Liberating the NHS: Developing the healthcare workforce Workforce planning, education and training Consultation Engagement

Overview  The White Paper “Equity and Excellence: Liberating the NHS” sets out a vision, strategy and proposals for the NHS where:  Patients are at the heart of everything the NHS does  Healthcare outcomes are amongst the best in the world  Clinicians are empowered to deliver results  Consultation Liberating the NHS: Developing the healthcare workforce launched on 20 th December 2010 and closes on 31 st March  Today is an opportunity to ensure common understanding of the proposals and consultation questions and to share views.

 Successful patient care depends on the whole workforce. Staff who are empowered, engaged and well supported provide better patient care.  The NHS Constitution requires all employers to ensure all staff have personal development, access to training, line management support to succeed and support to improve staff health and well being.  The White Paper sets out proposals for a new framework for education and training: driven by patient need, led by healthcare providers and underpinned by strong clinical leadership.  A focus on value for money, and effective linkage to delivery of better healthcare outcomes.  A strong relationship with education providers to ensure that we can improve on the quality and value for money for pre registration and post registration training and continued professional development. What are we trying to achieve

We want to design a system that has:  Robust workforce planning and security of supply.  A flexible workforce that can respond to the needs of local patients.  Continuous improvement in the quality of education & training of staff.  The right incentives and accountabilities to drive value for money.  A diverse workforce that has equitable access to education, training and opportunities to progress. The design principles are set out on page 18 of the consultation.

Where We are Now  Greater security of supply, more patient focused  Increased focus on the quality of education  Improved engagement with professions through new professional advisory boards  Improved partnerships across health, education and research  Centre for Workforce Intelligence starting to put forward recommendations and improve workforce information quality.  Strides in implementing skill mix changes in some areas  Stable funding system with increased transparency Building on Success  Planning and development of the whole workforce- more flexible and adaptable to patients and public needs.  Integration between service development and financial and workforce planning for continuous quality improvement  A streamlined, whole system approach shifting the balance to local planning with clear accountabilities  Tackling chronic shortages of particular skills  Stronger engagement and ownership of employers  Funding transparently linked to activity to provide incentives for value for money

What the system needs to do

Local ‘skills networks’ will take on SHA workforce functions. Quality of education and training will remain under the stewardship of healthcare professions, working in partnerships with universities, colleges and other education providers.

Local Autonomy & Accountability  Healthcare providers are the engine of the new system.  All providers have an obligation to plan and commission thoughtfully for the whole workforce and long-term sustainability.  Clinical leadership will raise standards of education and training at every level.  Appropriate ‘checks and balances’ will provide accountability.  Centre for Workforce Intelligence will raise standards of education and training at every level.

 Clear duties for providers:  To consult on workforce plans.  To provide data about the current and future workforce needs.  To cooperate in planning the healthcare workforce and planning and provision of professional education and training. Do these duties provide the right foundation for healthcare providers to take on greater ownership and responsibility for planning and developing the healthcare workforce? Are there other incentives and ways in which we could ensure an appropriate degree of cooperation, coherence and consultation in the system? Local Autonomy & Accountability

 Will decide how they work together.  Will need to create and own a legal entity to:  Manage workforce data.  Develop and consult on a local skills and development strategy.  Hold and allocate education and training funding.  Contract for education and training, secure value for money and quality.  Manage all clinical placements including deanery functions.  Work in partnership with universities and other education providers.  Work with LAs across the health, public health and social care workforce.  Contribute to the development of national policy.  Will decide on size and governance of their local ‘skills networks’ Are there other functions that healthcare providers working together need to provide? Healthcare Providers

 A new executive expert organisation bringing together interests of healthcare providers, the professions, patients and staff.  Building on the work of MEE and professional advisory bodies, involving patients and promoting equality.  HEE will have four main functions:  Providing national leadership on planning and developing the workforce.  Supporting the development of healthcare provider ‘skills networks’.  Promoting high quality education and training responsive to the changing needs of patients and local communities.  Allocating and accounting for NHS education and training resources. Are these the right functions? How should the governance and functions be established so they have the confidence of the public, professions, healthcare providers, commissioners of services and higher education institutions? Health Education England

 Current funding is based on historical funding flows and varies across the country.  Need increased clarity and transparency on what is funded and how funding flows.  The Government is committed to the principle of tariffs for education and training as the foundation for a transparent funding regime providing genuine incentives and minimising transaction costs.  Central budget should only fund education and training for the next generation of clinical staff. Healthcare providers responsible for funding development of their existing workforce.  In the long term, further transparency achieved through a levy on providers to align funding and incentives to secure supply of skills without chronic shortages or significant over-supply. What should be the scope for central investment through the MPET budget? How can we manage the transition to tariffs for clinical education in away that provides stability, is fair and minimises the risks to providers? What is the appropriate pace to progress a levy? Moving to a fairer more responsive funding system

Transitional Arrangements  SHAs lead on investment and commissioning of education & training and planning with providers and the higher education sector throughout 2011/12. Leading transition to the new system, building up local processes and infrastructure, supporting smooth migration of functions. Maintaining/building effective partnerships with health and social care sector.  Health Education England (HEE) will be established in shadow form in 2011 and as a special health authority from April  Healthcare Provider ‘skills networks’ - healthcare providers set up ‘skills networks’ that can enter into legally binding contracts. Models developed and shared. Agreed signed off processes. Operational from April  Education Sector – continue strong engagement with education sector building effective partnerships with universities, colleges and other education providers.

Timeline Dec 10 Jan 11 Feb 11 Mar 11 Apr 11 Jun 11 Sept 11 Dec 11 Jan 12 Feb 12 Mar 12 April 12 Onwards Consultation Transition SHA closure HEE ‘skills networks’ Shadow form Development *

 Increased autonomy of providers, best placed to understand the needs of their patients, staff and local communities.  Increased staff engagement to improve staff well-being and support during their career progression.  Robust workforce planning to ensure sufficient numbers of staff with the right skills mix to ensure high quality patient care.  A flexible high quality, adaptable workforce offering better value for money.  Strong clinical leadership to ensure high quality education and training.  HEE bringing together the interests of providers, the professions, patients and staff to provide leadership and assurance in the whole system Benefits of the new framework

Big Questions What should we preserve out of the old system? Do we have the right checks and balances? What are the key success measures for the new arrangements? How to secure strong clinical leadership? How to ensure provider ownership to drive the new system? What should be funded from a central education and training levy? What is the sensible pace of change? What about Public Health education and the role of Local Authorities? How to ensure effective partnerships with universities, colleges and other education providers? What are the critical risks?