The quality, safety, effectiveness and efficiency of healthcare services depend on the availability of sufficient numbers of well-trained and well-motivated staff. The NHS has, therefore, rightly attached a high priority to the education and training of staff. Despite this, however, there is now an urgent requirement for a whole-system review of the education and training of the health and care workforce.
This is made necessary by the consequences of the wider NHS reforms. More substantively, this situation presents a welcome opportunity to address some of the weaknesses of the current arrangements. These are complex, inflexible and unfair, and may be an obstacle to desirable changes in healthcare provision.
The challenge of workforce planning
Effective workforce planning in the NHS depends on the availability of up-to-date, high-quality data and intelligence. We welcome the remit that has been given to the Centre for Workforce Intelligence and commend its ambition to tackle deficiencies in workforce data. It is clearly not sufficient for the Centre simply to collate and interpret data. It should also challenge data from individual health economies against current clinical standards to ensure their workforce plans make adequate provision for the best skill mix.
However, we are concerned at some of what we have heard regarding the Centre's capacity and capability. We are also concerned at the apparent lack of clarity about how it will fit into the new workforce planning system. The Department needs urgently to explain how it is ensuring that the Centre is adequately resourced to fulfil its remit, as well as clarify the Centre's role in the new system. The Centre is substantially dependent for its success on data that is provided by employers. The Government must ensure that there are clear contractual obligations on all providers of NHS-funded services to provide full, timely and accurate workforce data; these obligations must be backed up by clear, strong and enforceable penalties.
Innovation in skill mix and clinical roles is crucial to achieving a more efficient and flexible workforcebut it is important for policy to be grounded on solid evidence.
We note that the Government has announced arrangements for the voluntary registration of healthcare assistants. However, the requirements of this key element of the workforce for training and professional development must be kept under review. In the longer run, only independent professional regulation will provide the best assurance to patients.
An acid test of the effectiveness of the new education and training arrangements will be their ability to deliver the more flexible medical training programmes which were described in the 2008 Tooke Report. We have received a broad basis of evidence which shows how it is possible to reconcile reasonable hours for junior doctors with high quality training and, most importantly, high standards of care for patients.
A clear mandate must be set for the new system to take account in workforce planning of the full range of evidence-based treatmentssubject to the evaluations carried out by the National Institute for Health and Clinical Excellence.
We believe that the openness of the UK to clinical staff trained overseas, and the ability of UK-trained staff to work overseas, is a continuing source of strength to UK healthcare, and that this openness should continue to be reflected in workforce planning. However, we also welcome the Government's view that planning of the UK health and care workforce should not be dependent on significant future flows of trained staff from overseas.
Locum and agency staff provide a necessary element of flexibility in NHS staffing arrangements. However, they do not provide an optimum solution, either in terms of quality of care or value for money. We, therefore, urge the Government to proceed quickly with improved arrangements for workforce planning which should reduce the importance to the NHS of locum and agency staff.
Organisation of education, training and workforce planning
We welcome the inclusion in the Health and Social Care Act 2012 of an explicit duty on the Secretary of State to secure an effective system of education and training. However we are concerned that there continues to be insufficient clarity about how the Secretary of State intends to discharge this duty. The Department of Health must spell out how exactly Health Education England will be held to accountincluding the part that the planned Education Outcomes Framework will play.
We welcome the plan to set up Health Education England as an executive body with overall responsibility for education, training and workforce planning across the whole workforce. However, we are concerned that the Government has been slow in developing a coherent plan for the new organization. Greater clarity is particularly needed about how Health Education England plans to ensure that it develops a dynamic view of the changing education requirements of the whole health and care sector.
We also welcome the Government's plan to create Local Education and Training Boards as provider-led bodies to take responsibility for education, training and workforce planning below the national level. We are concerned, however, at the Government's protracted failure to produce concrete plans in respect of the Boards, which poses a significant risk to their successful establishment. It is unsatisfactory that so much about the Boards still remains vague and indeterminate.
The integration of the postgraduate deaneries into the new system will be crucial to its success. Although there is now greater clarity of intention, the period of uncertainty led to a regrettable loss of experienced staff. There continues to be an urgent need for more precision about how the deaneries will operate in future.
We welcome the Department's intention to continue within the new system the work done to link innovation with education and training. We also welcome the intention to build on this through the creation of Academic Health Science Networks. However, there is a risk that the resulting arrangements could be incoherent and ineffective of they are too cluttered.
Funding education and training
The current arrangements under which providers are paid by the NHS for education and training are anachronistic and anomalous. Payment is only partially based on student or trainees numbers; it is not linked to quality; it is unjustifiably inconsistent between different professional groups, parts of the country and types of provider; and there is an almost total lack of transparency about how it is spent. Accordingly, we welcome the Government's intention to move payment onto a tariff basis, including a quality premium. However, we note that there is so far slender evidence of progress in converting this desirable policy into a system that will work in practice. This work needs to attract a greater sense of urgency. At the same time, the Government needs to recognise that there are significant difficulties involved in constructing a workable tariff; the transition to any new system must not threaten the quality of clinical services.
We support the Government's intention to introduce a levy on all healthcare providers (whether or not they supply services to the NHS) to provide a more transparent and accountable system of funding for education and training in the health and care sector. We are unconvinced by arguments from the independent sector representatives that this would put them at an unfair disadvantage. We recognise that there are particular concerns about the potential effect of a levy system on smaller voluntary-sector organisations, but workable exemption arrangements should be possible. Here again, there is slender evidence of progress in converting this policy into a system that will work in practice; this work needs to attract a greater sense of urgency.
The Department's policy is currently to keep NHS funding for education and training broadly the same in cash terms from year to year. Against a background of inflation and major cost pressures, this is an extremely challenging financial settlement. We have heard evidence that education commissions are being significantly cut. Given the wider financial situation in the NHS, there is also the risk that SHAs will raid education and training budgets in 2012-13, as they have done before; the Government must act to safeguard funding during this period.
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