1. Educational Outcomes Framework in England Draft Version for Autumn Guidance Feedback by 14 October (Draft for discussion dated 28 Sep) 1 Allan Jolly Nick Wood Associate Director of Workforce and Education Workforce Education Policy Team South Central SHA Department of Health 01962 7185220161 625 7297 07825 03411007818 533377 allan.jolly@nesc.nhs.ukallan.jolly@nesc.nhs.uk nick.wood@northwest.nhs.uknick.wood@northwest.nhs.uk

2. Contents Background to the Educational Outcomes Framework (EOF) Relationship between health care education and quality of care Draft Educational Outcomes Framework Proposed indicators for 2012/13 Accountabilities Glossary Summary 2

3. Julie Moore Chair, Education and Training Group Chief Executive University Hospitals Birmingham NHS Foundation Trust Education and Training A report from the NHS Future Forum “Healthcare education and training must deliver excellence in practice but must also strive to ensure that a world‐class healthcare education system is developed and maintained...Education and training are regarded as an essential part of the NHS not only to deliver excellence but to ensure that the NHS is responsive to changes in patient needs and in healthcare.” 3 Background

4. Government response to the NHS Future Forum report (20 June 2011) “To reinforce its importance, we will introduce an explicit duty for the Secretary of State to maintain a system for professional education and training as part of the comprehensive health service. To ensure consistently high quality around the country, we will develop a national education and training outcomes framework, setting out the outcomes that HEE would expect providers to meet.” 4 Background

5. The education and training of the healthcare workforce is the foundation on which the NHS is built and the single most important thing in raising standards of care...the ultimate aim should be to have a multi- disciplinary and inter-professional system driven by employers... We therefore remain committed to greater accountability and responsibility for employers to plan and develop their workforce, held to account by HEE. Background Government response to the NHS Future Forum report (20 June 2011) 5

6. Patients receive safe, high quality care as their needs are met by appropriate numbers of staff with the right skills, qualifications and experience Sufficient numbers of people are being educated and trained with the right capability, skills, and flexibility to meet future health needs CQC regulates suitability of staffing as part of essential standards Professional regulation of the quality of education & training Healthcare Providers Clinical Commissioning Groups NHS Commissioning Board Department of Health Health Education England Local Education & Training Boards Education Providers Centre for Workforce Intelligence Note: Professional bodies, Royal Colleges and Societies provide significant input to professional education and training, selection and recruitment and policy development Education & Training System Overview 7 6

7. Educational Outcomes Framework A high level strategic workforce planning, education and training framework providing a clear line of sight, and improvement, to patient outcomes [NHS, PH, SC Outcomes Frameworks] through high quality education and training The accountability mechanism between DH & HEE and it will also form the basis of contracts between HEE & LETBs and LETBs & Education and Service Providers A catalyst for driving quality improvement and outcome measurement throughout the NHS by encouraging a change in culture and behaviour, including a renewed sense of focus on addressing variation in standards and ensuring excellence and innovation in education provision 7 Background

8. Educational Outcomes Framework The Educational Outcomes will be designed to help the integrated healthcare workforce meet the clinical outcomes set out in the NHS, public health and social care outcomes frameworks. The Educational Outcomes Framework will also emphasise the importance of the right investment in education and training to ensure that the right values, behaviours and team-working to provide person-centred care. 8 Background

9. Constitution, Policy and Outcomes Educational Outcomes Framework Develop staff to meet the clinical outcomes set out in the NHS, public health and, in the future, social care outcomes frameworks 9 Background

10. NHS and Public Health Outcomes 10 Domain 1Domain 2Domain 3Domain 4Domain 5 Health Protection and Resilience: protect the population’s health from major emergencies and remain resilient to harm Tackling the wider determinants of health: tackling factors which affect health and wellbeing and health inequalities Health Improvement: Helping people to live healthy lifestyles, make healthy choices and reduce health inequalities Prevention of ill health: reducing the number of people living with preventable ill health and reduce health inequalities Healthy life expectancy and preventable mortality: preventing people from dying prematurely and reduce health inequalities NHS PH Background

11. New Territory Commissioned RAND to scope international comparisons – no country produced education outcomes framework Educational Outcomes Framework drafted that indicates broad accountabilities Outline needs to be included in the Autumn Guidance Longer term view/end state – a clear transparent workforce education planning system with outcomes/indicators that demonstrate improvement in patient experience/outcomes 11 Background

12. Where we are …. Building on existing processes Learning and Development Agreements (LDA), education contracts Education Commissioning for Quality (ECQ) framework Contract Performance Indicators (CPIs) Draft Medical Quality Indicators (MQI) Quality Assurance Agency (QAA) for Higher Education Regulators – quality assurance processes Other assurance processes Current systems are complex; ambiguity of roles and responsibilities and not linked directly to patient outcomes 12 Background

13. Relationship between health care education and quality of care Quality healthcare education and training can directly and substantially benefit care. The EOF will provide a framework to make these benefits explicit and enable further research to directly link education and learning to improvements in patient care outcomes. 13 Relationship

14. Impact model applied to Healthcare (adapted from Mackinnon Partnership 2000, SfH 2007) Better outcomes for patients Better treatment & patient care Better trained staff (competent & capable) Education & Training Programmes Inputs: Money, staff time, etc 14 Relationship

15. Impact model & evaluation (adapted from Mackinnon Partnership 2000, SfH 2007, Kirkpatrick 1975 and Kearns 2005) Better outcomes for patients Results: What is the result of this changed behaviour? Outcome: To what extent do patients benefit? Better treatment & patient care Behaviour: Do they change their behaviour? Better trained staff (competent & capability) Learning: Do participants learn? Education & Training Programmes Reaction : What is participants immediate reaction/feedback? Inputs: Money, staff time, etc 15 Relationship

16. Feedback guiding this draft of the EoF Support EOF link to NHS and PH Outcome Frameworks Clear Accountabilities – EOF is overarching framework for health and education system – DH hold HEE to account Applicable to all staff/learners not just professions Encourage innovation and new roles/ways of working by providing framework that challenges traditional approaches Linked to new leadership framework Harness input from Statutory and other relevant bodies e.g. Professional Regulators Clarity of definitions and levels (Outcome, domain, metrics etc) Identify and use already established metrics Avoid duplication and repetition 16 Draft EOF

17. Outcomes Excellent quality care in learning environments – ensuring students have an excellent experience and education & training is delivered in a safe environment for patients, staff and learners. Competent and capable staff – ensuring that people are cared for by staff who are properly qualified, having the requisite knowledge, skills and values to do their job Fitness for purpose and leadership – ensuring all staff are competent in each of the five core leadership framework domains: demonstrating personal qualities, working with others, managing services, improving services and setting direction Excellence of education, learning and development – enhancing the quality of care by ensuring excellence of education, training and CPPD for the current and future workforce delivered in a way that enables staff flexibility that is patient focussed and responsive to service demand. Individuals and professional groups aligned to workforce demand- ensuring a balanced approach responding to local employer need and national priorities. 17 Draft EOF

18. Plan, develop and secure supply of a professional and capable patient centred workforce Excellent quality care in learning environments Competent and capable staff Fitness for purpose & leadership Excellence of education training & development Educational Outcomes Framework – Outcomes Individuals & professional groups aligned to workforce demand Excellent experience for students and trainees Safety Effectiveness Outcomes Aim Outcomes Quality Draft EOF 18

19. 19 Meet standards set by independent regulatory/statutory bodies Promote professional development, research and innovation – creating a workforce receptive to research and innovation, so that patients have access to the most effective healthcare within available resources Support NHS Constitution values and behaviours – ensuring that people have a positive experience of care by supporting the healthcare workforce to develop the values, behaviours and team- working to provide person-centred care Promote health and wellbeing and address health inequalities Promote effective team and interdisciplinary working Respond to changing service demands - and support new ways of working, building a flexible workforce where individuals are resilient and able to promote and adapt to change Meet strategic & local workforce and commissioning plans Domains Draft EOF

20. Plan, develop and secure supply of a professional and capable patient centred workforce Excellent quality care in learning environments Competent and capable staff Fitness for purpose & leadership Promote health and wellbeing and address health inequalities Support the NHS constitution values and behaviours Promote effective team and interdisciplinary working Respond to changing service demands Excellence of education training & development Educational Outcomes Framework Domains Individuals & professional groups aligned to workforce demand Meet strategic & local workforce & commissioning plans Meet standards set by independent regulatory / statutory bodies Excellent experience for students and trainees Safety Effectiveness Domains Aim Outcomes Domains Quality Draft EOF Promote, professional development research and innovation 20

21. Indicators Build on what exists. Propose two national indicators for NHS providers for 2012/13 1.Board/Executive Team level engagement in workforce planning, education, training and leadership of all staff; provide evidence of an annual education and training plan, linked to workforce development, to meet strategic priorities; have active Board/Executive Team engagement and educational governance in place, to review plans and education and training standards; demonstrate commitment to CPPD planning evidenced by demonstrable improvements to patient care. 2.Safe trainee/student supervision: meet standards for learning environment for education and training including LDA, CQC and clinical governance standards assure adequate levels of supervision including induction, handover, appropriate access to senior support and graded experience; meet the standards required by educational curricula; ensure all clinical staff are engaged in educational support and supervision activities. 21 Indicators

22. Excellent quality care in learning environments Competent and capable staff Fitness for purpose & leadership Promote health and wellbeing and address health inequalities Support the NHS constitution values and behaviours Promote effective team and interdisciplinary working Respond to changing service demands Excellence of education training & development Educational Outcomes Framework Indicators Individuals & professional groups aligned to workforce demand Meet strategic & local workforce & commissioning plans Meet standards set by independent regulatory/ statutory bodies Excellent experience for students and trainees Safety Effectiveness Plan, develop and secure supply of a professional and capable patient centred workforce Indicators Promote, professional development research and innovation National required indicators for 2012/13 Board / Executive Team level engagement in workforce planning, education, training and leadership of all staff. Safe trainee and student supervision National required indicators for 2012/13 Board / Executive Team level engagement in workforce planning, education, training and leadership of all staff. Safe trainee and student supervision Indicators Aim Outcomes Domains Quality Indicators 22

23. Accountability HEE accounts to SoS/DH for the delivery of outcomes LETBs account to HEE for the delivery of domains. Healthcare & education providers account to the LETB for the delivery of indicators against contracts and Professional Statutory Regulatory Bodies 23 Draft EOF

24. Excellent quality care in training environments Competent and capable staff Fitness for purpose & leadership Promote health and wellbeing and address health inequalities Support the NHS constitution values and behaviours Promote effective team and interdisciplinary working Respond to changing service demands Excellence of education training & development Educational Outcomes Framework Accountability Individuals & professional groups aligned to workforce demand Meet strategic & local workforce & commissioning plans SoS/DH HEE Meet standards set by independent regulatory/ statutory bodies Excellent experience for students and trainees Safety Effectiveness LETB (inc health & education partners) Healthcare Org Plan, develop and secure supply of a professional and capable patient centred workforce Accountability Promote, professional development research and innovation Professional Statutory Regulatory Bodies National Required Indicators for 2012/13 Board/Executive Team level engagement in workforce planning, education, training and leadership of all staff. Safe trainee/student supervision National Required Indicators for 2012/13 Board/Executive Team level engagement in workforce planning, education, training and leadership of all staff. Safe trainee/student supervision 24

25. Summary The Education Outcomes Framework : supports the integrated healthcare workforce to meet the clinical outcomes set out in the NHS, public health and social care outcomes frameworks. identifies outcomes that HEE would expect providers to meet and an accountability mechanism between DH & HEE, HEE & LETBs, LETBs & Education and Service Providers provides a direct line of sight between education and training and patient experience is a catalyst for driving quality improvement and outcome measurement throughout the NHS identifies two, high level, transitional indicators for 2012/13 - with further indicators being introduced at a later date when HEE is established 25

26. Glossary It is recognised that many of the terms used have differing definitions and are debated widely: this glossary provides an explanation of meaning for this presentation Education: for the purposes of this discussion the term education is used to encompass the entire range of learning experience. Competence: a competence is a statement which details the standard required for the appropriate performance of a single function or task within the healthcare workplace. Competences focus only on the function itself, and not on the personal attributes of the individual performing the function. Capability: capability recognises the attributes and values of the individuals undertaking a role or function associated with healthcare working in a complex environment (next slide), and the extent to which an individual can: apply knowledge in practice; adapt their practice; synthesise new knowledge from experience; and continue to improve their performance including undertaking CPPD CPPD: Continuing Personal and Professional Development. Used to indicate that continuing development applies to all staff. 26 Glossary

27. EOF aims to deliver competent & capable staff CompetenceCompassionCredibilityCapacityConfidenceCaringManage Competing Priorities Managing Complexity Capability Jolly 2011 27

28. Glossary The Education Outcomes Framework is comprised of 3 interrelated elements: Outcome: An end result; a consequence, something that follows from an action A range of consequences required by HEE from LETBs and the broader health, PH and social care sector Domain: A sphere of activity, concern, or function; a field Specific expectations, that will be monitored and required by contract, to be delivered by LETBs and others on behalf of providers to improve specific areas of education Indicator: An instrument used to monitor the operation or condition of a system; a meter or gauge Measurable detailed data, collected and analysed to gauge performance against domains and provide evidence for strategic decision making 28 Glossary