3 Helping staff to work differently
11. The Knowledge and Skills Framework represents
the other main element of the Agenda for Change reform programme,
and is the key to unlocking significant improvements in staff
capabilities, more flexible working and, ultimately, better care.
Together, Agenda for Change and the Knowledge and Skills Framework
were designed to contribute to breaking down 'silos' within the
NHS, particularly around historical roles and responsibilities
and to allow staff to work in new ways.[21]
No obligation, however, was placed on Trusts or staff to be more
productive in return for higher pay, or to use the new freedoms
and flexibilities provided by Agenda for Change and the Framework
to create new roles or work differently.[22]
12. Agenda for Change has been used locally to introduce
some new ways of working. Commonly these have been enhanced roles
for healthcare assistants to take on tasks previously carried
out by qualified nurses. Similarly, 'nurse consultant' roles have
been developed under which senior nurses undertake elements of
work formerly carried out by doctors, such as prescribing. There
are also examples of the creation of new roles focused on patient
needs, such as generic mental health workers to deliver a range
of services to mental health patients at home in one visit, in
place of several different healthcare professionals visiting at
different times. The introduction of new roles generally has,
however, been local and sporadic, rather than systemic and NHS-wide.[23]
13. The Knowledge and Skills Framework requires managers
and their staff to agree an outline of the particular knowledge
and skills needed for each job and to review individuals' progress
against this outline at least annually. The reviews provide individuals
with the opportunity to discuss with their manager how they are
performing their role, and to identify training needs and agree
development plans. The reviews are designed to result in better
focused training and performance management.[24]
14. The Department intended that the Framework should
be an intrinsic part of Agenda for Change but it placed more emphasis
initially on getting staff on to the new pay bands. Consequently,
Trusts focussed their efforts on job evaluation and assimilating
staff on to new pay bands in the period December 2004 to December
2006.[25] As a result
of the slow adoption of the Framework, it was not until spring
2007 that the Department took action to re-launch it. In spring
2008, the Department reinforced this with a letter from the Minister
to all Trust Chief Executives, stressing the benefits of using
the Framework fully. By September 2008, only 54% of NHS staff
had had a Knowledge and Skills review in the previous 12 months.[26]
15. Implementing the Framework requires an initial
investment of staff time and effort in order to put in place the
necessary processes, and many individuals and managers have yet
to be convinced that the effort required is worthwhile.[27]
Where the Framework is supported by Trust management, staff have
been given sufficient time to prepare for annual reviews and with
their managers allowed to develop the skills and culture needed
to conduct appraisals as part of wider performance management.
The Framework Handbook is complex and over 262 pages long, and
there is a lack of clarity about how the respective functions
of the two IT systems that support the Framework and career development
should be used.[28]
21 Qq 58, 88 Back
22
Q 3 Back
23
C&AG's Report, paras 3.4, 3.29 Back
24
Q 22 Back
25
Q 45 Back
26
C&AG's Report, para 3.27 Back
27
C&AG's Report, para 3.30 Back
28
Q 48; C&AG's para 3.32 Back
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