of education effectively. The new leadership team has started to take appropriate steps to improve the provision.

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better?

Leaders ensure that the programme meets the needs of those who want to work in healthcare but have no healthcare experience. This supports a national and local skills need to increase the healthcare workforce and to meet demand. Apprentices learn new knowledge and skills so they can move into permanent healthcare roles. 14 to 16 December 2022

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The majority of apprentices receive their entitlement to training away from the job. However, due to the ongoing pressures and impact of COVID-19 in hospitals, a few apprentices struggle to take their study time. Leaders recognise the need to ensure they plan adequate training time for apprentices and monitor this closely. They have suitable plans in place to do this.

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Leaders and teachers ensure that the content of the apprenticeship is well sequenced. As new healthcare practitioners, apprentices start by learning the topics that are most important to the welfare of patients. For example, apprentices learn the foundation knowledge about safeguarding and infection control. Later in the course, teachers introduce more specialist topics, such as how to monitor blood pressure. As a result, apprentices are confident to apply this knowledge on their wards, such as when they interpret patients’ blood pressure readings.

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Line managers and nurses on wards provide apprentices with highly effective training in the workplace. For example, nurses train apprentices to undertake electrocardiogram tests to check their patients’ heart rhythms. They also train apprentices to observe the health of patients and escalate concerns to the ward nurses if there are signs of health deterioration. As a result, apprentices develop clinical skills that they put into practice. The standard of apprentices’ practical work is high.

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Leaders do not ensure that apprentices who need support to improve their mathematics and English skills receive this early enough in their programme. As a result, apprentices, including those who speak English as an additional language, do not receive sufficient teaching or the help they need to improve these important skills.

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Leaders do not ensure that apprentices receive enough impartial careers advice and guidance. As a result, too few apprentices know about the potential career opportunities available to them, nor do they know the steps they need to take to pursue different job opportunities.

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Apprentices work confidently with a range of patients from different backgrounds and protected characteristics. They develop an ongoing awareness of diversity, which helps them in their healthcare role. For example, apprentices are aware of the differing needs of terminally ill patients from different cultures. They work with empathy and help to preserve their dignity.

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Leaders set high expectations around attendance, and the majority of apprentices have good attendance. Where apprentices do not attend sessions, ward managers are routinely notified. Leaders recognise the need to move to an approach where they have a better overview of apprentices’ attendance, in order to highlight any absence trends.

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Leaders ensure that staff receive professional development to further their expert clinical skills. However, they are not given enough support to improve their teaching or assessment practice. 14 to 16 December 2022

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The majority of apprentices use their skills and knowledge in healthcare to progress to higher grade positions within the hospital Trust when they leave the apprenticeship programme.

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Safeguarding

The arrangements for safeguarding are effective.

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Safeguarding

Leaders undertake comprehensive checks on the staff they recruit. Consequently, leaders ensure that staff are suitable to work with adult apprentices.

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Safeguarding

Leaders support apprentices and staff to gain a certified safeguarding and ‘Prevent’ duty training qualification. This helps apprentices to recognise where there may be concerns about the safety or welfare of their patients. However, apprentices do not always recall what they learned at induction about keeping themselves safe.

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Safeguarding

Leaders put in place a range of support services to help apprentices with their well- being and mental health. For example, apprentices have access to counselling if they need it.

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Safeguarding

Apprentices feel safe. This is because staff and learners do not accept bullying, harassment, discrimination or abuse. If apprentices feel uncomfortable in any of their working relationships with staff or patients, they receive effective support from more experienced members of staff.

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What does the provider need to do to improve?

 Leaders must ensure that apprentices receive effective support to develop their mathematics and English skills from the start of the programme, ensuring that apprentices have longer to develop these essential skills.  Teachers should ensure that apprentices receive developmental feedback on their work and in reviews so that apprentices know what they need to do to improve their work further.  Leaders should ensure that apprentices are given impartial advice and guidance about the career opportunities available to them so that they fully understand the full range of options available to them at the end of the course.  Leaders must ensure that apprentices are fully aware of the significant commitment that they need to make before they start an apprenticeship so that more apprentices continue with their training and achieve their qualifications. 14 to 16 December 2022

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Address

Chelsea & Westminster Hospital 369 Fulham Road London SW10 9NH

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Address

Principal, CEO or equivalent Lesley Watts

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Address

Provider type Independent learning provider

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Address

Date of previous inspection Not previously inspected

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Address

Main subcontractors Runway Apprenticeships Limited 14 to 16 December 2022

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Information about this inspection

The inspection team was assisted by the head of apprenticeships, as nominee. Inspectors took account of the provider’s most recent development plans, and the previous monitoring visit report. The inspection was carried out using the further education and skills inspection handbook and took into account all relevant provision at the provider. Inspectors collected a wide range of evidence to inform judgements, including visiting learning sessions, scrutinising learners’ work, seeking the views of learners, staff and other stakeholders, and examining the provider’s documentation and records.

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Inspection team

Mike Finn, lead inspector His Majesty’s Inspector David Baber Ofsted Inspector 14 to 16 December 2022

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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.

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