Setting

06 November 2001

Inspectors use a seven-point scale to summarise their judgements about the quality of learning sessions. The descriptors for the seven grades are: • grade 1 - excellent • grade 2 - very good • grade 3 - good • grade 4 - satisfactory • grade 5 - unsatisfactory • grade 6 - poor • grade 7 - very poor.

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06 November 2001

Inspectors use a five-point scale to summarise their judgements about the quality of provision in occupational/curriculum areas and in New Deal options. The same scale is used to describe the quality of leadership and management, which includes quality assurance and equality of opportunity. The descriptors for the five grades are: • grade 1 - outstanding • grade 2 - good • grade 3 - satisfactory • grade 4 - unsatisfactory • grade 5 - very weak.

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06 November 2001

The two grading scales relate to each other as follows:

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SEVEN-POINT SCALE FIVE-POINT SCALE

grade 1 grade 2 grade 3 grade 4 grade 5 grade 6 grade 7 grade 2 grade 3 grade 4

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Adult Learning Inspectorate

The Adult Learning Inspectorate (ALI) was established under the provisions of the Learning and Skills Act 2000 to bring the inspection of all aspects of adult learning and work-based training within the remit of a single inspectorate. The ALI is responsible for inspecting a wide range of government-funded learning, including:

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Adult Learning Inspectorate

• work-based training for all people over 16 • provision in further education colleges for people aged 19 and over • the University for Industry’s provision • adult and community learning • training given by the Employment Service under the New Deals. learndirect

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Adult Learning Inspectorate

Inspections are carried out in accordance with the by teams of full-time inspectors and part-time associate inspectors who have knowledge of, and experience in, the work which they inspect. All providers are invited to nominate a senior member of their staff to participate in the inspection as a team member. Common Inspection Framework

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Inadequate provision

The final decision as to whether the provision is inadequate rests with the Chief Inspector of Adult Learning. The overall judgement as to whether the provision is adequate or inadequate is included in the summary section of the inspection report. A provider’s provision will normally be deemed to be less than adequate where • one third or more of published grades for occupational/curriculum areas and New Deal options are judged less than satisfactory, or • leadership and management are judged to be less than satisfactory LEEDS TEACHING HOSPITALS NHS TRUST

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SUMMARY

Leeds Teaching Hospitals National Health Service NHS Trust was established in 1998. It has provided work-based learning in dental care and general care since August 2000. Leeds Teaching Hospitals NHS Trust is located in the teaching hospitals close to Leeds city centre.

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SUMMARY

The quality of work-based learning is good. The leadership and management of the training departments are satisfactory. Equality of opportunity is promoted well, but arrangements for assuring the quality of training are not satisfactory. The provision is adequate to meet the reasonable needs of those receiving it.

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GRADES

Health, social care & public services 2 Contributory grades: Work-based learning for young people 2

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KEY STRENGTHS

• clear direction to improve training • good internal and external communications • effective promotion of equal opportunities • good recruitment and selection procedures • comprehensive range of work placements • good opportunities for learners’ progression Equality of opportunity 2 Contributory grades: Leadership and management 3

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KEY STRENGTHS

© 2002 ADULT LEARNING INSPECTORATE 1 LEEDS TEACHING HOSPITALS NHS TRUST

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KEY WEAKNESSES

• no evaluation of training procedures • inadequate sampling strategy for internal verification • inadequate recording of some learners’ reviews .

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OTHER IMPROVEMENTS NEEDED

• more points of entry during the year for cadet nurses

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OTHER IMPROVEMENTS NEEDED

© 2002 ADULT LEARNING INSPECTORATE 2 LEEDS TEACHING HOSPITALS NHS TRUST

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THE INSPECTION

1. A team of three inspectors spent a total of 12 days at Leeds Teaching Hospitals NHS Trust (the Trust) in November 2001. They interviewed 35 learners, conducted 25 interviews with staff from the Trust, visited 12 work placements and interviewed 20 workplace supervisors. Inspectors observed five training sessions. They examined a range of documents, including learners’ portfolios of evidence, learners’ records, the Trust’s strategic plan and departmental business plans, policies and procedures, promotional materials and awarding bodies’ reports. Inspectors also studied the Trust’s first self-assessment report, which was produced in May 2001.

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THE INSPECTION

Grade 1 Grade 2 Grade 3 Grade 4 Grade 7 Total Grades awarded to learning sessions Grade 5 Grade 6 Health, social care & public services 0 1 4 0 0 5 0 0

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THE INSPECTION

© 2002 ADULT LEARNING INSPECTORATE 3 LEEDS TEACHING HOSPITALS NHS TRUST

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THE PROVIDER AS A WHOLE

2. The Trust was established in 1998. It is located in the teaching hospitals close to the centre of Leeds. The Trust provides training in dental care and general care for learners employed at the Leeds teaching hospitals and in community health and dental care practices throughout the Leeds, Bradford, Huddersfield and Dewsbury areas. Training is managed through the professional development department of the Trust and the dental institute. Five full-time staff are responsible for the training and further specialist staff participate in training as needed. There are 65 work-based learners currently in training. Of these, 32 are training in dental care and 33 in general care as cadet nurses.

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THE PROVIDER AS A WHOLE

3. Work-based learning is funded through a contract with West Yorkshire Learning and Skills Council (LSC). The proportion of people from minority ethnic groups in Leeds at the 1991 census was 5.8 per cent, compared with 6.2 per cent in the country as a whole. In June 2001, the unemployment rate in Leeds was 3 per cent, the same as the national average. In 2000, the proportion of school leavers in Leeds achieving five or more general certificates of secondary education (GCSEs) at grade C or above was 40 per cent, compared with the national average of 49.2 per cent. Currently, 73 per cent of school leavers in Leeds stay on in full-time education or enter training, compared with 79 per cent nationally.

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THE PROVIDER AND ITS CONTEXT

© 2002 ADULT LEARNING INSPECTORATE 4 LEEDS TEACHING HOSPITALS NHS TRUST

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Work-based learning for young people

4. Standards of attainment on all care training programmes are good. Learners demonstrate high levels of knowledge, skills and understanding in their work placements, in training sessions and in their portfolios. The rate of completion of units of national vocational qualifications (NVQs) is good, with all learners completing their units within the agreed timescales. The cadet nurses have all completed their key skills assignments. It is too early to judge the rate of achievement of full modern apprenticeship frameworks and NVQs. Retention rates for dental care are excellent, with 95 per cent of learners remaining on their training programme. In general care, retention rates are satisfactory and have improved from 63 per cent in 2000-01 to the current rate of 100 per cent.

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Work-based learning for young people

5. The quality of work-based learning in dental care and general care is good. There are good recruitment and selection procedures. Applicants’ personal details are not given to staff involved in shortlisting so that selection is made on the merit of the application. Induction is effective in helping learners settle into their training programmes and in helping to prepare them for the wide range of clinical placements in the hospitals and community-based services. Learners have a good understanding of the NVQ and the link between background knowledge and the development of practical skills. The programme for dental care is well structured and learners are given details about their training in clinical placements and in the training centre in advance. The cadet nurses have an excellent range of resources for learning. There are well-qualified and professionally experienced specialist staff, excellent resources in the hospitals and in the university and

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Work-based learning for young people

good written materials. There are good progression opportunities in the hospital and community settings. Learners who decide not to continue with a career in care are offered other employment in the Trust. The standard of teaching observed was at least satisfactory and in most sessions, good. The tutors effectively related background knowledge for the NVQ and key skills to current clinical practices. However, assessment plans for care learners lack detail and are not always agreed with assessors before the learners begin to develop evidence of their knowledge, understanding and skills. On the dental care programme, individual learning plans are not used effectively to plan and record training. Although tutors regularly review progress with the learner and their workplace supervisor, the results of these reviews are not always recorded in sufficient detail.

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Work-based learning for young people

© 2002 ADULT LEARNING INSPECTORATE 5 LEEDS TEACHING HOSPITALS NHS TRUST

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LEADERSHIP AND MANAGEMENT Grade 3

7. The Trust’s commitment to work-based learning is clearly stated in the mission and strategic objectives. The business objectives of the dental institute and the professional development department are set within the context of the Trust’s strategic objectives. Clear targets for improving the quality of training are set within business plans and progress towards meeting these targets is carefully monitored. The professional development department and the dental institute have detailed development plans. These show required actions, specify dates by which they must be achieved and identify the people responsible for the actions. Management information is effectively collected 6. The Trust’s professional development department is responsible for the management of work-based learning in care and the dental institute is responsible for the management of training in dental care. The dental nurse manager leads a team of four staff who carry

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LEADERSHIP AND MANAGEMENT Grade 3

out dental care training and assessment in the training centre and manage training that takes place in hospital and community-based settings. Twelve professionally qualified tutors are involved in managing the training and assessment of young people on the cadet nurse training scheme. The assessment management board oversees training in care and dental care. The board consists of members of the Trust, training managers and representatives of staff involved in training. Dental care and cadet nurse training is carried out in the training centres and in work placements located in hospitals and community health services. There are qualified work-based assessors in all the work placements for cadet nurse training. In dental care, where NVQ training was introduced in September 2000, six assessors have achieved training and development lead body assessor units and two are qualified internal verifiers. Training in, and assessment of, key

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LEADERSHIP AND MANAGEMENT Grade 3

skills are integral parts of training towards the NVQ. Key skills development and support sessions are offered by key skills specialists from Leeds University. The professional development department and the dental institute follow the policies and procedures of the Trust to promote equality of opportunity and assure the quality of training. The Trust produced its first self-assessment report on work-based learning in May 2001.

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STRENGTHS

• clear direction to improve training • good communications • detailed and thorough staff performance review and target-setting • effective promotion of equal opportunities

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WEAKNESSES

• no evaluation of training procedures • inadequate internal verification sampling strategy

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WEAKNESSES

© 2002 ADULT LEARNING INSPECTORATE 6 LEEDS TEACHING HOSPITALS NHS TRUST

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WEAKNESSES

and used to monitor achievements towards meeting targets.

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WEAKNESSES

8. The management of training is satisfactory. Communication in the training departments, with workplace supervisors and with external partners is good. A planned schedule of meetings for staff involved in training is used to monitor training and consult staff on training issues. A newsletter keeps staff informed about the cadet nurse scheme. Effective internal communications have given learners the opportunity to develop and demonstrate their care skills in a wide range of hospital and community- based care settings. Learners who do not wish to continue training in care are given the chance to take up other employment opportunities within the Trust. Links with organisations outside the hospital environment also benefit learners. Through close links with Leeds University, learners can use good resources for the development of information technology (IT) and numeracy skills. Parts of the care training programme

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WEAKNESSES

count as accreditation towards the university’s common foundation programme. All learners who achieve an NVQ at level 3 are guaranteed an interview for professional nursing training. Links with the national association of dental nurse tutors and the northern regional group for cadet nursing provide opportunities for staff to discuss common training issues, share good practice and update their skills.

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WEAKNESSES

9. Staff appraisal is detailed, thorough and identifies each staff member’s contribution towards achieving the business objectives of the training departments and strategic objectives of the Trust. Line managers of training staff in the professional development department and the dental institute carry out staff appraisal annually. Clear business and personal development targets are set for each member of staff. These identify their responsibilities in achieving training objectives. Managers frequently meet staff individually to monitor the progress they are making towards their targets.

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WEAKNESSES

© 2002 ADULT LEARNING INSPECTORATE 7 LEEDS TEACHING HOSPITALS NHS TRUST

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Equality of opportunity

10. Equality of opportunity is promoted well. The Trust clearly states its commitment to recruiting staff from the local community to meet local needs. There is a comprehensive and detailed equal opportunities policy that refers to relevant legislation and is regularly reviewed. Selection procedures include removing information about the gender and ethnic origin of applicants before the shortlisting process. As part of the recruitment process, training is promoted to groups under-represented in care training and the Trust has successfully recruited men onto care courses. Marketing materials are reviewed to ensure that they effectively promote training to under-represented groups. Learners with learning difficulties are given good support. Assessment plans identify small stages of knowledge and skills development for learners to achieve. Learning aids such as audio tapes are used for learners to provide background knowledge evidence in place of written

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Equality of opportunity

evidence. The Trust collects and collates data and uses them to analyse each group of learners and compare their backgrounds with those of the local community.

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Equality of opportunity

11. Learners understand equal opportunities issues well. At induction, they receive copies of the equal opportunities policy, and training to develop their awareness and understanding of issues related to equality of opportunity. Tutors promote equality of opportunity through all aspects of training in the training centre and in work placements. Learners showed a good understanding of their rights and responsibilities in the workplace.

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Contributory grade 2

© 2002 ADULT LEARNING INSPECTORATE 8 LEEDS TEACHING HOSPITALS NHS TRUST

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Quality assurance

12. The commitment of the Trust to providing good training is clearly stated in the mission, strategic objectives and the business objectives of the training departments. The Trust has a comprehensive quality assurance policy and procedures to cover some aspects of training. However, the training procedures have not been evaluated. Some of the procedures are insufficiently detailed to ensure the consistency of training practices. Inspectors noted differences in how learners’ reviews were carried out and recorded. The results of learners’ reviews were sometimes recorded inadequately. Training managers had not identified this issue in the self-assessment report.

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Quality assurance

13. Training programmes are regularly reviewed and action is taken to make improvements where necessary. As part of the review process, staff consider statistics on retention and attendance, the progress of learners towards achieving their qualifications and the views of learners on the quality of training. As a result of the programme reviews, the induction programme has been revised to allow learners more time to prepare for hospital placements. Learners’ feedback on the revised training programme is very positive.

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Quality assurance

14. The internal verification process lacks a clear strategy for checking a proportion of assessments. There is insufficient observation of assessment in the workplace. Internal verifiers have not produced plans to check assessments to make sure that the work of all assessors and learners across the range of NVQ units is regularly checked. Currently, all units of new assessors are checked, but only the first four units of experienced assessors are checked, which is too few to assure the quality of the assessment process.

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Quality assurance

15. The Trust produced its first self-assessment report on its training in May 2001. The report was self-critical and detailed. Although inspectors agreed in general with the strengths and weaknesses identified in the report, they thought that some were overstated. Some weaknesses in training and in promoting equal opportunities had been rectified by the time of inspection. The action plan developed as a result of self- assessment was detailed and included plans to share strengths, deal with weaknesses and allocate responsibilities for actions. Timescales were set for the completion of actions.

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Good Practice

Cadet nurse representatives from the level 2 and level 3 programmes are included in the cadet nurse programme management group. They are encouraged to provide feedback on the quality of training at the regular programme review meetings.

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Good Practice

© 2002 ADULT LEARNING INSPECTORATE 9 LEEDS TEACHING HOSPITALS NHS TRUST

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Health, social care & public services Grade 2

16. The Trust has offered training and assessment for learners in dental nursing and care since September 2000. Cadet nurses and dental care learners are recruited mainly from schools, the careers service and open days at the hospital. There is an annual intake for the cadet nurse programme and an intake every six months for dental care. Twenty-one advanced modern apprentices are working towards NVQs at level 2, and 12 are working towards NVQs at level 3 on the cadet nurse programme. Thirty-two learners are working towards the new NVQs in dental care. Learners are in work placements at the Trust’s two main teaching hospitals, at the dental institute and in community-based health care and dental services. All cadet nurse learners are in placements where there are work-based assessors, who are either qualified or working towards the assessors’ qualification. Visiting assessors carry out assessment in the

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Health, social care & public services Grade 2

workplace for dental care learners. Training in background knowledge is provided during weekly study days in the hospital training departments. Day and evening lectures are available in the dental institute for dental care learners. Key skills training for the cadet nurse learners is provided by Leeds University and takes place during study days. Programmes inspected Number of learners Contributory grade 65 Work-based learning for young people 2

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Health, social care & public services Grade 2

The tables below show the achievement and retention rates available up to the time of the inspection

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Health, social care & public services Grade 2

% % % % Advanced modern apprenticeships (AMA) 1997-98 1998-99 1999-2000 No. No. No. Work-based learning for young people

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Health, social care & public services Grade 2

2000-01 No. 2001-02 No. % 19 Number that started 21 12 63 Still in training 21 100 0 0 AMA framework completed 0 0 0 0 NVQ level 2 completed 0 0 0 0 NVQ level 3 completed 0 0 7 37 Left without completing the framework 0 0

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Health, social care & public services Grade 2

© 2002 ADULT LEARNING INSPECTORATE 10 LEEDS TEACHING HOSPITALS NHS TRUST

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Health, social care & public services Grade 2

17. The recruitment procedures for care and dental care learners are good. The Trust tries to attract under-represented groups to its work-based learning programmes and the effective promotion of care training to men has resulted in 10 per cent of cadet nurses being men. Open days are held to inform interested people about the cadet nurse and dental care programmes. Current cadet nurses are involved in recruitment activities. They meet potential learners and give them an insight into the training by sharing their own experiences. Potential learners are invited for a full day of selection procedures that includes an initial assessment of their communication and numeracy skills, in addition to their understanding of, and experience in, the care sector.

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Health, social care & public services Grade 2

18. Induction programmes are effective. Care learners attend a comprehensive three- week induction that covers health and safety, equality of opportunity, infection control, personal care activities, NVQ requirements and an introduction to key skills. One-to-one

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STRENGTHS

• good recruitment and selection procedures for learners • effective induction • well-structured training in dental care • extensive range of resources for learning • comprehensive range of work placements • excellent retention rates on dental care programmes • good opportunities for learners’ progression

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WEAKNESSES

• insufficient detail in assessment plans • no use of individual learning plans in dental care • poor recording of some progress reviews % % % % NVQ Training 1997-98 1998-99 1999-2000 No. No. No. NVQ Training

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WEAKNESSES

2000-01 No. 2001-02 No. % 20 Number that started 13 19 95 Still in training 13 100 0 0 Individual learning plan completed 0 0 1 5 Left without completing individual learning plan 0 0

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WEAKNESSES

0 0 NVQ level 1 completed 0 0 0 0 NVQ level 2 completed 0 0

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WEAKNESSES

© 2002 ADULT LEARNING INSPECTORATE 11 LEEDS TEACHING HOSPITALS NHS TRUST

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WEAKNESSES

tutorials cover areas of concern or difficulty. Dental care learners have a well-structured eight-day induction to their training. The topics covered include the structure of NVQs, health and safety, equality in the workplace and some simulated practical work training. All tutors and assessors take part in the induction programme. Emphasis is put upon safe disposal of needles and sharp instruments to safeguard the learners’ health. All learners have a good understanding of NVQs. Written work produced during induction provides evidence towards their NVQs. Following induction, learners are able to work safely under supervision in clinical areas and are well prepared for their first placement. New cadet nurse learners acquire an early understanding of the key skills requirements.

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WEAKNESSES

19. The dental care training programme is well structured and managed. Learners have copies of the lecture timetable and are thoroughly prepared for the topics to be covered. They work alongside qualified dental nurses, spending two weeks in every department. They cover a varied range of clinical practice that provides them with valid evidence to meet the requirements for NVQ units. The structure of the cadet nurse training is satisfactory but there is a lack of flexibility in that there is only one intake of learners each year.

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WEAKNESSES

20. There is an extensive range of learning resources. Training staff for both programmes are appropriately qualified and occupationally competent. Specialists contribute to training in the workplace and in training centres. Handouts and materials used in training are of a high standard. Training rooms are comfortable and well equipped. A good range of teaching methods are used that maintain learners’ interest effectively.

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WEAKNESSES

21. A comprehensive range of work placements is available. Cadet nurse learners work in hospital wards, clinics and community health service locations. These well-resourced work placements provide a wide range of learning experiences. Learners demonstrate good and appropriate clinical and personal caring skills and good levels of knowledge and understanding early in the programme. They take part in all work-based learning sessions carried out on the wards and in the community health service departments.

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WEAKNESSES

22. There is not enough detailed assessment planning on the care apprenticeships. Assessment plans are not fully recorded or agreed with the assessor before evidence is collected. The details on the plans do not identify the NVQ units being assessed and do not always clearly indicate the practical activities that need to be carried out.

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WEAKNESSES

23. Retention rates on the dental care programme are excellent. The retention rate was 95 per cent in 2000-01 and 100 per cent so far in 2001-02. There are good opportunities for learners to progress to higher levels of training or into employment when they complete their training programme.

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WEAKNESSES

24. All the cadet nurse learners are on target to achieve the learning objectives agreed in their individual learning plans for NVQs and key skills. Care learners are actively encouraged to apply for nurse training on completion of the NVQ at level 3. Learners who decide that they do not wish to continue with a career in care are offered

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WEAKNESSES

© 2002 ADULT LEARNING INSPECTORATE 12 LEEDS TEACHING HOSPITALS NHS TRUST

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WEAKNESSES

25. Arrangements for drawing up and using individual learning plans are weak. Staff do not use the plans to identify appropriate training objectives and learning support needs for dental care learners at different stages of their training. The learners’ only involvement in developing their individual learning plan is filling in their personal details. Learning plans are often left incomplete.

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WEAKNESSES

26. Tutors regularly review and record the progress that learners are making, although they do not always record the results. Learners are not always set short-term learning targets to help them with the next stage of their learning. Learners’ understanding of equal opportunities and health and safety issues are not recorded. Further review dates are not always arranged. Individual learning plans are not updated at the progress reviews. The procedure for reviewing the progress of individual learners is not detailed enough to ensure that the review process is effective.

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WEAKNESSES

27. The documents used to monitor learners’ progress is satisfactory, but not all assessors and learners have access to the useful summary document.

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Good Practice

One care learner experienced difficulties in her first work placement. A member of staff carried out spot checks to monitor the situation. She then gave additional support by working alongside the learner on the ward until the problems were resolved.

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