Health CommitteeWritten evidence from the Academy of Medical Sciences (ETWP 12)

This letter outlines the view of the Academy of Medical Sciences in response to the Committee’s inquiry, “Education, training and workforce planning”, particularly in view of the Government’s current proposals for reform. There is a real opportunity to improve healthcare education and planning as the NHS is reorganised. To realise this, the Government must ensure robust governance arrangements are in place, centred on healthcare leadership at the national level. This will support a smooth transition and the establishment of an effective education and training system.

Workforce Flexibility

The Academy welcomes the Government’s ambition to deliver an efficient, responsive healthcare workforce and regards the need for a flexible workforce that can adapt to the ever changing scope of healthcare delivery as essential.

Now is the opportunity to properly address the specific issues regarding training and development, creating a research-aware healthcare workforce equipped to develop and deliver innovative treatments and respond effectively to the needs of patients. However, we wish to highlight that training and development of those already employed within the workforce has not been addressed sufficiently in the education and training proposals to date. We believe there is no end-point to training and that lifelong learning should be the accepted norm.

Local arrangements must encourage flexibility throughout the career pathway to best capitalise on the skills of individuals and to meet the healthcare needs of the population most effectively. The shift to community care has profound implications for how the workforce is structured, educated and deployed. This is an important factor in the changing nature of healthcare delivery.

Health Education England

The Academy welcomes the establishment of Health Education England (HEE) and the joining-up of education and training provision across the healthcare sector. In reforming the system, the Government must take the opportunity to establish clear, formal lines of accountability with regard to education and training. HEE is an ideal body to provide oversight and formal leadership during the transition period. For HEE’s leadership to be effective, its establishment must be prioritised.

HEE should lead on drawing together all of the relevant stakeholder organisations to develop medical curricula and to address ongoing concerns around the variation in the quality of healthcare education and training across the UK.

National planning and coordination will continue to play a major role in workforce planning (especially within medicine). Sufficient oversight must exist through HEE to ensure high quality and consistent standards across the UK and that sufficient numbers of trainees exist across all specialties. National priorities and needs must be able to shape local education and training plans. Local Education and Training Boards (LETBs) will need to be responsive to the national priorities set out by HEE, which in turn will be informed by the Centre for Workforce Intelligence and nationally determined healthcare priorities.

More specifically, HEE must be able to manage overall trainee numbers on a UK-wide basis. For example, it should provide indicative numbers for professional training. This is particularly important for medical specialties, where the planning cycle needs to take account of the length of medical training and the need to sustain critical mass in small volume but crucial areas, such as community paediatrics, medical ophthalmology, allergy and public health.

Local Education and Training Boards

The Government has made strong commitments to encourage and establish partnerships between the NHS and academia.1 These commitments must be reflected in the education and training of the workforce reforms to ensure their success. LETBs are an ideal place for such NHS/academic partnerships to be fostered at a local level. Amongst advanced nations, the UK is alone in that higher education institutions (HEIs) do not have strong formal links with postgraduate medical education development or provision. We must take the opportunity to redress this issue; a partnership arrangement must lie at the core of LETB governance. This approach would enable curricula to be co-produced by academia and service providers, thus ensuring the workforce is fit for purpose.

LETBs must be structured with clear lines of accountability; conflicts of interest must be minimised. Balanced representation of service and education providers on the LETB board is absolutely essential. The current assumption is that HEIs have a conflict of interest while service providers do not. We simply do not understand how this conclusion could be drawn. Under the current arrangements, service providers will commission themselves to provide postgraduate training. This represents a significant conflict of interest. As neither education nor service providers are free of conflicts of interest, it is essential that they are both represented on LETB boards.

We recommend that LETBs are comprised of an independent Chair and board members drawn from both HEIs and service providers. Academic Health Science Centres provide a good model for a successful partnership between HEIs and HEE and a positive example for LETB governance.

HEE should be established as a sole legal entity with the LETBs under HEE’s control, operating as “sub-HEE boards” rather than separate entities. This will help to address issues of accountability and ensure that HEE provides appropriate oversight. This model should be used by LETBs across the country to ensure consistency whilst retaining the flexibility for LETBs to respond to local needs.

Postgraduate Deaneries perform important functions and their work should be continued under HEE’s guidance with support from LETBs. The work of Postgraduate Deaneries would be enhanced by establishing more consistent links with HEIs. To this aim, the individual responsible for heading up the provider function of postgraduate deaneries should be employed within a university.

Research

The Government response to the NHS Future Forum’s June 2011 report made strong commitments to research, innovation and the use of evidence.2 This has been further strengthened by the commitments in the NHS innovation review, Innovation, health and wealth, and the Strategy for UK life sciences.3 , 4 The Academy believes that this commitment must be reflected in workforce education and training. Indeed, it is critical to acknowledge the interdependence of research, education and service—all NHS constitutional requirements.

Establishing close links between academia and the NHS within the reformed system will only serve to strengthen the capacity for research and innovation across sectors.

December 2011

1 For example: Office for Life Sciences (2011). Strategy for UK Life Sciences. http://www.bis.gov.uk/assets/biscore/innovation/docs/s/11-1429-strategy-for-uk-life-sciences

2 Department of Health (2011). Government response to the NHS Future Forum report. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_127719.pdf

3 Department of Health (2011). Innovation, health and wealth: accelerating adoption and diffusion in the NHS. http://www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_131687.pdf

4 Office for Life Sciences (2011). Strategy for UK Life Sciences. http://www.bis.gov.uk/assets/biscore/innovation/docs/s/11-1429-strategy-for-uk-life-sciences

Prepared 22nd May 2012