More stringent regulation of the RTOs, installing clinical mentors in facilities, enhanced nursing oversight - the opinions on what's needed to address quality concerns in Cert III training abound. Darragh O Keeffe reports.
When Certificate III training began in the mid 1990s it operated under strict guidelines governing curriculum and competencies. This has gradually been downgraded and as a result, the courses have lost their academic rigor.
That's according to Maree Bernoth, aged care researcher and lecturer in nursing at Charles Sturt University.
Bernoth's comments echo those of numerous fellow academics, aged care providers and unions who had raised concerns about the variable quality of Cert III and IV training with the Productivity Commission during public hearings into their draft report.
"What started as a substantive system has been diluted and downgraded to what it essentially now meaningless," Bernoth says.
There is no set number of hours a student must attend, and students undertaking Cert III are not subject to the same scrutiny of their clinical practice and competency as someone undertaking nursing, she says.
She says some RTOs have become "dollar focused". If they can get someone through a Cert III in a weekend, they will do it, she says.
She strongly criticises the current system of judging a student's competency.
"Some RTO will give a student a booklet of skills they have to be competent in. If they are mentored by an AIN, he or she can tick off the student and mark them as competent. That mentor doesn't get training or any extra time to do the assessment," she says.
Further, some RTOs doesn't see how the students completed their booklet.
"We could have a student with very poor English getting someone else to fill it in for them; or getting a friend's book and copying the answers. There are a lot of holes in the system."
The monitoring of the RTOs themselves is also problematic, says Bernoth.
"It's like the problem with aged care accreditation - it's all about checking the paperwork, but not the actual outcomes. A quality assessor comes in to the RTO, they look at the paperwork, see that competencies have been ticked, and check they have the right records. But they don't look at the processes. And, they don't look at the outcomes. Is the person awarded a Cert III actually competent?"
Further, she says the quality of the training is not monitored. Often, the trainers are AINs who have completed a Cert IV, she says. "Basically anyone can go in and train people, with very little experiential learning."
Growing chorus of concern
Bernoth's comments echo those of providers and unions alike, speaking at the PC's public hearings earlier this year.
Stephen Kobelke, CEO of Aged and Community Services Western Australia, told the Perth hearing his organisation had also noted a "significant difference" in the training provided.
"In Western Australia we've had what we term the fast-track RTOs who are moving people through a Cert III within weeks and then they try to place them. Providers are really getting somebody who has had no on-the-ground experience and it's not working. Worse than that, that person then is not re-eligible for other training because they've been through it," said Kobelke.
He said ACSWA had done its own internal investigation and was working to develop relationships with trainers "so we can put our members towards [RTOs] that offer a more... holistic training program which involves a period of time where people are on site getting on-the-job experience as they go through the qualification".
Similarly, Tracey Osmond, CEO of the College of Nursing, told a Sydney hearing that she couldn't be confident about the quality of Cert III training.
She said the views of her members on the quality of Cert III training ranged from 'glowing reports' all the way to 'it's just a minefield and I can't rely on those individuals'.
Paul Gilbert of the ANF Victoria said there could be no certainty that two people with Cert IIIs would have the same skill set.
"You don't get that quality in the Cert III, and it's unfair on the people who pay for it, and it's unfair on the people who rely on care, as the majority of people providing care in aged care clearly either have the Cert III or potentially nothing at all," he said.
Complaints system not used
Sue Lyons of United Voice says she has often heard the same criticisms, however, she asks why more complaints are not being made.
"I mean, all these training providers - and some are better than others - are accredited," she says.
"There are formal ways to raise these issues. But often these comments and criticisms are raised through the media, or through forums like the Productivity Commission, rather than through the formal accreditation process where action could be taken."
As a result, no one can know whether a particular training provider has 100 complaints against them, or a 1000, she says.
She says the sooner the new VET regulator (the Australian Skills and Quality Authority) begins operating, the better.
While Bernoth agrees stronger oversight of the RTOs is needed, and hopefully will be provided by the new VET regulator, she says broader strategies are also needed.
She is considering the potential role of 'clinical mentors'; professionals who would be trained and registered differently.
"They're responsible for a geographical area and work across several facilities. They work alongside the carers while they're doing their training and the day-to-day caring, and they provide clinical support and supervision."
Coupled with this, a more "sophisticated model" for teaching personal care workers is also needed.
This should involve TAFE, providers, academics and the RTOs.
For Dr Alan Montague, a lecturer in higher education at RMIT, a key issue is the lack of recognition of prior learning (RPL). In other words, the training needs to be more sophisticated and tailored to the individual.
"We should recognise the skills people already possess and therefore don't require further training in, and focus on providing training so they acquire the skills they are lacking," says Montague.
AINs or PCWs need very good communication skills, cultural skills, and observational skills. These skills are often underestimated and aren't held in high esteem by the people providing the training, he says.
Montague also feels better articulation pathways are needed, "particularly given the shortage of division 1 and 2 nurses. I mean, 43 per cent of people in the general workforce don't have any post secondary qualifications."
Elsewhere, both the College of Nursing and the RCNA have called for enhanced nursing oversight of the courses.
Osmond told a PC hearing in Sydney that the programs established and reviewed by the VET sector should also come under a nursing accreditation process. This would provide "an understanding that those programs had had that second eye of the experts in care delivery... graduates of those programs would be felt to have a common base."
Similarly, Maryann Curry of the RCNA, told a PC hearing in Canberra that the college recommended an 'endorsed practice framework'.
She said there was a number of RTOs delivering training in various ways.
"What we're recommending is that a framework is put in place where all of those RTOs are actually working to the same practice framework so that we get some sort of continuity across RTOs, let alone across states."
Industry skills council responds
The Community Services and Health Industry Skills Council has said it was aware of the "variations in training delivery" in aged care.
Responding to questions put to it by Nursing Review's sister publication INsite, the council cited its 2011 'environmental scan' which found that "qualifications are being delivered to candidates in short time periods with poor skill outcomes. There is particular evidence of this in aged care."
However, it stressed it had no authority over the training quality of RTOs and had no formal mechanism to gather this information. "We do understand that the newly formed Australian Skills Quality Authority (ASQA) will be seeking to monitor delivery more stringently and implement tougher accreditation guidelines," its response said.
When asked about the oversight of RTOs and how they judge a student's competency, the council said it believed the "endorsement of a qualification should involve a partnership between an RTO and an enterprise requiring on-and-off the job demonstration of competencies."Do you have an idea for a story?
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