Dear Mr Horstead, Thank you very much for sharing a copy of your report with Skills for Care and giving us the opportunity to respond. Firstly, we would like to express our deepest sympathies to the family, friends and carers of Mr Waite for their loss at what will continue to be a difficult time. Skills for Care is the strategic workforce development and planning body for adult social care in England. Whilst we have no regulatory remit, we strive to support the adult social care sector to consider good and best practice approaches to enable it to always deliver quality care. Our guidance and advice is informed by consultation with employers and includes recommendations related to workforce development. This advice spans the initial induction training for new care workers, through to the refreshing of knowledge and skills of experienced workers, as well as their longer-term development. Our advice includes encouraging adult social care providers to arrange training and assessment related to First Aid, including Basic Life Support for frontline carers from the moment they join the sector to the end of their careers. Our guidance and advice include: Core and Mandatory training This guidance is currently being updated in line with the Care Quality Commission’s new Single Assessment Framework and is due for republication in spring 2024. Pertinent to this request, our current guidance states that all care workers should ‘Understand and know how to follow procedures for responding to accidents and sudden illness’ and ‘Be able to provide basic life support’. In line with HSE guidance, it further states that ‘Establishments must provide adequate personnel to respond if someone is taken ill or injured at work. It’s the employer’s responsibility to determine how many people need training and to what level.’ We note that this HSE guidance applies to First Aid and First Aid at Work, not specifically to Basic Life Support.

The adult social care sector’s statutory training requirements for the non-regulated workforce are drawn from general employer requirements, e.g. in relation health and safety, or from CQC regulations. CQC recommendations We note that the Coroner is requesting information directly from the CQC. Skills for Care draw on CQC recommendations and guidance when developing our products and services, and signpost stakeholders across the sector to CQC documentation. Pertinent to this request, Skills for Care notes CQC’s recommendations relating to Regulation 18: Staffing, which include (but are not limited to): ‘Providers must ensure that they have an induction programme that prepares staff for their role’ and ‘Where appropriate, staff must be supervised until they can demonstrate required/acceptable levels of competence to carry out their role unsupervised’. We also note CQC recommends that ‘Staff should be supported to make sure they can participate in: [....], Other learning and development opportunities required to enable them to fulfil their role. This includes first aid training for people working in the adult social care sector’. Care Certificate The Care Certificate is an agreed set of 15 standards that define the knowledge, skills and behaviours expected of specific job roles in the health and social care sectors.

It was introduced in 2015 and was jointly developed by Skills for Care, Health Education England and Skills for Health under a grant commission from the Department of Health and Social Care. Skills for Care host a wide range of Care Certificate resources on our website.

The 15 standards are:

1. Understand your role
2. Your personal development
3. Duty of care
4. Equality and diversity
5. Work in a person-centred way
6. Communication
7. Privacy and dignity
8. Fluids and nutrition
9. Awareness of mental health, dementia and learning disabilities
10. Safeguarding adults
11. Safeguarding children
12. Basic life support
13. Health and safety
14. Handling information
15. Infection prevention and control

Standard 12: Basic life support states: The learner must be able to carry out basic life support. This BSL training must meet the UK Resuscitation Council Guidelines.

The Care Certificate is not a mandatory programme for care providers. Instead, it is considered to be the minimum training, supervision and assessment that staff ‘new to care’ (health and adult social care) should receive as part of a robust induction and before they start to deliver care out of the line of sight of more experienced workers.

In practice, it is employers who determine the point at which a worker can work out of the line of sight of more experienced workers based on their assessments of their workers’ competence and the skills required in particular situations.

Level 2 Adult Social Care Certificate Qualification Earlier this year Skills for Care was commissioned by the Department of Health and Social Care (DHSC) to develop a specification for the development of a new Care Certificate qualification based on the existing Care Certificate standards. Awarding organisations are currently developing the qualification in preparation for a June 2024 launch. The qualification will not be mandatory. And it will not replace an employer’s responsibility to provide appropriate support, training, professional development, supervision and appraisal as necessary to enable the worker to carry out the duties they are employed to perform. Employers are expected to provide a robust induction as part of this process. It's the employer’s responsibility to ensure staff undergo any mandatory training as part of an induction, and relevant mandatory training cycles. As with the current version of the Care Certificate, those undertaking the qualification will need to understand procedures for responding to accidents, sudden illness and providing basic life support. Learning from Events Skills for Care’s digital module, Learning from Events, may be of interest to the Coroner. It is available at no cost to the sector and is based on the PAcE model (People, Activity and Environment). The module aims to support leaders and managers carry out learning reviews to holistically explore adverse events and create actions plans to avoid repeat incidents. Learning from Deaths Review Programme (LeDer): We acknowledge that due to the circumstances of Mr Waite’s death, a LeDer review would be completed and that recommendations from this may also be considered if directed to Skills for Care or it leads to sector-wide mandated training or regulatory changes. If this was to happen, Skills for Care would align our guidance and advice to reflect updated messaging from CQC and HSE etc. Coroner’s Concerns To reiterate, Skills for Care recommends that every frontline care worker within a CQC regulated services should be supported to receive First Aid training, including

basic life support as part of their initial induction to the sector, and ensure these skills and competences are regularly refreshed beyond that. We recognise the importance that First Aid training, including Basic Life Support, and encourage providers to adhere to the CQC’s Regulation 18: Staffing recommendation: ‘Where appropriate, staff must be supervised until they can demonstrate required/acceptable levels of competence to carry out their role unsupervised’. In this context, we believe that this would mean that staff scheduled to work alone, out of sight of more experienced colleagues must receive the training before being left unsupervised, rather than before they start working in a care environment. Whilst Skills for Care is committed to influencing improvements in the standards and the quality of personalised care across the adult social care sector, as an independent charitable body, we are not able to mandate or enforce what training is undertaken. We hope this information and advice is useful to any further actions. Skills for Care would be happy to engage further on this matter with your office, the CQC and the provider should you deem that helpful. Our deepest sympathies again to the friends, family and carers of Mr Waite.

Dear Mr Horstead, Re: Peabody response to the Prevention of Future Deaths report I am writing to update you on the actions we have taken following Mr Michael Waite’s death and the subsequent Prevention of Future Deaths report (Regulation 28). First, I would like to extend my condolences to Mr Waite’s family. Michael was a wonderful person who brought joy to all who knew him. He continues to be missed by our colleagues and residents. The concern that has been identified in the PFD report is that there is no requirement for care workers employed by Peabody to provide support to customers in a supported living environment to undergo certified First Aid and Basic Life Support training prior to starting work providing solo support to customers. In the sad case of Mr Waite, the care worker who assisted him when he was taken unwell had completed his Basic Life Support training. Moreover, the issue of a care worker who has not completed their basic life support and first aid training prior to them starting to work alone has not given rise to any incidents to date. However, we accept and understand the concerns highlighted by the Coroner during this inquest and are keen to ensure that all learning is captured and acted upon, in order to ensure that the service we provide to our customers remains of the highest standard. Therefore, we have now improved our training programme for care workers who assist customers in supported living environments. I have set out below all the steps we have taken to address the concerns raised in the report.

Statutory requirements for basic life support and first aid training for care workers

We have reviewed the statutory requirements in relation to the training and provision of suitably qualified staff to support customers in a supported living or domiciliary care environment. This would include customers such as Mr Waite, who received a domiciliary care service in his own home. Personal care is a regulated activity under The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Section 18 of the Act states:
18.—(1) Sufficient numbers of suitably qualified, competent, skilled and experienced persons must be deployed in order to meet the requirements of this Part.

(1) (2) Persons employed by the service provider in the provision of a regulated activity must— (a) receive such appropriate support, training, professional development, supervision and appraisal as is necessary to enable them to carry out the duties they are employed to perform, (b) be enabled where appropriate to obtain further qualifications appropriate to the work they perform… The Care Quality Commission (CQC) is responsible for ensuring registered providers adhere to The Act. In doing so, the CQC have developed a set of Fundamental Standards, which help define the points set out in The Act. Further to this an organisation called Skills For Care worked in collaboration with Skills For Health and Health Education England to set a minimum training standard for people working in the Adult Social Care sector. This minimum standard is currently defined in the Care Certificate. There is no statutory requirement to complete the Care Certificate and as such the CQC cannot enforce its use. However, CQC inspectors can enforce regulations covering how care colleagues are trained. The Care Certificate was designed to ensure those minimum standards are met and is generally considered an industry standard. Standard 12 in the Care Certificate covers Basic Life Support. Skills For Care state that “The minimum that should be covered is practical simulation of Cardio-Pulmonary Resuscitation (CPR).” All our new care workers working in a domiciliary care service complete this certificate. Even although their certificate can be brought across from a previous organisation, we still ask them to complete it again when they join us. This ensures we are confident in the quality of their training. We know many other providers take this approach as well.

Actions taken by Peabody regarding basic life support and first aid training

Our South Essex Domiciliary Care service was inspected by the CQC in July 2023, after Mr Waite’s sad death. The service retained its overall ‘Good’ rating. This rating was given to all five domains, including ‘Safe’, which incorporates colleague training and fitness to work. Training requirements were considered as part of the inspection and there were no notable concerns. This is partly because our existing training programme already meets the minimum standards for Basic Life Support training identified in the Care Certificate. However, upon careful consideration of the risks raised by the Coroner and having reviewed the risks inherent with our supported living customers, we have put in place additional measures to improve our training and quality of service. As a result, we have introduced a revised training programme for our care workers. This includes a more advanced, certified Emergency First Aid training course (which incorporates Basic Life Support). It is a one-day, in person course provided by Nuco Training Limited (details attached). In addition to using an external provider, we will also be delivering more training in-house. All our new care workers will complete the enhanced training programme as part of their induction process. They will be required to complete the Emergency First Aid training

component within their first month of starting with us during which time they will not be allowed to lone work. Our existing care workers will also be required to complete the new course. This affects over 420 employees. We have given ourselves a target of one year to complete the roll out of this training programme, which has already commenced. This is on top of the basic life support training that our existing care workers who provide solo support have already completed. To ensure training is kept up to date, we use a learning management system called My Learning. This allows our colleagues to book training and complete e-learning from any device, at the time of their choosing. This includes refresher training which is set according to the course and the role of the worker. It also gives managers oversight of their teams’ learning activity. Our colleagues and their line managers receive automated reminders when a course is due for completion or renewal. We also receive monthly training compliance reports from our learning and development department and have a digital dashboard that shows compliance per team for each course. We recognise the need to continue upskilling our workforce into the future and maintain our resilience to changing customer needs. Therefore, we have also recently launched an Ofsted-registered Academy within our organisation, which will provide Care Certificate Training and also Level 3 Adult Care Worker standard and Level 4 Adult Care Practitioner standard apprenticeships. Thank you for highlighting your concerns in the PFD report and I hope you feel that our response to Michael’s tragic death has been robust and swift. If you would like any additional information, please do not hesitate to contact me.

Dear HM Coroner Sean Horstead

CQC response to prevention of future death report Michael Brian Waite

Thank you for naming the Care Quality Commission (CQC) as a respondent in the prevention of future death report issued following the death of Michael Brian Waite on 19 August 2022.

The CQC is the independent regulator of health and social care in England. We gather and analyse data from people who use services, providers, and our system partners and stakeholders to help us to monitor the quality of care and to be more targeted with what we look at during our inspections. This forms the basis of our intelligence-driven approach to inspection. We take enforcement action if providers are not meeting the regulations. We encourage all services to improve, whatever their level of performance.

The relevant regulation concerning this matter is the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; Regulation 18: staffing.

The intention of this regulation is to make sure that providers deploy enough suitably qualified, competent and experienced staff to enable them to meet all other regulatory requirements described in this part of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. To meet the regulation, providers must provide sufficient numbers of suitably qualified, competent, skilled and experienced staff to meet the needs of the people using the service at all times and the other regulatory requirements set out in this part of the above regulations. Staff must receive the Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA

support, training, professional development, supervision and appraisals that are necessary for them to carry out their role and responsibilities. They should be supported to obtain further qualifications and provide evidence, where required, to the appropriate regulator to show that they meet the professional standards needed to continue to practise.

Following receipt of your prevention of future deaths report, the CQC commenced a responsive assessment to assess the service on training and learning culture; and on 27 February 2024, requested that the provider forward details on the actions taken since Mr. Waite’s death, including the investigation report and lessons learnt by the provider in their effort to reduce the risk of a similar incident occurring. We also requested information on any additional actions the provider intended to take, in response to the prevention of future death report (including clear timescales).

On 11 March 2024, the provider submitted copies of the accident and incident reporting form and investigation review report produced following Mr. Waite’s death. We also received associated care plan and staff training documentation. On 19 March 2024, we met with the provider to discuss this submission and to identity any proposed additional actions in response to your prevention of future death report.

The above took place to enable us to respond to the concerns raised in your Regulation 28 prevention of future deaths report and to make an assessment as to whether we needed to take further action. We deal with each of your concerns as follows:

1. Although the support worker involved in this case had received Basic Life Support training, the evidence of senior witnesses for Peabody, including the Assistant Head of Service and the Director of Care, confirmed that there is presently no requirement for Support Workers, employed by Peabody to provide 24-hour solo support to clients in supported living accommodation, to undergo certificated First Aid Training including Basic Life Support training, prior to assuming their role.

The provider has confirmed that their protocols have now been revised; such that enhanced emergency first aid training (incorporating basic life support) is now a mandatory part of training for all new support workers. The provider has also confirmed they are in the process of ensuring that all existing support workers complete this enhanced training within 12 months.

2. Whilst it is recognised that residents in supported living accommodation have varying capabilities and varying abilities to care for themselves, as in this case, many will require help and support and, as such, will have varying - including significant - degrees of vulnerability. In my view, for those who are solo providers of support in such circumstances (i.e. are working alone in providing the support required) to not have received formal, certificated First Aid training, including Basic Life Support training, prior to assuming their duties gives rise to the risk of future deaths.

The provider has confirmed that protocols have now been revised so that no support worker across the organisation is allowed to lone work without having undertaken enhanced training (comprised of emergency first aid and basic life support training).

However, as highlighted above, we have been advised that the entire existing support worker workforce will not have completed their enhanced training for 12 months. This risk is partially mitigated by a new provider requirement that, where support workers are working together, one must have completed enhanced training. To conclude, Peabody have mitigated the risk of future occurrence by ensuring enhanced emergency first aid training is available to all new and existing staff. Whilst existing staff are trained, Peabody are ensuring that there will be appropriately trained personnel on every shift.

Since 1 April 2015 CQC has assumed enforcement responsibility for health and safety incidents where patients and service users have died or sustained avoidable harm or have been exposed to a significant risk of avoidable harm as a result of a failure by the registered person to provide safe care or treatment. As a result of the information you have shared in this case, CQC will be considering Mr Waite’s case under this framework.