Health CommitteeWritten evidence from St Andrew’s Healthcare (ETWP 21)

About St Andrew’s Healthcare

St Andrew’s Healthcare is the country’s largest charity sector provider of NHS care, and a unique specialist teaching hospital based outside of the NHS offering unique educational opportunities across the health professions.

These opportunities are available for postgraduate doctors and psychologists, and students in nursing, medical and allied professions. We are a leading provider nationally for specialist areas of training like forensic mental health, women’s services and psychiatric occupational therapy.

The Charity is committed to training students and post-graduates across the professions and has a strong Continuing Professional Development programme. We have partnerships with King’s College London (Institute of Psychiatry) and the School of Health at the University of Northampton.

Our unique training opportunities are supported by over 100 senior psychiatrists and psychologists, many of whom have academic roles at King’s.

The Central Training and Education Committee of the Royal College of Psychiatrists has approved the role of the independent and voluntary sectors in training psychiatrists. We work closely the NHS Postgraduate Deaneries to meet the needs of trainees, particularly in specialist areas that can be difficult to provide on local training schemes.

Established as a charity more than 170 years ago, St Andrew’s offers services and centres of excellence across mental health, learning disability, autistic spectrum disorders, brain injury, and neurodegenerative conditions such as Huntington’s disease and dementia. The Charity provides secure care for over 1000 service users across four sites in Birmingham, Essex, Northampton and Nottinghamshire.

Summary of Response

As a charity, St Andrew’s Healthcare has worked closely with the NHS since its inception in 1948, and welcomes proposals to open up planning and provision of health education, training and development to the charitable and independent sectors.

We believe that the proposals offer a rare opportunity to take an innovative approach to professional healthcare training and development, and to enshrine personal qualities and competencies in the professional and clinical training of future leaders in healthcare services.

The Charity already demonstrates the practical benefits of providing high quality training and education outside of the NHS. We recommend that all training providers should be held accountable for the quality of the learning experiences they provide.

Decoupling Ministerial oversight and strategic planning for the health workforce is welcomed and will support a transparent and effective process to meet future needs for quality healthcare based on reliable data and comprehensive professional opinion.

We are, however, concerned how little clarity there is at this stage of implementation, and the impact that this is having on current training structures and provision for trainees in all disciplines. In particular we feel it is important to define how local, regional and national workforce requirements will be rationalised and how independent providers will play an effective role in this process.

We acknowledge that it is necessary to have open and frank debate about the future commissioning and delivery of health education and training. We call on the Minister to undertake the widest possible consultation with all levels of stakeholders in the country’s healthcare.

Comments on Considerations

1. Will the proposals support the right numbers of appropriately qualified and trained healthcare staff (as well as clinical academics and researchers) at national, regional and local levels

1.1 St Andrew’s Healthcare welcomes the proposals. We consider that they represent an opportunity for a more flexible approach to healthcare training and workforce development.

1.2 Through widening and diversifying training opportunities, the brightest and best will be attracted into healthcare professions. As a charity our approach to multi-disciplinary mental healthcare is well established over many years and we can demonstrate the practical benefits of this way of training and development in the quality of our workforce.

1.3 We also have significant expertise in inter-agency working which we integrate into training programmes. Visiting undergraduate students have emphasised how St Andrew’s shows the real-life importance of their communication skills training.

2. Will the training curricula reflect the changing nature of healthcare delivery, including the medico-legal context

2.1 Working in partnership to plan and deliver workforce education and training is a constructive approach for service providers and professionals. Over its long history St Andrew’s has played a significant role in developing speciality training, with its School of Occupational Therapy becoming part of the School of Health at Northampton University, with whom we have a long-standing track record of professional training and development.

2.2 We believe that similar links should be developed across the whole healthcare sector, to create better communication between practising professionals, trainers, commissioning bodies and regulators to ensure and enhance the quality of patient care and professional standards.

3. Will all providers and commissioners of healthcare (both NHS and non-NHS) play an appropriate part in developing the future workforce (see also 5 below)

3.1 As the model of healthcare commissioning changes it is essential that the NHS and independent healthcare providers work more closely together to provide streamlined and focused training that can deliver the best possible standards of patient care with limited resources.

3.2 If the methods of funding for this training are to be reviewed, then the approach must be transparent and reflect the relative contributions and benefits of different bodies to professional qualification and continuing development to meet national needs.

3.3 An essential part of this process will be an agreed and effective framework for quality assurance.

3.4 St Andrew’s Healthcare supports the creation of Health Education England and awaits further information about how the strategic and practical requirements will be coordinated.

3.5 St Andrew’s believes that the General Medical Council continues to be the appropriate body to assure the quality of medical education and training. The Royal Colleges represent the views of professionals in the public, private and charitable sectors and should continue to be responsible for the formulation and ratification of educational policy.

3.6 Ultimately it will be the responsibility of the training bodies to deliver education that meets the exacting standards required and will be fit-for-purpose in the context of modern and flexible health service.

3.7 St Andrew’s welcomes the openness of the proposals to training provided outside the NHS.

4. Will there be multi-professional and multidisciplinary leadership and accountability (encompassing the full range of healthcare professions, specialties and grades) at all levels

4.1 St Andrew’s healthcare believes that leadership is essential to the success of the proposals. This quality needs to be included in the training programmes provided so that future potential leaders can be identified and supported throughout their careers. We offer leadership development to all of our employees.

4.2 In reality leadership is not something that can be created within formal structures, but is rather something that can be inspired by them. Trainers and trainees need to be aware that this is part of their role and quality assurance mechanisms are needed to be sure that this is part of the thrust of the new proposals.

5. Will high and consistent standards of education and training be maintained

See 3.1 above.

6. Will the existing workforce be developed and re-skilled for the future (through means including post-registration training and continuing professional development)

6.1 Having recognised the importance of providing overarching strategic direction to health education and training it is essential to recognise that this is not a static process. Some parts of the workforce will need to be re-directed or re-skilled now. Some may face this challenge in the future.

6.2 Crucially it is important for everyone in healthcare to know that they must keep up with the ever-increasing pace of change brought about by new research, new ways of working, improved treatments and a changing environment.

6.3 Adaptability and a capability to accept and respond to change though continuing research and training must be part of the essential skill set of future healthcare professionals.

7. How will the proposals provide open and equitable access to all careers in healthcare for all sections of society (by means including flexible career paths)

7.1 The proposals can give a wider and more comprehensive approach to establishing strategic need for core competencies and skills. This could mean that much greater clarity can be given to those considering a future in healthcare.

7.2 In this way more people can be aware that their personal qualities are needed in this profession.

7.3 Academic qualification need not be the only point of entry to the healthcare professions.

7.4 This could mean that those who might not currently achieve their full educational potential could still be considered for recruitment in healthcare. Employers and higher education partners could offer nationally recognised routes of formal accreditation for those wishing to develop but who did not hold professional status. This could be similar to the foundation degree developed for healthcare assistants by St Andrew’s and the University of Northampton, as a route to life-long learning.

7.5 At the same time some of our most academically talented young people could be encouraged to consider healthcare as a profession who would not have done so previously. Their early study choices need not prevent them from considering the option of healthcare, particularly where opportunities for formal accreditation and recognition are provided.

Comments on Key Themes:

1. Plans for the transition to the new system, up to April 2013

In light of current progress and information available we are concerned that this timescale is very short. This may create uncertainty for students and trainees and affect future planning of training and education.

2. The future of postgraduate deaneries

We believe that the deaneries will continue and have an important role to play in the planning and delivery of high quality training and education and will provide important continuity during the transition period. A number are already working with St Andrew’s to meet the need for training in speciality areas such as forensic psychiatry and are very open to the potential for innovation in the delivery of training and education requirements.

3. The implications of a more diverse provider market within the NHS

For new trainees and continuing professional development, it will be essential to provide a wider understanding, as part of the educational experience, of healthcare outside of the NHS as the new approaches to commissioning come in to effect.

4. How to balance the workforce requirements of providers of NHS and non-NHS healthcare

The challenge of planning for the future needs of the healthcare system is shared by NHS and non-NHS providers and must be tackled jointly. The process needs to be realistic and flexible and capable of responding to the changing environment. It must not only deliver the right numbers of appropriately qualified healthcare professionals, but also allow for retraining and redeployment as necessary.

A new and more varied healthcare economy where finances are seriously constrained demands the flexibility for healthcare professionals to move between NHS and non-NHS organisations and across regional and national boundaries, receiving appropriate and consistent education and training wherever they are and to a recognised quality standard.

The intelligence and risk assessments on which plans are made need to be shared, robust and independently verified. Levels of professional flexibility and access to training and retraining need to be agreed and supported throughout the healthcare professions.

5. Protecting and distributing funding in the new system

Undergraduate qualification should continue to focus on demand-led learning that meets the verified requirements of the workforce plan and for which cooperative joint funding between the NHS and non-NHS healthcare providers and employers could be negotiated locally.

Postgraduate training and retraining funding should be nationally funded and “follow the student” to the best learning environment to meet their needs and the requirements of the workforce plan at this level of expertise.

Recommendations

The perspective of healthcare teaching centres outside the NHS is included in oral evidence to the Committee, to help balance the NHS view of future arrangements.

All training providers are held accountable for the quality of the learning experiences they provide.

An open consultation about the ongoing funding mechanisms to protect and enhance high quality education and training for the health workforce involving national and local government, NHS and non-NHS providers and professional bodies is initiated immediately.

Personal qualities of leadership, flexibility and adaptability are included in the training programmes for all health professionals.

Personal dedication and commitment to quality healthcare is recognised in continuing vocational and professional development and early educational choices or performance should not unduly limit entry to healthcare professions.

December 2011

Prepared 22nd May 2012