Further supplementary evidence submitted
by the Department of Health (WP 01C)
PURPOSE
1. This note updates the Health Select Committee
on progress with the review of workforce planning, education and
training. The review was commissioned in July 2006 by Lord Warner,
Minister of State for Reform. In summary the purpose of the review
is to:
— consider how workforce planning and
commissioning strategies can support health reform and the implementation
of the White Paper "Our Health, Our Care, Our Say";
— look at what works well in the present
arrangements;
— identify what does not work well
and any gaps;
— consider how we can improve systems
and relationships; and
— consider how we can strengthen partnerships.
METHOD
2. Our approach has been to meet internal
and external stakeholders across health and education. We held
a major stakeholder event in October and have followed that up
with meetings with universities and the Department's Workforce
Programme Group. We have also worked closely with DfES as agreed
with Bill Rammell, Minister of State for Higher Education and
Lifelong Learning. It is vital that we also represent the views
of Strategic Health Authorities (SHAs) and we are currently in
the process of consulting them.
3. We have conducted the review at a time
when concern about funding education and training in the NHS has
been heightened by the need for the NHS to achieve financial balance
and because of a policy shift in DH where educational budgets
have been assigned to SHAs without ring-fencing in order to provide
maximum local flexibility. This has helpfully engaged the key
players but we also note that short-term concerns that the review
is a cost-cutting exercise have inevitably coloured what is a
longer-term look at education, planning and commissioning.
HEALTH REFORM:
IMPLICATIONS FOR
THE WORKFORCE
4. The NHS workforce strategy until recently
has focussed heavily on increasing service capacity, recruiting
more staff and reforming pay. This has seen major policy development
with increases in the number of doctors and nurses, international
recruitment, pay and contractual reform for a number of staff
groups including Agenda for Change with its attendant Knowledge
and Skills Framework.
5. After a long period of unprecedented
levels of investment targets there is now a strong focus on financial
sustainability in the NHS. We also expect the next spending review
settlement for health to be tight. The "More Staff, Working
Differently" motto much used about the NHS workforce no longer
has the relevance it did. However, "Working Differently"
remains an important theme.
6. Health Reform policies and "Our
Health, Our Care, Our Say" will change the way care is delivered:
— patients will be able to access more
services closer to home;
— there will be closer working between
health and social care;
— there will be greater plurality of
provision and greater patient choice;
— payment by results will profoundly
affect decision-making; and
— there will be stronger emphasis on
public health and self-care.
7. This array of reform demands that we
re-assess our workforce strategies to make sure they respond effectively
to these developments. We also accept that we need to do better
on public/patient involvement in the training and development
of health professions and the wider workforce. A greater patient-focused
approach would see a more flexible workforce dedicated to a more
flexible response to patient need. There are opportunities here
too to put a greater and much-needed accent on inter-professional
education and training not least through more responsive development
processes for curricula at all levels. In particular, we need
to recognise the need to develop common elements on leadership,
management and clinical engagement in curricula.
CONSENSUS: PLANNING
8. Consultation with stakeholders has highlighted
a number of issues. In terms of planning there is a consensus
that:
— it can be very complex with variable
quality;
— it is by its nature often long-term
in its focus, however, this means it can be unresponsive to service
needs;
— much of the information produced
by the existing systems is not reliable;
— it works better for the larger professions
but is more difficult for smaller specialties and disciplines;
— there is a lack of strategic approach
to the wider workforce;
— at all levels, nationally, SHA, PCT
and trust, workforce planning lacks integration with financial
planning and with service planning;
— too often workforce planning appears
reactive and is not used to lead change;
— it is often done at a junior level
in organisations which suggests it is not taken seriously enough;
and
— clinicians are often not effectively
engaged.
9. Not everything is negative though. At
present:
— we have a better match between supply
and demand than ever before;
— variations are much less than other
countries;
— most medical specialties have a good
match between supply and demand; and
— the system has been able to reply
to shortages.
CONSENSUS: EDUCATION
10. The issues around education, training
and funding are closely linked with planning.
— investment and innovation is blighted
by short-term financial considerations;
— loss of ring-fenced budgets has brought
about uncertainty and damaged relationships with higher education
(HE);
— the MPET formulaic system doesn't
sit well with a world of plurality of provision;
— working relationships between the
NHS and HE are not effective at all levels;
— there is no consistent approach to
commissioning;
— there is no formal conduit for service
providers to influence national commissioners or regulators;
— there is a lack of support for innovation
and new roles—HE not always responsive/innovative enough,
NHS not always good at articulating what it wants; and
— the approach to student support is
incoherent and counter-productive.
ACTION IN
THE SHORT-TERM
11. There are a number of areas where we
need to focus our attention to make progress in the short-term.
— The need for more effective working
relationships between SHAs, the NHS and HE at all levels.
— A national workforce planning overview
function, but with a more strategic local approach to workforce
planning with greater integration between service, financial and
workforce planning. This might be achieved through:
— promotion of shared best practice
nationally;
— identifying and sharing best
practice at SHA/HE partnership level;
— strengthening the role of Workforce
Review Team (WRT) and SHA ownership of WRT;
— extending to other professions
the national quota system (which we use with the Higher Education
Funding Council for England (HEFCE)) for medical and dental undergraduate
education—with strengthened input from SHAs; and
— identifying workforce as a key
measure of assessment in PCT Fitness for purpose frameworks and
Whole Health Community Diagnostic tools.
— Formal conduit for service providers
to influence national commissioners or regulators.
— A more consistent approach to commissioning
with a view to addressing financial instability.
— A strategic approach and investment
in the wider workforce.
— Support for innovation and new ways
of working (including new roles) in the NHS and in HE.
ACTION IN
THE MEDIUM-TERM
12. Some issues are not easily solvable
and will require more detailed consideration and consultation
with stakeholders in order to develop options for change that
respond to existing concerns but will also be flexible enough
to stand the test of time.
— Implementing improved funding arrangements
under the MPET Review—to incentivise education and training.
— Reviewing and addressing student
support anomalies.
— Changing the structure and content
of undergraduate courses to improve the competence-base and to
improve links with employer needs and inter-professional learning.
— Addressing variations in unit costs—mapping
funding flows to achieve more transparency and VFM.
FURTHER OPTIONS
FOR CHANGE
13. It is clear that there is scope for
incremental improvements in existing arrangements, particularly
in terms of the relationships between NHS and education planners
and commissioners including their mutual responsiveness. However,
incremental improvements may not reflect the nature and pace of
system reform where there are major shifts in provision into the
community, the emergence of foundation trusts and an increasingly
plurality of health provision.
14. We need to look beyond incremental change
and examine more basic change based on a market approach. How
in a more open, fluid and devolved system can we best secure a
well-motivated workforce in the right numbers and of the right
quality and capability?
15. Areas to explore might include:
— Transferring responsibility for healthcare
professional training directly to HEIs and HEFCE.
— Transferring responsibility for career
decisions to students by moving to a loan system.
— Influencing overall supply by targeting
loans at students in disciplines where HEI decisions and self-funding
lead to market failures.
— Whether a market system would see
employers invest in training and development to provide specialist
skills.
— Potential for postgraduate training
and development funding to be invested across all employers through
the tariff.
— A variation on the current system
of MPET funding would provide employers with bursaries to support
FP, specialty and GP training.
— A bursary system reflecting current
training patterns and funding to avoid instability.
— Incentives to invest in post-graduate
training to meet the primary aim of modest over-supply. Bursaries
might provide SHAs with a strong lever for driving change. Some
bursaries could be available to develop specialist skills in other
shortage areas, for example, healthcare scientists and public
health.
— A new and different role for HEFCE.
Options include a "HEFCE for Health" along the NHS Education
for Scotland model or a system similar to the Training and Development
Agency for Schools.
SUMMARY
16. Consultation with stakeholders continues,
in particular with SHAs and employers. As demonstrated above,
we have identified a wide range of issues where changes are required.
The next phase of work over the coming months will see the development
of a range of detailed options to address these issues. The Health
Select Committee will be kept informed of progress.
Department of Health
December 2006
| 
