Health CommitteeWritten evidence from Ed Macalister-Smith (ETWP 07)

1. I am writing in a personal capacity.

2. I am the Interim Independent Chair of the shadow LETB—Leadership, Education and Training Board—for NHS South Central (South of England). NHS South of England has written to you separately and I support that submission. However, there are some additional comments that I can make more easily in a personal capacity.

3. The LETB for NHS South Central has the resources of a workforce team, the two Deaneries in Oxford and Wessex, an annual budget of c £320 million, and around 22,000 trainees and learners every year.

4. Following early guidance, and enthusiasm from key players in the region, a shadow LETB was established and has met four times.

Summary of my Comments

5. The opportunity afforded by the proposed changes to the education and training system should be used to:

(a)Enable the education and training systems nationally to be a foundation stone for safe and respectful care and treatment, alongside provider’s own induction and staff development resources.

(b)Enable the education and training system locally to provide a key part of the leadership development role for the service, alongside the proposed national leadership academy.

(c)Enable the education and training system locally to connect with other NHS innovation and quality improvement work, and be seen as a key component of organisation or system turnaround in the case of system failure.

(d)Enable the local health economies both to support national requirements for workforce numbers, but also to resist nationally imposed directives which may not be required locally.

(e)There is an urgent need to resolve the future organisational ownership of staff.

Safe and Respectful Care

6. Our view locally is that the education and training function should not simply be seen as a mechanistic vehicle for working out the future workforce requirements in a coming period, and then commissioning that volume of training places. Ensuring that staff have clear preparation for their work in the NHS, instilling key values for the service in relation to respect and dignity for patients, and instilling mutual respect between professions in multi-professional training environments are all important contributions to service excellence. This is not to deny the vital role of employer’s own induction, training and CPD responsibilities—rather it is about ensuring a systematic baseline on which employers can build. HEIs must allow these issues to be a part of the training programmes, even though HEIs may perceive that they are training staff for careers other than in the NHS—the NHS is paying for most of it, and local NHS providers arrange most of the work placements.


7. Our local translation of the LETB acronym deliberately starts with the word “Leadership” (rather than the usual designation of “Local”). It is our view that leadership development should be, indeed must be, an essential component of the role of local systems. NHS South Central through the Medical Director Peter Lees has developed an exemplary programme of leadership training and development which operates in a multi-disciplinary way, and which reaches future leaders early in their careers. It adjusts flexibly to local needs (eg most recently to CCG leader development). This position is not to deny the importance of a national leadership academy as proposed for the NHS Commissioning Board, but rather is complementary to that. There will simply not be enough capacity at a national level, and it will be unable to be locally flexible to meet the needs of the service, unless there is a local component to leadership development.

De-cluttering and Partnerships

8. There is an excellent opportunity to build on the proposals from the NHS last week (INNOVATION) to mandate a national roll-out of Academic Health Science Networks (maybe 14–18 systems nationally). This to be accompanied by a de-cluttering of related and overlapping organisational structures, in a process that needs to be led preferably at CEO (or Executive Director) level in every provider organisation. The geographic footprints of LETBs could usefully be co-terminous with AHSNs, and could incorporate HIECs and CLAHRCs. Provided that these systems are multi-professional, and fully representative of (and owned by) all local organisations, they could be powerful, mutually supportive forces for service change and improvement. However, there are risks to manage in reaching for this opportunity:

(a)Avoiding the loss of current local excellent initiatives, while gaining the benefits of reduced bureaucracy and merged overheads.

(b)Take-over by single sectoral interests (eg a University, Foundation Trust, or individual profession)—in this context I disagree with the position put to Secretary of State by COPMED and AMRC two weeks ago that might tend to isolate medical education from the need to work with local provider organisations and with other professions.

(c)On the other hand, adopting a single national operating model and “requiring” innovation might tend to unhelpfully bureaucratise the process and neutralise the world class excellence of eg doctor training at Oxford University, which is a great asset locally.

Local Autonomy

9. There is no point in having local structures unless they have a clearly defined and significant degree of local autonomy (otherwise it would be cheaper and quicker to operate by centralised directive). Two examples may help to define what I would regard as local decisions, but which currently are largely centrally mandated.

(a)At a national level, there is a need to train more GPs. GPs often enter practice close to where they have trained. Parts of the affluent south east of England have significantly more GPs than their “fair share” of NHS funding would suggest is affordable. These areas should not be required to train more GPs if they do not see the need, and if they wish to invest instead in expanding other community services.

(b)Some areas are well-supplied with health visitors. National initiatives to increase numbers everywhere will distort local priorities.

Urgency to Resolve Organisational Ownership

10. Changes to education and training arrangements were announced many months ago. Future arrangements remain unclear, especially for the organisational ownership of staff associated with this work whether workforce teams or deaneries. This matter does require rapid resolution, as continued delay is highly de-stabilising for staff who have been very committed to running a high quality system.

I do hope that these comments are helpful.

December 2011

Prepared 22nd May 2012