Health CommitteeWritten evidence from the Cheshire & Wirral Partnership Trust (ETWP 110)

Introduction

The Cheshire & Wirral Partnership Trust welcomes the Health Select Committee (HSC) Inquiry on Education, Training and Workforce Planning and the opportunity to contribute in the form of this written submission. The comments made below are entirely those of the Trust.

Key Themes

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

The Trust whole heartedly endorses proposals for making workforce planning more local employer led—but recognises that both education and training of some parts of the healthcare workforce realistically needs to be organised at regional/national levels. The Trust works hard at developing sustainable local partnerships (both between and beyond healthcare organisations) and also believes that this approach will be absolutely fundamental to making new arrangements effective. To be effective, partnerships require openness, dialogue and preparedness to adapt on the part of all parties: those attributes will be key in making new arrangements work.

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

This represents a significant challenge, particularly in the current financial climate and the complexities of shifting service provision to the community, whilst maintaining current hospital infrastructures safely. It will be addressed by continuing to work in partnership with regulators, service colleagues and education providers.

3. All providers and commissioners of healthcare (both NHS and non-NHS) play an appropriate part in developing the future workforce

Agreed that this is a cornerstone to success. The challenge for the future is that, whilst many organisations have articulated their support to this in the past, limited progress has been made. The opportunities opened up by this new era of major individual health and social care employers having individual responsibility for forming the planning of the future workforce will need to be grasped in practice in a time when support resources are being severely curtailed.

In particular, NHS organisations (whether commissioners or providers) will need to show leadership in growing local partnerships and turning links into real engagement within local education, training and workforce planning bodies.

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

Locally, there is already an emphasis placed on trainees growing their personal skills within both patient pathway and service improvement settings, in addition to acquiring the specialist skills which are core to professional identity. Learning in and from teams on clinical placements is part of that. All grades of staff are encouraged to contribute to discussions about patient care and where there is the potential for it to be less than excellent.

Patient safety is also enhanced by ensuring all staff have good levels of literacy and numeracy, accessing SFA/NAS funding where eligible, to achieve the appropriate basic skills and competence and help stimulate a learning culture across the whole workforce.

5. High and consistent standards of education and training

Locally, standards of education and training for medical and nursing staff are promoted through the use of Learning and Development Agreements (LDAs) and formal contracts with education providers. These tend to be inflexible and one of this Trust’s expectations of new arrangements is that providers will have greater input to their content.

6. The existing workforce can be developed and reskilled for the future (through means including post-registration training and continuing professional development)

As a mental health and community services provider, this Trust is very focued on best ensuring that all parts of its workforce are enabled/encouraged to develop and is concerned that what appeared to be the very broadly based ambitions for the role of local workforce developmnet partnerships ssems to have become mainly focused around deaneries. Efforts will need to be made in practice to ensure that the more widely written original expectations of a more holistic “employer led” approach are delivered.

In this Trust’s view, ensuring good CPD for the whole of the health and social care workforce should be a crucial part of the work of the future provider led networks. That includes having a focus on staff in AfC job bandings below band 5.

7. Open and equitable access to all careers in healthcare for all sections of society (by means including flexible career paths)

See comments at section 6 above. This should be one aspect of the work of local networks.

Specific Issues the Committee will Look at

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

Given the key role to be played by the network groups, it is vital that all role/responsibility and governance related issues are resolved at the earliest possible stage so that the focus of activity during transition can be on engaging with key partners—which will inevitably take time.

9. The future of postgraduate deaneries

No additional comments.

10. The future of Health Innovation and Education Clusters

No comments.

11. The role of the Secretary of State for Health in the new system

It will be important for the Secretary of State to have overall accountability and to ensure that MPET funding is appropriately protected in the new system.

12. The proposed role, structure, governance and status of Health Education England (including how it will take on the roles of Medical Education England and the Professional Advisory Boards), and its relationship to professional regulators and to the other parts of the new NHS system architecture

The multi-professional nature of HEE will provide important opportunities to address the changing nature of healthcare and the requirements of workforce development. It follows that, as part of putting in place clear “accountability” arrangements between LETBs and HEE, the need for appropriate local determination of matters of key local concern should be formally recognised by the HEE—and respected in practice.

13. The proposed role, structure, status, size and composition of local 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

This trust is of the view that the sensible balance between HEE and provider led networks is to ensure that functions are done as locally as possible unless there is a clear “business case” for them being doen at a higher level. It follows that most education and training is best done at local organisation level. Provider led network level should focus upon only those things that are best organised at a regional level, such as contract management, doctors in training coordination and overall workforce needs assessment.

This trust supports the local SHA’s view that HEE needs to provide a strategic framework for provider led networks to work within—but should not commission or organise education and training directly. It should commission the networks to undertake this including lead commissioning on behalf of other networks for smaller professions.

CWP also supports the view that provider led networks are part of the NHS, either as new NHS statutory bodies or through hosting by Foundation Trusts. Clinical Commissioning Groups will need to have appropriate local links to LETBs. There is a risk that a social partnership approach will not enable us to keep sufficient staff to carry out the planned responsibilities at provider led network level.

CWP is of the view that each provider led network (as part of its terms of authorisation) should be required to have in place an overarching workforce and education and education commissioning strategy for its area. That should incorporate a comprehensive portfolio of education and training for the workforce in its area.

However, this trust does not share the view that there needs to be a statutory duty placed on provider organisations to submit workforce plans and otherwise participate in the new networks—that will inevitably be driven by the twin “organisational survival” imperatives of securing a supply of competent staff and accessing funding for training.

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

It is considered key to the success of the new arrangements that there is a broadly based involvement of all provider organisations in the formulation and development of curricula.

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

It is considered important that the widest possible range of footprint health and social care providers are accorded the opportunity for active involvement in the work of local networks—ranging from individual independent health & social care providers to bodies such as Skills for Care. Experience indicates that only through such a collaborative will it prove possible to maximise potential benefits, addressing local workforce planning issues and creating sustainable models of training.

Equally, the basis upon which clinical placements are facilitated/managed should be consistent across all providers (NHS and none) to maximise both flexibility of use and breadth of student experience.

16. How the workforce requirements of providers of NHS and non-NHS healthcare will be balanced

Over time, by engendering confidence in the robustness of the work of the local networks by demonstrably focusing on the key challenges emerging from the adopted workforce strategy and planning. It has to be acknowledged from the outset that, for historic reasons, it may take time to produce totally integrated health and social care plans.

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

The draft education outcomes framework needs further development on the detail so appropriate metrics and/or indicators show linkages to patient outcomes.

There is potentially a role for the Centre for Workforce Intelligence in collecting, comparing and reporting upon education outcomes framework information.

18. The role of the Centre for Workforce Intelligence

To provide high quality workforce intelligence data, as commissioned by the HEE/local networks.

19. The roles of Skills for Health and Skills for Care

The view of this Trust is that, as their central funding is continually constrained, consideration should be given to combining the current roles of these 2 organisations. Such an amalgamation would add further some impetus to promoting joint working between the sectors.

20. The role of NHS Employers

NHS Employers should play a key role in pay and conditions national negotiation. It also has an important role as an independent body for providers.

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

HEE will need to build in formal controls/accountability for funds allocated to LETBs. Ideally, funds allocated to local networks should be a) based on the needs identified within each network’s workforce and training plans and b) planned over a multiple year period (the latter to aid planning continuity). In reality, allocations may be made for identified “core” and “local discretionary” needs.

22. How future healthcare workforce needs are being forecast

This trust’s view is that, although the importance of workforce planning has been much talked about in the past, local practice has often fallen short of expressed ambitions or been overtaken by more immediate matters—the result being reliance falling back on the SHA. The opportunity within the new local networks (coupled with the very real workforce challenges ahead over the next five plus years) will help incentivise a much strengthened approach within participating employers. A five years workforce planning horizon is required to allow for the time between education commissioning and the production of new graduates for non-medical courses: that could helpfully form the foundation upon which comprehensive planning is built.

23. The impact of people retiring from, or otherwise leaving, healthcare professions

Almost 17% of this trust’s workforce is aged 56 or over, so the challenge of continuing workforce supply is very real. The proportion of the nursing workforce falling into the same category is even higher.

24. The place of overseas educated healthcare staff within the workforce

No comments—this is not a major issue for this trust.

25. How the new system will relate to healthcare, education, training and workforce planning in the other countries of the UK

No comments.

26. How the public health workforce will be affected by the proposals

No comments.

December 2011

Prepared 22nd May 2012