Health CommitteeWritten evidence from The Newcastle upon Tyne Hospitals NHS Foundation Trust (ETWP 98)

Liberating the NHS: Developing the Health Care Workforce

Thank you for the opportunity to contribute to the Health Select Committee Review of the above. In principle, we welcome the opportunity for the employer led approach to workforce development and education commissioning and we support a process that will enable us to achieve our required outcomes for a fit for purpose workforce, responsive to changing service needs and one that provides value for money. We acknowledge that it is a complex area, with many historical variables that require addressing.

With reference to your information on the Internet detailing your areas of interest for the inquiry, we have provided a response on aspects that we have specific concerns about.

1. The proposed Provider Skills Networks/Local Education and Training Boards, including how plans for their authorisation by Health Education England will address issues relating to governance, accountability and potential or perceived conflicts of interest, and how the Boards will relate to Clinical Commissioning Groups and the Commissioning Board

We have a number of concerns in relation to the impact of the role, responsibilities and structure of LETB at a regional level.

In particular we are concerned that the proposed structure will not fully facilitate the goal of employer engagement. This specifically pertains to our ability to ensure our Trust workforce and education needs are met through an effective and proportionate representation within the process. As a major provider of specialist services, and often being the only available area for teaching in some fields, we consider that the LETB needs to operate in a manner that it cognisant of this requirement and we would need the ability to work outside the regional framework as required to meet our specialist workforce development and supply issues.

The balance of the Executive team roles within the proposed LETB is a matter of concern in particular ensuring that it is able to address the wider workforce requirements and not become focussed on medical issues, including Deanery business. We are concerned that both the LETB and the HEE have a strong medical workforce focus which would not represent the wider NHS workforce including Nursing, Allied Health Professions and non clinical and support staff. We have a number of apprehensions about the proposed supporting groups including ensuring wider workforce needs are addressed, and preventing silo thinking/working. The possibility that the Partnership Council, as detailed in the draft North East LETB Model, may only meet infrequently adds to this concern.

We are as yet unclear as to how HEE will address issues of conflict and what authority they will have and if there will be a process for arbitration if required either between the HEE and LETB or within the stakeholders in the LETB. The relationship between LETB and Clinical Commissioning is not clear.

2. How future healthcare workforce needs are being forecast; the role of the Centre for Workforce Intelligence; how the workforce requirements of providers of NHS and non-NHS healthcare will be balanced; the implications of a more diverse provider market within the NHS

The original vision for the networks was a focus on the “future generation” and we raised the issue of the definition of this staff group in our response to the national consultation. We require clarity on the scope of the definition in relation to new and advanced roles and how these might be commissioned and the education of these roles would be funded. As a major provider of specialist clinical services, both regionally and nationally, this is a key requirement to enable us to keep pace and also drive service delivery and improvement. This includes requiring clarity on the proposed arrangements for both the processes to manage this need and funding/resources that will be available.

We consider that there is a role for CfWI, but that clarity is required on where accountability for taking action in respect to any significant findings from their work will lie.

The need to ensure workforce demand and supply issues across the whole healthcare economy are addressed is welcomed. Historically the NHS has funded and supported in training a number of professional groups and individuals whose destination is the non NHS sector. This will require access to the LETB structure and processes, but also a commitment by Any Qualified Providers in relation to providing quality teaching and learning environments and support.

3. The future of postgraduate deaneries

It is the clear view of this organisation, endorsed by our Board, that the Deanery should be hosted by Newcastle University, not part of the LETB, and that the LETB should only employ a small Executive team and that the existing SHA workforce should be subject to a process of rationalisation before transfer to a suitable hosting organisation.

4. The future of Health Innovation and Education Clusters

We consider that there needs to be evidence of return on investment from HIECs and that they would, if continued, be a supporting role in the development of the healthcare workforce in relation to reviewing evidence and facilitating innovation in education and adaptation of it within education provision.

5. How professional regulators, healthcare providers and commissioners, universities and other education providers, and researchers will all participate in the formulation and development of curricula

We consider that current good practices should be continued and developed, on the basis of there being a clear requirement by education providers for employer engagement and evidence of action in response to reasonable requests for changes to provision and quality improvements in line with service needs.

6. The role and content of the proposed National Education and Training Outcomes Framework

The principle of the ETOF and its link to patient care outcomes is welcomed. There is currently limited information on the ETOF in respect of the detailed performance measures to be used, though the proposal to use existing NHS quality measures is supported. Further details are required including clarification of whether the ETOF achievements by organisations will be linked to clinical commissioning and any contracted income.

7. How funding will be protected and distributed in the new system

We require clarity on intentions regarding current funding available for CPD from the regional MPET allocation as to whether this will be redistributed and available to employers to enable them to meet the proposed requirement to meet their own workforce CPD requirements.

We consider there is both an opportunity and a requirement to address the true cost of providing education and training in clinical practice and this includes ensuring recognition and reward of time for all training supervision and supporting infrastructure.

We remain significantly concerned over the plans to change the current arrangements for MPET, though accept a review is necessary, and require assurance in respect of securing value for money, equity of process and to avoid destabilising individual organisations within the LETB.

There is currently additional activity locally, reducing available resources within the MPET levy for non medical staff groups which will impact on future workforce needs, particularly in addressing the widening participation agenda. This raises concerns regarding whether there is sufficient funding investment on a recurrent basis to support our future workforce requirements.

December 2011

Prepared 22nd May 2012