Health CommitteeWritten evidence from Brook (ETWP 47)

1. Executive Summary

1.1 Brook is the UK’s leading provider of sexual health services and advice for young people under 25. The charity has over 45 years of experience working with young people and currently has services in England, Scotland, Northern Ireland and Jersey.

1.2 Brook welcomes the clear statement from the Government in Liberating the NHS: Developing the Healthcare Workforce consultation that, “education and training are integral to ensuring the values and calibre of staff”. We agree that training is vital to the delivery of safe and high quality sexual health services for young people. However, we have significant concerns that removing the central oversight of education and training currently exercised by the Department of Health will lead to a lack of consistency in the training provided.

1.3 It is vital that the new workforce development system is supported by sufficient funding to ensure that sexual health professionals who work with young people can access the training they need, including cover for their posts where this is necessary. There should also be clear career pathways for sexual health professionals.

1.4 Brook welcomes the recognition that there needs to be workforce planning and development specifically for the public health workforce, which includes the sexual health workforce, but there needs to be more clarity around how the training for the public health workforce and healthcare workforce will be integrated, planned and managed.

1.5 We believe that for improvements to be made in training and education for sexual health then provision for nurse training in sexual health must be addressed.

2. Local Skills Networks

2.1 Brook has significant concerns that training will no longer be delivered in a systematic and coherent way if responsibility for planning and commissioning it is devolved to local skills networks. Our concerns are based on the experience of the devolution of decision making on sexual health training for nurses.

2.2 Previously the English National Board for Nursing (ENB) and its equivalents in Scotland, Wales and Northern Ireland co-ordinated training for nurses in a variety of disciplines including sexual health. Following the dissolution of the ENB no other organisation took on this co-ordination and oversight role. Instead, individual institutions now make decisions about the training they offer with the result that there is not a single recognised curriculum for sexual health training and nurses who have attended different institutions may have a qualification with the same name but will not necessarily have all of the same knowledge or skills. This makes it difficult for employers to assess whether nurses have the competencies they require. Brook is concerned that this lack of co-ordination will be replicated across the country if responsibility for training is devolved solely to a local level.

3. Protection of Funding

3.1 Brook also has significant concerns about the funding available for training and education within the NHS. It is vital that the new workforce development system is supported by sufficient funding to ensure that professionals who work with young people can access the training they need, including cover for their posts where this is necessary.

3.2 In the document Liberating the NHS: Developing the Healthcare Workforce it stated that transparency will be introduced into the funding arrangements for training which will support a level playing field between providers. Brook warmly welcomes the proposal that would ensure funding reflected the cost of providing continuous professional development for staff.

3.3 In addition, Brook is concerned that the proposals for a tariff for the delivery of training could deter some providers. For example, the vast majority of contraception training takes place in community contraception clinics. When training is taking place this can reduce the capacity of the clinic and therefore have an impact on the number of people who can be seen, unless there is funding for the post of the trainer to be covered during the training. We believe that the tariff will be developed based solely on the cost of the training provided and will not take account of the wider potential costs to services of providing training. We are concerned that this could act as a deterrent to providing training, especially in an environment where healthcare providers are competing with one another.

4. Public Health Workforce

4.1 In the Public Health White Paper, Healthy Lives, Healthy People comprehensive sexual health services were identified as part of public health. Brook welcomes the commitment in Developing the Healthcare Workforce that preventative medicine will remain a key area of work for all NHS staff. We agree that there needs to be workforce planning and development specifically for the public health workforce. We also welcome the further details on plans for the public health workforce that were included in Healthy Lives, Healthy People: Update and Way Forward. However, we are still awaiting the publication of a public health workforce strategy which will contain more detailed proposals on the public health workforce.

4.2 There is currently not any clarity around how clinical training for people delivering public health services will be planned and managed. For example, sexual health services will be part of the new public health structure but many of the skills required to deliver these services are clinically based, such as carrying out STI tests and initiating treatment. It is not clear how strong links will be made between public heath workforce planning and healthcare workforce planning to ensure these training needs are identified and met.

4.3 We are also concerned about the potential loss of expertise in the non-clinical public health workforce through the transition period into the new public health structure. As the reforms will change the way sexual and reproductive health services will be commissioned we are concerned that experienced commissioners from Primary Care Trusts may be lost along with their local knowledge and expertise.

4.4 Nurse provision of sexual health services is a vital part of accessing services for young people. We believe that to ensure that sexual and reproductive health services to fully meet the needs of young people then provision for nurse training in sexual health must be a priority when looking at the development of a public health workforce strategy.

4.5 Finally Brook believes that training must be a part of the commissioning process. This would recognise that commissioned specialist services such as Brook’s sexual health services for young people are part of training provision and cover the training needs of staff who will be delivering those specialist services.

December 2011

Prepared 22nd May 2012