Health CommitteeWritten evidence from the Academy of Medical Educators (ETWP 96)

1. Executive Summary

The proposals for education training and workforce planning include bold and radical measures to implement principles that should be widely supported: security of supply; responsiveness to patient needs and changing service models; high quality education and training that supports safe, high quality care; greater flexibility; value for money, and widening participation. The Academy was concerned that little acknowledgement was given to the substantial reorganisations in education and training within the NHS occurring in the past decade, and were noted only as “piecemeal”. When set alongside an ambitious timescale for implementation of different new structures, the Academy views this as a cause for concern. This concern qualifies our support for some of the advantages set out in our response. It would be one more major setback for the NHS if hastily introduced reforms created problems that led to another round of increased central control and bureaucracy.

2. Academy of Medical Educators

2.1 The Academy of Medical Educators is the professional standard-setting organisation for all those involved in medical education. It is a registered charity whose aims are to improve patient care by providing leadership, promoting standards and supporting all those involved in the broad discipline of medical education, through all stages of a career.

2.2 The Academy is pleased to submit these comments to the Inquiry, based on our expressed response to the Government on publication of the White Paper Workforce proposals.

3. Comments for the inquiry

Established in 2006, the Academy (AoME) exists to improve patient care by providing leadership, promoting standards and supporting all those involved in the broader discipline of medical education. Through its Professional Standards, which serve as a guide to curriculum and professional development, the AoME provides a recognised framework for those involved in teaching to demonstrate their expertise and achievement. The AoME is committed to patient centredness in education and training as well as patient care; and to interprofessional learning and the development of new and changing roles for health care. In the context of this consultation paper, the AoME is keenly interested in the implications of the proposed new structures. Many of our Members and Fellows have been involved in the numerous centrally driven changes of recent years, particularly in Postgraduate Medical Education and Training. In this regard we welcome broad comments that emphasise the Government’s commitment to the highest possible standards of healthcare education and training. The AoME supports proposals that will enable an appropriate workforce to deliver better patient safety, patient experience, quality improvement as well as value for money. Such outcomes are easier to describe than to deliver.

The principles for workforce planning, education and training set out in the preceding White Paper are laudable, and the consultation paper provided some detail on how it is proposed to enact these. The creation of health provider skills networks, now LETBs, will be another major restructuring exercise for the NHS—one that will be disruptive, time consuming, expensive and challenging (particularly at this time of major reorganisation and economic challenge). It would be good to know that learning has been assimilated from the Workforce Confederations that were set up to do this in the 1990s. It will be important to have some key baseline indicators that will enable us to judge whether new proposals achieve their aims. The perennial challenge of balancing “top down” versus “bottom up” reorganisation seems to have been addressed by conviction regarding the principles rather than substance. The significant developments of recent years within the NHS, including Agenda for Change; Knowledge Skills Frameworks; PMETB and subsequent developments; Modernising Medical (and other) Careers programmes; and the commissioning of education and training. Many of the underpinning details are unclear, which is understandable, but of concern given the ambitious timescale for the proposals. Currently, SHAs and Deaneries hold significant responsibilities in relation to quality, funding and workforce planning. Any future system design needs to be clear about where lie: accountability (for driving up quality and reducing cost); ensuring capability and capacity (developing providers and the “market” where necessary); and innovative planning for the medium and long term. AoME is concerned that HEE will have sufficient capacity to do this for all England without some “meso-structure” currently provided by the Deaneries and SHAs.

The crucial interrelationship between Higher and Further Education Institutions and the NHS in all matters relating to education and training for the healthcare workforce needs full attention from the LETBs.

Broadly, the Academy is positive about the establishment of HEE, and its four main, high level, functions are welcome. Much will depend on the scope of its coverage; the complexity of its interrelationships with established (and yet to be established) groups of regulators and commissioners; and its representativeness of and credibility to professions and stakeholders. The worst possible outcome would be an increase in regulatory bureaucracy. Less clear is HEE’s relationship with HPC, GMC, NMC rather than with Monitor, CQC and Skills Councils. It seems that meaningful discussions about these interrelationships will be required, and that respective roles and responsibilities will need to be clarified before other questions about relationships with HPSNs or any “meso-level” structures can be clarified. A transparent and constructive relationship between HEE and the NHS Commissioning Board will be essential, with a degree of cross-representation to ensure education and training is not left to find its own solutions to strategic shifts in commissioning policy.

Successful establishment of Public Health England will be important to the future of the health of the population and to the NHS. It is axiomatic that it should be integrated into the education and training of the healthcare workforce.

The challenges of transition are considerable. What is proposed is another radical reorganisation, notwithstanding the lessons learned about costs, inefficiencies and morale damage in previous reorganisations. This might argue for a short implementation phase as proposed, but we would prefer staging of the changes in order to give HEE more opportunity as an established Executive to oversee the implementation.

December 2011

Prepared 22nd May 2012