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CHAPTER 5: TRAINING AND DEVELOPMENT - APPROVED COURSES

Summary

Description of process

5.1 The approval scheme covers training that meets the standards for smoking cessation in Scotland. It was launched in September 2004, following a successful pilot. It has been set up to help ensure that all smoking cessation training in Scotland is in line with the 'Standards for Smoking Cessation Training in Scotland' published by ASH Scotland in the autumn of 2003. PATH approval indicates that a course has met certain criteria in terms of its development and delivery and that the course content is in line with national standards for smoking cessation training in Scotland.

5.2 At present it covers the same three areas as the accredited courses:

• The provision of brief advice to stop smoking;
• The provision of specialist cessation support for individuals;
• The provision of specialist cessation support for groups.

5.3 Training providers offering courses in any of these areas can apply to have their courses approved by PATH. At present, only courses provided by not-for-profit organisations are considered, pending the results of further discussion and consultation around the issue of approval for commercial training providers. Training providers seeking course approval submit information about their courses to PATH who check this information against the standards and other criteria. PATH provides detailed guidance notes on completing the required forms to training providers applying for approval.

5.4 If the course meets the standards and the other criteria stipulated in the documentation, PATH approval is given. If not, participants are given constructive feedback on their submission and are offered the opportunity to resubmit their materials. In such cases, PATH provides advice and assistance to the provider to help them gain approval. PATH aims to give providers initial feedback as to whether or not they have gained approval within four weeks of submission.

5.5 A proportion of the submissions are passed on to an external verifier, who helps ensure quality and consistency in the approval scheme by checking a random sample of the approval decisions made by PATH. The external verifiers follow the same checking process as PATH, matching the materials sent in by providers and checking them against the approval scheme criteria. Their decision about whether or not a course gains approval is then compared with PATH's decision, and further investigation is undertaken if there are any discrepancies. If PATH is unsure whether or not a course meets the approval criteria, external verifiers are also asked to evaluate the submission. All information sent to external verifiers is anonymised to ensure complete impartiality and confidentiality.

5.6 The PATH approval scheme is linked with the following two schemes:

• NHS Education for Scotland ( NES):
• • The Nursing, Midwifery and Allied Health Professionals Directorate of NES has developed an approval scheme for educational programmes;
  • The PATH approval framework has gone through this NES approval system, which means that on receiving PATH approval, a course also automatically receives NES approval;
• EPASS:
• • PATH's approval system has also been accredited by EPASS (Education Providers Accreditation Scheme Scotland) from the Royal College of General Practitioners Scotland ( RCGPS);
  • This means that PATH approved courses are eligible for EPASS accreditation.

5.7 PATH has developed a detailed and comprehensive set of procedures for those training providers wishing to submit courses for approval. There is also an appeal process if approval for a course is withheld and the provider feels that PATH has not followed the procedures set out in its approval documentation.

5.8 Having gained PATH approval, training providers can use the available associated logos when marketing the course. At present the available logos are those for PATH/ ASH Scotland and EPASS. PATH provides detailed guidelines for their use. As approval is granted on a course-by-course basis, these logos can only be used for the specific course that has received approval. They should not be attached to other courses run by the training provider.

5.9 If subsequent changes are made to an approved course, these should be agreed with PATH as they may invalidate its existing approved status. In addition, approval is only valid until any changes are made in the Smoking Cessation Guidelines for Scotland or the Standards for Smoking Cessation Training in Scotland.

PATH's achievements to date

5.10 The approval scheme was launched at the end of September 2004. Application packs were distributed to potential training providers in Scotland and several additional requests for packs were received from providers based in England.

5.11 PATH keeps a detailed tracking database showing when information has been sent out and received. This database also shows when key decisions have been made. According to the database, 15 submissions have been received:

• Brief Advice:
• • NHS Grampian;
  • ASH Scotland;
  • Education for Health;
  • NHS Greater Glasgow;
  • NHS Lothian;
• Specialist Individual:
• • NHS Grampian;
  • Education for Health;
• Specialist Group:
• • NHS Grampian;
• Unspecified:
• • NHS Lanarkshire (2);
  • NES (Pharmacy Directorate - smoking cessation CD- ROM);
  • Glasgow young people's project;
  • Health at Work (and Smoking Concerns);
  • Glasgow Caledonian University (training for smoking cessation with older adults);
  • The Essentia Group.

5.12 In addition, although the following organisations requested and received approval forms, they did not submit these:

• Brief Advice:
• • NHS Greater Glasgow - Pharmacy 'Starting Fresh' project;
  • NHS Fife;
  • NHS Highland;
• Specialist Individual:
• • NHS Tayside;
  • NHS Highland;
  • NHS Lothian;
• Specialist Group:
• • NHS Tayside;
• All levels:
• • Kirkcaldy & Levenmouth CHP;
• Unspecified:
• • NHS Forth Valley.

5.13 Of the 15 submissions, two were approved on the basis of their first submission, eight needed to make a second submission before being granted approval, and one gained approval after their third submission. Four of the initial submissions have not been approved, although some may still be going through the approval process. Several organisations seem to have experienced recent staff turnover which may have delayed or even terminated the process of seeking approval.

Feedback from stakeholders and discussion

5.14 The interviews with stakeholders were used to explore, where relevant, their views on the process for gaining approval for locally-developed smoking cessation training. However, as illustrated by the above material, submission of training courses for approval by PATH has been inconsistent, with most interest being shown by a relatively small number of providers. Several of these providers have been relatively large NHS Health Boards, where local training in smoking cessation was already well-established.

5.15 Feedback to PATH in the early months of 2005 from co-ordinators across Scotland who had not submitted at that time suggested that a lack of time to compile a submission was the main barrier. However, two of the smaller Health Boards indicated that they did not have the resources to develop any training locally (and therefore particularly welcomed the development of the accredited modules).

5.16 The submissions that have been received have tended to come in as a slow trickle. As stated above, some submissions have not been progressed to completion due to staff changes within the submitting organisations. However, various staff changes within PATH have also meant that the amount of time available within the organisation to promote the submission of local training materials for approval has also varied. It is clear that, when internal resources have been stretched, the development of the accredited courses has always taken priority over marketing the approval process. For example, progress relating to the approved courses has rarely been included in the updates prepared for meetings of the PATH Advisory Group in recent months.

5.17 Those stakeholders who were able to provide feedback on the approval process via the telephone interviews often stressed that the process was very cumbersome and time-consuming. Although PATH staff were seen as being helpful and supportive, it was clear that most of the Health Boards that made submissions needed to do so at least twice before being granted approval. This required additional time from both those making the submissions and from PATH staff.

5.18 Nevertheless, it was also clear from the stakeholder interviews and the discussions in the focus group/workshop, that the approval process is valued, as it enables local courses to gain national recognition, which can be important for staff needing to provide evidence of continuing professional development. Stakeholders want a more straightforward, streamlined process rather than no process for approval.

5.19 The final concern to emerge from the interviews - which was mainly raised by PATH staff - was that those organisations whose training courses had been approved were not seeking agreement from PATH before making changes to their material. However, those stakeholders with approved courses (or considering submitting courses for approval) felt that more guidance was needed on differentiating between updating and changing course material and it was also suggested that all courses should be re-submitted every three years, say, for re-approval.

5.20 The above views can be interpreted in several ways. They could reflect the fact that many training providers have underestimated the time requirements associated with presenting their course material in a satisfactory manner. Ensuring a robust, national framework for smoking cessation training requires consistent, rigorous approaches and high quality course material to gain approval. Another interpretation is that PATH is being unnecessarily pedantic in its requirements (which in part may be determined by the requirements of NES and/or EPASS). This may result in local providers continuing to run their own courses without seeking approval, which will lead to inconsistent standards across Scotland.

5.21 When compared with the material in the PATH Action Plan to 2008 (see Annex B), progress in this area has been relatively slow. For example, by March 2007 PATH should have "assessed the continued value and relevance of our NES and Royal College of General Practitioner ( RCGP) approved training course-approval scheme and, if continuing, launched the database of courses". However, given the underlying interest in having a mechanism to grant national approval to local courses, it seems worthwhile for PATH to look at ways to simplify the process (including determining when re-submission is required) and then promote it again during 2008. PATH could also help local Health Boards explore how they could link their locally-developed courses in smoking cessation to national competency frameworks.

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