1 Introduction
1. The quality, safety, effectiveness and efficiency
of healthcare services depend on the availability of sufficient
numbers of well-trained and well-motivated staff. Throughout its
existence, the NHS has, therefore, rightly attached a high priority
to education and training of both new and current staff. In 2011-12
it spent £4.9 billion, around five per cent of its budget,
on education and training.[2]
2. Despite this long-standing commitment, however,
we believe there are two reasons why there is now an urgent requirement
for a whole-system review of the education and training of the
health and care workforce:
- The first is the obvious point
that the passage of the Health and Social Care Act 2012 means
that various institutions and structures within the education
and training system will no longer exist, or no longer exist in
their previous form, which creates a practical requirement to
make alternative arrangements.
- More substantively, however,
we believe that this practical requirement creates a welcome opportunity
to address some of the weaknesses of the current arrangements
and create new structures which will be better able to meet the
needs of the health and care system of the future.
3. If we are to take advantage of this important
opportunity to improve the effectiveness of our education and
training structures, it is important to begin with an understanding
of the weaknesses of the current system as it has developed. We
believe these can be summarised as follows:
- It is too complex, meaning
that few people understand how it operates and that accountability
is poor because of the lack of clarity.
- It is inflexible and does not
respond effectively to the changing demands of service delivery.
- It is regularly accused of
being unfair in the way in which it distributes the cost burden
of training.
- There is a danger that its
inflexibility may itself prevent or delay desirable changes in
provision.
4. That being so, it is possible to see what
the criteria for an effective system of education, training and
workforce planning are:
- The system needs to be service-led.
- It needs to be transparent
and accountable—it has to be simpler than the current system.
- It needs to be responsive to
demand.
- It needs to be dynamic, in
the sense that it must be capable of understanding and reflecting
the need for continuous change.
- As part of that process, it
needs to maintain an up-to-date concept of what "good"
looks like, and to be able to change accordingly.
- It must be apparent that the
costs of the system are fairly borne by all service providers.
- The education, training and
planning that the system provides need to be of high quality,
and need to provide value for money.
It is against these criteria that we have set out
to judge the Government's proposals. (The terms of reference for
our inquiry are set out in Annex A.)
5. During the course of the inquiry, 119 memoranda
of written evidence were received and five evidence sessions were
held. Oral evidence was taken from: Medical Education England,
the Health Education England steering group, the Centre for Workforce
Intelligence, a Strategic Health Authority cluster, the General
Medical Council, the Conference of Postgraduate Medical Deans
of the United Kingdom, the Higher Education Funding Council for
England, the Health Professions Council, the Nursing and Midwifery
Council, Skills for Health, million+, the NHS Future Forum Education
and Training group, the Council of Deans and Heads of UK University
Faculties for Nursing and Health Professions, a Health Innovation
and Education Cluster, a Skills Academy, NHS Employers, the NHS
Partners Network, Independent Healthcare Advisory Services, the
Junior Doctors' Committee of the British Medical Association,
UNISON, the Royal College of Nursing, Unite / Community Practitioners'
and Health Visitors' Association, Rt Hon Simon Burns MP, the Minister
of State for Health, and officials from the Department of Health.
We are grateful to our specialist adviser, James Buchan, Professor
in Health Workforce Policy at Queen Margaret University, Edinburgh.[3]
2 Department of Health, Liberating the NHS: Developing
the Healthcare Workforce - From Design to Delivery, January
2012, para 124 Back
3
Professor Buchan declared his interest as a columnist for the
Nursing Standard and a Professional Adviser to the Centre
for Workforce Intelligence. Back
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