Training reforms make the grade

In April 2013 Health Education England will take over strategic health authorities’ responsibilities for education and training. Together with the newly operational local education and training boards it will provide three big opportunities: to look at education and training for the whole workforce; to better integrate workforce, financial and service planning; and to make decisions that best meet the needs of patients locally.

Operating through local LETBs, employers will be able to engage with both clinicians and commissioners to develop the best services for patients. They will also be able to look at the range of workforce issues and the links between pay, employment practice, regulation and education and training.

“Employers are not just looking at education and training in isolation,” says Sue Covill, director of employment services at NHS Employers. “So it’s really an opportunity to see the whole workforce, with all the dynamics, working together in a positive way with employers in the driving seat.

“The new structure gives us an opportunity to support the development of all staff including bands 1-4, which are our more junior staff and have the majority of patient contact,” says Ms Covill. “Until now, the opportunity to work collectively on their development hasn’t been there.”

Supply or demand?

Locally, service providers will be able to integrate workforce planning with planning services, rather than keep the workforce separate from that planning process.

“Too much focus in the past has been on supplying staff rather than on taking account of what the employer wants and patient needs,” says Sir Andrew Cash, chief executive of Sheffield Teaching Hospitals and chair of NHS Employers policy board. “That supply was poorly integrated with finance and workforce planning, and medical workforce planning took place completely separately.

“[In] the new system under LETBs it will be integrated and it will be a whole workforce point of view with the employers leading it,” he adds. “We move from a system focused on supply to one that’s focused on demand; what employers actually need in order to run the services for patients.

“Too much focus in the past has been on supplying staff rather than on taking account of what the employer wants and patient needs”

Employers are faced with a number of issues that will influence their workforce requirements. These include an imperative to integrate hospital and community services, in an effort to keep patients in their own homes and as independent as possible. Around 16 million people in England have a long-term condition like stroke or diabetes and many have multiple long-term conditions. There is a growing population of frail elderly, and efforts are needed to keep them out of hospital and as independent as possible. Plus there is a growth in the use of assistive technology that helps disabled or elderly people stay independent. “These are all things that we’re going to be tackling now and in the next decade and therefore [the task is to] create a workforce that matches that,” Sir Andrew explains.

Workforce planning has gone wrong in the past because it was too far removed from providers. Employers need to be realistic about what services they want to provide and what staff they will need, and communicate this to universities and colleges. The results should be a workforce that is able to continually meet the needs of and improve services for patients.

Sir Andrew says: “The important thing is to get employers involved with this debate and leading it [because] they do have this responsibility now.”

Spend it wisely

It isn’t just engagement with employers that is key to the success of the reforms.

Susan James, chief executive of Derby Hospitals Foundation Trust and interim chair of East Midlands LETB, believes it is important for provider chief executives to get involved, because in the current climate, dealing with workforce issues will require innovation rather than cash.

“The way in which we use our workforce for the future is absolutely central to the success of the NHS,” she says. “As a chief executive of a large organisation – I employ 8,000 staff – I have to make sure that the pipeline feeding those staff into my organisation, and indeed their continued development once they’re here, is managed effectively.”

By working together in LETBs, employers and deaneries can make sure everyone’s requirements are met while at the same time avoiding agency costs.

Flexibility of the medical workforce is a longer term problem. Employers need more generalists who can manage patients with long term conditions and those with a range of conflicting comorbidities. “Employers need to be much more involved and work together with the professions, to ensure that we can give a great service to everyone,” says Ms James.

One of the issues the East Midlands LETB is tackling is staffing of emergency departments. If, for example, there is a decrease in the number of trainee doctors who want to become emergency department doctors, that immediately becomes a major service delivery problem in a high profile and exposed part of the trust.

Hospitals in the East Midlands with large accident and emergency departments are working with the deanery, through the LETB, to ensure that there are sufficient medical staff to work in A&E. Some of those staff are trainees, but the LETB is looking at other ways to cover the gaps. That includes changing GP training so they have more time in the emergency department and using advanced nurse practitioners and physicians assistants – a solution using the whole workforce.

Working through the LETB in this way will create a flexibility in the workforce that will help reduce the need for agency staff and improve the service for patients.

The reforms in education and training are beginning to bear fruit. In future there is the potential for this agenda to move closer to academic health science networks, which are in development and are poised to maximise opportunities for innovation in education and training.

But the current focus is on LETBs being the best that they can be: bringing employer-led decision making that supports the whole workforce and brings better services for patients.