Health CommitteeWritten evidence from the Foundation Trust Network (ETWP 35)

1. The Foundation Trust Network (FTN) is the membership organisation for public providers and gives a distinct voice to NHS Foundation Trusts and those working towards FT authorisation. The FTN has 216 members from across the acute, mental health, community and ambulance sectors. In a recent survey of members, NHS providers clearly expressed the view that the FTN should be the means by which employer voice is heard.

2. FTs will represent the vast majority, some 95%, of providers in the NHS at the implementation of the system reforms and they have a critical interest in the success of the proposed workforce framework. We welcome the government’s proposals for reform of education and training as they are consistent with the direction of wider NHS reforms and offer employers the opportunity to work with professional stakeholders to shape a workforce that is attuned to the immediate and long-term needs of served populations.

Executive Summary

3. Our response focuses on the following issues that we hope are of interest to the Committee’s inquiry:

The importance of provider-led architecture.

System alignment.

Local Education and Training Boards.

The place of innovation and research in those Boards.

HEE governance and transition.

A more plural provider market and supportive funding flows.

Flexibility in training programmes.

Centre for Workforce Intelligence and NHS Employers.

Conclusions—what is needed?

Discussion

Provider-led architecture

4. The government’s emphasis on a provider-led framework for the new workforce planning, education and training arrangements is welcome as it has the potential to give providers the autonomy to manage their staff resource appropriately, enabling a responsive system that is efficient, effective and best-geared towards meeting patients and populations’ needs.

5. This is a once in a generation opportunity to design and implement an education and training system that embodies greater local accountability, decision making closer to patients, and heightened clinical engagement, to meet both immediate needs and longer-term workforce requirements.

6. Providers will want to work on this task with appropriate professional input and advice; if a professional interest or organisation is well placed to add value to consideration of workforce issues—such as standard setting and quality assurance of training—then they should have the opportunity to contribute as part of agreed processes. Foundation trusts recognise the need to ensure all relevant stakeholders are involved in creating the strategies and plans and feel that their voices are heard.

7. However, the importance of employer leadership on these matters should remain the focus of attention—employers need the freedom to plan and allocate resources in cost-effective, responsive and innovative ways, across new modes of delivering patient-centred care. Employers should articulate a vision and specification and professional advice should look to support this being realised.

A system in alignment

8. A provider-led architecture in the workforce domain provides the necessary consistency and alignment with the wider NHS system reforms, enabling providers to respond to clear service commissioning strategies by investing suitably and innovatively in a workforce that provides patient-centred care, increasingly out of acute settings.

9. NHS foundation trusts recognise that they need to demonstrate that they are ready to take on enhanced responsibility for workforce issues, but in areas where freedoms already exist, the track record of stepping up to the challenge is there to see. As we outlined in our original response to the DH workforce consultation, since becoming NHS foundation trusts providers have taken increasing responsibility for securing a successful, sustainable future for their services on behalf of the populations they serve. With their freedoms FTs have made unprecedented investments to secure long-term benefits from new facilities (driving quality and safety improvement), research support (prioritising innovation) and staffing (often in new roles such as theatre practitioners and acute physicians).

10. Healthcare providers working in the proposed Local Education and Training Boards (LETBs) are ready to take on full responsibility for planning and developing their own workforce with strong clinical and professional leadership.

Local Education and Training Boards (LETBs)

11. FTN members are currently working on appropriate shadow arrangements for LETBs. We consider that providers should have the freedom to determine organisational form, with suitable assurance arrangements in place to enable HEE to hold LETBs to account for planned outcomes. We advocate a localised approach that appropriately incentivises employer participation—LETBs need to demonstrate value to providers and a return on investment—in terms of senior management time and appropriately trained staff that are best placed to deliver productive quality care.

12. We consider that any perceived conflicts of interest can be managed through transparency of operation and clear contract management approaches.

LETBs and deaneries

13. LETBs should be positioned to commission a fit for purpose workforce that is aligned with providers’ demand—which includes ensuring that the LETBs determine the number of training places in a given specialty. The new LETBs need to look and feel different from the current SHA/Deanery commissioning functions as they need to be much more employer-led. However it is acknowledged that individual expertise exists and will need to be secured by the new system. LETBs should assume responsibility for the functions of deaneries as soon as practical, achieving the right balance between an important smooth transition and sustaining momentum.

Education and training linked with research and innovation

14. Innovation is closely aligned with education, research and service delivery—and leadership on the provider side is needed. There is a compelling case therefore to situate innovation funding and support with LETBs, building on the success of Health Innovation and Education Clusters (HIECs). HIECs have served better to engage NHS organisations with Higher Education institutions; and which, with relatively small dedicated resource have been able to achieve traction on the ground (for example allocating Regional Innovation Funds), making progress towards the goal of diffusing innovation.

Academic Health Science Networks

15. These “enhanced” LETBs described above, fully enabled to work in partnership with Academic Health Science Centres and emerging Academic Health Science Systems/Networks where appropriate, offer a real opportunity to deliver the necessary capacity and incentives in the system for employers to come together with stakeholders and work to address long term strategic issues. They offer a means of ensuring a wider coverage of research orientation and culture within the system as a whole, supporting academic medicine, for direct patient benefit.

HEE governance and transition

16. The new system is designed around a number of principles including “doing at national level only what is best done at national level”. FTN considers that Health Education England (HEE) will be most successful by focussing on:

(a)Outcomes and accountability for outcomes, rather than performance management;

(b)Enabling flexibility of LETB design to meet local needs and inspire provider confidence;

(c)Overseeing the national allocation of MPET resources and leading negotiations with DH and HMT on funding for healthcare education and training;

(d)Identifying national workforce priorities and pressures drawn from the workforce plans of the LETBs;

(e)Setting standards for the quality of healthcare education; and

(f)Scrutinising LETBs’ plans and holding the Boards to account for meeting both immediate and longer term requirements and for addressing the needs of the whole healthcare workforce.

17. HEE should be independent of the NHS Commissioning Board in order to support provider confidence. Its reporting line should be to the Department of Health.

18. Workforce issues are currently being considered by the Future Forum and in our submissions on these matters we have argued for a strong continuing commitment to provider-led arrangements and an enabling framework that ensures that provider ambition can be properly realised.

19. This implies independence for LETBs and means that the national HEE infrastructure needs to have a strong scheme of delegation, exhibiting the governance and behaviours in transition to support ultimate LETB independence.

A more plural provider market and supportive funding flows

20. We welcome the direction of travel towards a tariff and provider levies (though the operational detail of the latter requires further discussion); this should be managed in a manner that promotes provider stability.

21. This approach will ensure fair distribution of funding over time and enable employers to exercise suitable control over commissioned outcomes. It will also facilitate new providers’ contributions to the costs of training.

22. The transition to tariff funding of educational activity should be completed before introducing the change from an allocation system to a provider levy to fund workforce development budgets. Levies should fund the LETBs and those levied should have appropriate controls—we should welcome further conversations on how funding formulae will be devised.

23. The described approach sends a strong message about the government’s will and supports all employers across the sector maintaining a strong and comprehensive interest in the suitable delivery of the education and training function. It is important to achieve a re-distribution of cost on a fair and proportionate basis.

24. The workforce requirements of non-NHS healthcare providers will need to be accommodated through the new system and what is proposed at the level of principle appears a reasonable way of achieving support for the whole healthcare workforce. Clearly further discussions are required. As a general point, we anticipate that the new NHS framework will prompt more partnership working between NHS and alternate providers and workforce questions will be addressed in part through navigation of these new partnerships.

Flexibility in training programmes

25. As the new architecture is put in place, it will be critical that providers are able to make best use of resources for the benefit of their served populations and staff. An important variable here is the flexibility to direct resources to meet demand, without undue delay. This flexibility will be critical, not least in clinical training programmes, so that the professionals trained today can respond suitably to the requirements of tomorrow.

26. Flexibility has an immediate importance as employers, particularly those (but not exclusively) who have recently acquired community services and who are looking to generate cost savings and staff re-deployment opportunities across their portfolio of services.

27. We understand that the Future Forum is looking supportively at the flexibility of training programmes and we hope that the Select Committee will consider strongly supporting flexibility in its recommendations.

Centre for Workforce Intelligence and NHS Employers

28. The Centre for Workforce Intelligence (CfWI) will be an important source of workforce data in the new system and the FTN is working with colleagues in the CfWI to ensure that the Centre has an appropriate understanding of employer priorities.

29. We are carrying out a survey of members to evidence base this work and will be contributing perspectives on the proposed CfWI business plan into Spring 2012.

30. NHS Employers has performed an important role in providing support and guidance to providers on workforce issues. They have been contracted by the DH to negotiate national agreements on behalf of the service. The shape of their offer in future should increasingly be determined by the needs of providers of NHS healthcare and their ability to meet that need.

Conclusions—what is needed?

31. FTN is enthusiastic about the proposed reforms as the issues of commissioning education and training and the planning of workforce requirements are the issues that have, hitherto, acted as one of the key barriers to NHS foundation trusts realising their full potential.

32. While some stakeholders in the NHS have expressed concerns about changes to the structures and funding flows associated with the workforce reforms, we consider that these can be managed and indeed are being managed. As we have noted, in areas where they already have freedoms, FTs have a track record of investing for the long term in quality and FTs as organisations have a clear and direct interest in a quality workforce.

33. We consider that for the proposals to have the best chance of success there is a need for a provider-led approach, suitably incentivising providers to participate. This is best achieved through a visible system commitment to locally-owned LETBs that are supported and encouraged by a HEE scheme of delegation that is assurance-based. Tariffs and levies, supported by robust contract management will ensure system transparency and a check on quality but transition should be managed sensibly and with regard to wider NHS changes.

December 2011

Prepared 22nd May 2012