Evidence submitted by Skills for Health
(WP 12)
I am pleased to submit this self contained memorandum
of evidence to the Health Select Committee. Skills for Health
consider that the inquiry is well timed in the light of significant
changes in the service and the resultant impact on the workforce.
As the Sector Skills Council for Health, we
have been charged with developing a Sector Skills Agreement (SSA)
which we and our partners consider will have a major role to play
in supporting improved workforce planning, skills development
and workforce productivity in the short, medium and longer term.
WHAT IS
"SKILLS FOR
HEALTH?"
1. "Skills for Health" is a Sector
Skills Council (SSC) with a UK wide remit. Our role covers all
healthcare employers—including those in the NHS, independent
and voluntary sectors. Established in April 2002, Skills for Health
is licensed by the Department for Education and Skills as the
SSC for the health and healthcare sector. We are part of a UK
network of Sector Skills Councils covering 85% of the UK economy,
and are integral to the government's Skills Strategy.
2. The aim of "Skills for Health"
is to help the whole sector develop solutions that deliver a skilled
and flexible UK workforce in order to improve health and healthcare.
3. To achieve this aim, we have expertise
in the following areas:
(a) Developing and managing national workforce
competences
Leading and facilitating the development, maintenance
and use of national workforce competence frameworks, embracing
National Occupation Standards and evaluating their impact and
use.[138]
— Describe the work activities
which need to be carried out to achieve a particular purpose.
— Outline the quality standards
to which these activities need to be performed.
— Indicate the knowledge and
skills people need to carry out these activities.
— Begin with the question—"What
do patients and their carers need?"
— Disregard existing boundaries
such as location and professional demarcations.
— Are patient-centred, recognised
UK-wide, transferable competences.
(d) Improving workforce skills
Developing and implementing a strategy for skills
escalation embracing the use of qualifications and career frameworks.
(e) Influencing education and training
supply
Ensuring the sector gets the skills it needs through
influencing learning supply. We are currently developing a UK
wide "Sector Skills Agreement" (SSA)—See Annex
1 and 3. We are also developing employer-led partnership approaches
to the quality assurance of education and training.
(f) Working with partners
Working in a focussed and strategic way with key
partners, stakeholders and customers across the sector.
INTRODUCTION
4. In the light of our forthcoming Sector
Skills Agreement (SSA), [139]Skills
for Health welcomes the Health Committee's timely decision to
initiate an inquiry into "Workforce Needs and Planning for
the Health Service". Our assumption is that the Health Committee's
remit for this inquiry encompasses all health service organisations—including
those in the independent and voluntary sectors. They draw from
the same labour pool and their interdependence in workforce terms
is important to our evidence. Although the focus of the Health
Committee is on England, the remit of SfH is UK-wide. This is
a critical factor in our response. Whilst we appreciate that health
policy is devolved to the 4 UK countries, there are significant
linkages across the UK Workforce (for example, radiographers who
train in Edinburgh may often work in London).
5. Our overall view is that whilst "traditional"
approaches to workforce needs and planning have worked fairly
well to date, we consider the sector is facing key new challenges.
These arise from a number of strategic drivers which, when combined,
have a significant impact on workforce needs and planning. We
put forward a case that traditional approaches to workforce planning
and decision making have to change if the sector is to secure
and maintain competent staff needed to deliver high quality healthcare
services.
EFFECTIVENESS OF
CURRENT WORKFORCE
PLANNING ARRANGEMENTS
6. Current arrangements in England are complex.
A wide range of organisations (and types of organisations) share
between them various roles and responsibilities. We assume Department
of Health will have covered these roles in detail but we summarise
them here for contextual purposes. Roles cover:
— Individual NHS organisations—required
to prepare their own workforce plans.
— Other employers in the sector (eg
Nursing Homes, independent hospitals, voluntary sector organisations)
who have the option of working closely with NHS organisations
in a particular Strategic Health Authority (SHA) area.
— Strategic Health Authorities who
have a co-ordinating role for producing coherent workforce plans
(linked to service and financial plans) for all the employers
in their area—for commissioning the education and training
in support of those plans; and submitting overall workforce and
commissioning plans to the Department of Health for approval.
— Skills for Health—per paragraph
3 above.
— The Workforce Review Team who advise
the Department of Health as to future workforce number requirements.
— National Workforce Projects (NWP)
who are taking forward a number of innovations in workforce development
to support service change.
— Royal Colleges who offer their own
advice to the Department of Health, especially in respect of future
requirements for doctors in training and Consultants/GP's that
come within the remit of each of the Colleges.
— Other "Advisory Committees"
and bodies such as NHS Employers and external organisations.
— Department of Health (DH), who have
a key role in assimilating this information and advice; and taking
key decisions. In particular, at a macro level DH seeks to ensure
that in aggregate, NHS workforce plans are coherent alongside
its financial and service plans.
— DH also has a central role to play
in `steering' the investment of (approximately) £4 billion
contained in the "MPET Levy" and issuing guidance and
targets to individual SHA's to inform their commissioning/investment
plans. In practice this means that a large proportion of SHA resources
are already pre-committed, firstly because there are many students
who are on programmes which started 2 or more years ago. Secondly,
DH comes to a view as to how many new pre-registration commissions
are needed nationally each year for each of the healthcare professions;
requiring each SHA to commission their `share' of the overall
total.
7. Despite the complexity, in general terms,
this approach has produced sufficient staff with appropriate skills
to deliver the volume and "style" of healthcare, within
affordable limits. However there is no guarantee that systems
of the past will continue to be effective in changing healthcare
contexts.
DEFICIENCIES IN
THE CURRENT
WORKFORCE PLANNING
ARRANGEMENTS IN
ENGLAND
8. Criticisms of the current arrangements
fall into the following main areas:
— Current workforce planning arrangements
pay too little regard to the large proportion of the workforce
not qualified as registered healthcare professionals. Similarly,
education and training resources to support future workforce planning
and development are almost exclusively devoted to professional
and other qualified staff.
— Workforce planning (and the focus
of investment) is currently based on numbers required in each
of the already established healthcare professions and workforce
groups. As a consequence, innovation needed to ensure that individuals
working in the sector have the right competences to deliver modern
healthcare is not prioritised. Growth in knowledge and technology
means that existing, new and changing job roles do not conveniently
fit into the workforce group `silos' designed many years ago.
Workforce planning returns and other workforce information submissions
to DH contain little reference to new roles particularly at Assistant
and Advanced practice levels, therefore the scope and flexibility
for investing in them is limited. This has the effect of fossilising
the structure of the workforce and assumes that `more of the same'
jobs and roles will meet service and financial requirements, at
a time when policy and market conditions across the sector are
changing radically.
— The strategic element of workforce
planning is insufficiently considered within current arrangements.
KEY STRATEGIC
DRIVERS FOR
FUTURE WORKFORCE
PLANNING
9. In analysing evidence gathered from the
early stages of developing the Sector Skills Agreement, we suggest
there are a number of key drivers impacting significantly on the
future healthcare workforce—some directly, others indirectly.
Some are sector wide, others more relevant to the NHS. A number
of them were specifically identified by the Health Committee in
the terms of reference for this inquiry.
10. The known key drivers include:
— European Working Time Directive 2009
(1)
— Modernising Medical Careers (2)
— "Payment by Results" (3)
— Reduced financial growth for the
NHS after the next Spending Review—ie from 2008 onwards
— "Agenda for Change" (4)
—the new NHS pay system[140]
— The `Knowledge and Skills Framework'
(5) which underpins `Agenda for Change'
— `Improving Working Lives' (6)
— The requirement for improvements
in `Productive Time'
— The implications of the Gershon report
(7)
— Changing market conditions including
growth of the independent and voluntary sectors as a provider
of NHS services
— The introduction of the "Electronic
Staff Record" system (7) in the NHS
— Demographic changes—both in
the population at large (eg more very elderly people) and in the
workforce (e.g. changes in retirement trends)
— Age diversity legislation in 2006
(8)
— Current financial pressures within
healthcare in 2005-06
— Retirement "hot spots"
in certain professions i.e. GPs
— Workforce shortages in diagnostic
services
— Government policies—eg `Commissioning
a Patient Led NHS' (9) and `Practice Based Commissioning' (15)
11. These drivers combined pose a challenge
to the existing paradigm that job roles can continue to be defined
purely in terms of the established workforce groups, inclusive
of healthcare professions. This does not mean that these groups
and professions do not continue to have a critical role, but healthcare
workforce planners need to contemplate the significance of the
drivers in developing `non-traditional' approaches to competences
and job roles to meet the challenges arising from them.
CONVERGENCE OF
STRATEGIC DRIVERS
12. The strategic drivers we highlight converge
in two specific areas namelythe need for a more flexible workforce
(a more effective mix of people undertaking wider and different
roles) and the role of competences as a currency and framework
for addressing skills gaps and their workforce development implications
through future planning and commissioning.
DEVELOPING THE
RESULTANT VISION
FOR FUTURE
WORKFORCE PLANNING
13. It is evident from our work in progress
on the Sector Skills Agreement that current models of workforce
planning are unlikely to meet the needs of the future health sector.
Simply planning for "more of the same" will be insufficient
to meet the challenges of the next 10 years and beyond. There
is a recognised need to produce a more flexible workforce rather
than to continue to commission workforce education and training
along traditional lines. Annex 2 sets out proposals for a systematic
process of "Skills Escalation".[141]
This process is founded on a structure of National Workforce Competences
(designed around what individuals and teams need to be able to
do to meet patients' needs). The vision for skills escalation
in the health sector represents the development of a holistic
system for workforce planning /development that supports individually
focussed healthcare, by optimising performance, practice and learning
opportunities for employers and employees. Key characteristics
include:
— Emancipating and equipping individuals
to reach their full potential in accordance with their abilities
and preferences
— Achieving maximum flexibility in
workforce development and planning/skill-mix choices for employers
— Enabling transferability of competence
and recognising achievement across the UK sector
— Ensuring that learning opportunities
are fit for practice, purpose and award
14. A full system of competence-based workforce
planning/investment would be underpinned by the development of
new/existing roles linked to a new career framework and a national
qualification framework—enabling transferability and progression
for individuals and workforce/team flexibilities for employers.
15. Much work has already been undertaken
towards developing a competence [en rule]based system of workforce
development and planning. Skills for Health have developed a framework
of National Workforce Competences that covers 70% of generic transferable
skills. Work is also underway on the development of a new national
Qualifications Strategy and related Career Framework. The emergent
Sector Skills Agreement outlines the strategic actions that will
need to be taken by a range of key stakeholder bodies if a competence-based
approach to workforce planning and development is to become a
reality on a "whole systems" basis.
SUMMARY AND
CONCLUSIONS
16. This memorandum of evidence demonstrates
that whilst the existing workforce planning arrangements have
served the health and healthcare sector in England reasonably
well; they are unlikely to be `fit for purpose' in the future.
This is partly because they undervalue the contribution of a large
section of the workforce, partly because they are focussed on
the individual `traditional' professions and partly because they
are not sensitive enough to local requirements—but mainly
because they are not long term enough to take account of strategic
drivers and the lead times needed to develop changes in the `shape'
of the workforce.
17. In order to deliver the modernised approach
to workforce planning suggested in this memorandum of evidence,
there will continue to be aspects which should be undertaken centrally
and locally—and elements which can best be addressed by
`the intermediate tier' (currently Strategic Health Authorities).
The key difference as compared with the current arrangements is
the need for a more strategic approach and the development of
Strategic Workforce Plans that demonstrate that they deliver the
more flexible, competency-based workforce that is needed.
18. This more sophisticated approach to
workforce planning and development needs to be matched with an
effective implementation process. We propose that the Sector
Skills Agreement should be an appropriate vehicle for future coherence
and action across stakeholders, partners and delivery bodies.
John Rogers
Chief Executive, Skills for Health
14 March 2006
REFERENCES:
(1) European Working Time Directive—for
more details as to how it impacts on the NHS see www.dh.gov.uk/PolicyAndGuidance/HumanResourcesAndTraining/WorkingDifferently/EuropeanWorkingTimeDirective/fs/en
(2) Modernising Medical Careers, Department
of Health, 2004 www.dh.gov.uk/
PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT—ID=4079530&chk=8RCFqk
(3) Payment by Results aims to provide
a transparent, rules-based system for paying trusts. It is intended
to reward efficiency, support patient choice and diversity and
encourage activity for sustainable waiting time reductions. Payment
is linked to activity and adjusted for casemix. Importantly, this
system is intended to ensure a fair and consistent basis for hospital
funding rather than being reliant principally on historic budgets
and the negotiating skills of individual managers. For more details
see http://www.dh.gov.uk/PolicyAndGuidance/OrganisationPolicy/FinanceAndPlanning/NHSFinancialReforms/fs/en
(4) Agenda for Change is the new pay system
that applies to all directly employed NHS staff, except very senior
managers and those covered by the Doctors' and Dentists' Pay Review
Body. A collective agreement was reached with the NHS unions at
the NHS Staff Council on 23 November 2004, following the completion
of a second ballot process by some unions. Agenda for Change is
being rolled out nationally beginning on 1 December 2004, with
pay and most terms and conditions backdated to 1 October. The
aim is for 100% assimilation (less those who wish to remain on
local contracts) by 30 September 2005.
(5) The NHS Knowledge and Skills Framework
(NHS KSF) and the Development Review Process, October 2004 www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT—ID=4090843&chk=dyrb/a
(6) `Improving Working Lives' is a blueprint
by which NHS employers and staff can measure the management of
human resources. Organisations are kite-marked against their ability
to demonstrate a commitment to improving the working lives of
their employees, www.dh.gov.uk/PolicyAndGuidance/HumanResourcesAndTraining/ModelEmployer/ImprovingWorkingLives/fs/en
(7) The Electronic Staff Record (ESR)
solution will replace 29 payroll systems and 38 HR systems with
a single, national, integrated solution and will be used by all
NHS organisations—some 615 throughout England and Wales.
For more details see http://www.esrsolution.co.uk/
(8) The Employment Equality (Age) Regulations
2006 come into force in October 2006 and will implement the age
strand of the EU Employment Directive 2000/78/EC. They will outlaw
age discrimination in employment and vocational training. The
Age Regulations will apply to all workers and to people who apply
for work, and in addition, they will cover access to vocational
training. The Age Regulations will prohibit direct and indirect
age discrimination, harassment and victimisation. See www.dh.gov.uk/PublicationsAndStatistics/LettersAndCirculars/DearColleagueLetters/DearColleagueLettersArticle/fs/en?CONTENT—ID=4126389&chk=otM0io
(9) Commissioning a Patient Led NHS is
the name given to the letter and document sent to NHS Chief Executives
and others on the 28th July 2005 from Sir Nigel Crisp, the NHS
Chief Executive. The document sets out the Government's plans
to restructure PCT's and SHA's which it feels are imperative to
support front line staff in the commissioning decisions they make
to reflect patient choices. www.dh.gov.uk/assetRoot/04/11/67/17/04116717.pdf
(10) Hospital at Night is a model of shift
patterns and staffing mix for the NHS to use in response to the
European Working Time Directive has delivered improvements to
patient care. For more details, see http://www.dh.gov.uk/PublicationsAndStatistics/PressReleases/PressReleasesNotices/fs/en?CONTENT—ID=4118010&chk=7P/nGP
(11) Department of Health Survey of Hours
Worked by Doctors in Training in March 2005—http://delphi.doh.gov.uk/422/intranets/mint/minintra.nsf/vWallDocs/EE6C3C397140FOB1802570
(12) Planning Now for Your Future Workforce
Needs, National Workforce Projects, 2005—http://www.healthcareworkforce.org.uk/C19/Planning%20now%20future%20work/Whole%20Document/planning%20now.pdf
(13) `Competences' and `Competency Based
Workforce Planning'—for more information, click on to http://www.skillsforhealth.org.uk/comps.php
and http://www.healthcareworkforce.org.uk/C5/Competency%20Based%20Planning/default.aspx
(14) The Gershon Review—`Releasing
Resources for the Frontline: Independent Review of Public Sector
Efficiency'. For more details see http://www.hm-treasury.gov.uk./spending
review/spend sr04/associated documents/spending sr04 efficiency.cfm
(15) Practice Based Commissioning enables
GPs and other front line clinicians to redesign services that
better meet the needs of their patients.
138 National Workforce Competences and National Occupational
Standards reflect a set of statements identifying what people
or teams need to know and be able to do to deliver that service:
They: Back
139
In the Government's national Skills Strategy the SSA is identified
as the critical mechanism through which Sector Skills Councils
will deliver four strategic objectives across the workforce (Increase
productivity; Address skills gaps and shortages; Provide greater
skills opportunities; Achieve more responsive education and training,
aligned with sector employment needs). The practical outcome is
a compact or "deal" between employers; partner organisations
(including education and training providers) the sector and government.
The agreement will be designed to ensure that "the skills
the sector wants are the skills the sector gets". The expectation
is that the SSA will result in employers shaping and endorsing
learning provision; skills demand more directly shaping supply;
employees benefiting from increased high quality learning linked
explicitly to better job prospects. Back
140
The Agenda for Change pay reform strategy is designed to replace
out-moded policies and ensure staff are developed in their existing
and future roles through an associated UK-wide `Knowledge and
Skills Framework' (KSF). KSF focuses on how knowledge and skills
needs to be applied to meet the demands of work. KSF is designed
to be consistent with occupational standards and workforce competences.
It will be a major lever in achieving `skills escalation, a modern
career framework and pay progression in the NHS. There will be
ongoing implications for staff working in the independent and
voluntary sector services over time and for medical staff. Back
141
Not printed here. Back
| 
