1. Beyond Inequality: Widening participation in learning in Healthcare Professor Bob Fryer CBE Chief Learning Advisor Department of Health Bob.Fryer@dh.gsi.gov.uk www.wideningparticipation.nhs.uk

2. The NHS and its workforce Largest employer of staff in Europe & third largest in the world Total budget of c£100 billion, still rising Total of 1.3 million staff in NHS - a further 1.5 in social care A highly professionally qualified staff 55% Level 4 or above NHS alone spends >£5 billion on learning annually

3. Recent Context of Challenge & Turbulence  Three-quarters way thro’ the NHS Plan  Five years of real increases in finance (7%+ year-on-year, but recent serious financial challenges  Fewer but still very demanding output targets  Creating a so-called ‘Patient-led’ NHS  New focus on Improvement, Patient Choice, provider ‘contestability’, Chronic/Long-term conditions & Public Health  ‘System Reform’ – PBR, (practice-based) commissioning, Connecting for Health  ‘Fitness for purpose’ recent reconfiguration of boundaries & functions of SHAs & PCTs  New Interfaces between health & social care, public & private, statutory & voluntary, patient & service provider  Next Stage Review, led by Lord Ara Darzi

4. Our NHS, Our Future Fair (equally equitable to all, taking full account of personal circumstances and diversity Personalised (tailored to individual need, with access and choice) Effective (clinical outcomes among the best in the world Safe (with patients confident of the care they receive) Locally accountable (staff empowered to lead change locally based on clinical evidence and the product of patient and public engagement)

5. Increased net demand for health & care occupations 2002-2012 (Plus 50% of current health & social care sector workforce!)

6. Some policy ‘headline’ messages…. “ The NHS depends on its staff. It needs a workforce which has the skills and flexibility to deliver the right care at the right time to those who need it.” “This report is about how we make sure we have the staff we need to deliver this new kind of service. It is about looking at the workforce in a different way, as teams of people rather than as different tribes. …. For too long we have planned and trained staff in a uni-professional and uni-disciplinary way.” A Health Service of all the Talents: Developing the NHS workforce. DH, April 2000

7. “Working Together - Learning Together” The aim of this framework document, according to the then Secretary of State for Health, Alan Milburn, was to: “…help make a reality of the concept of the ‘Golden Trust’ - an organisation which recruits, retains and sustains the morale and productivity of its staff, with measurable benefits to patients, their carers and families.”

8. Results from the 2006 NHS Staff Survey

9. Some recent evidence on learning opportunities in the NHS (%) Source: NHS Staff Survey 2003

10. Engaged in learning at work in previous 13 weeks

11. NHS staff qualifications by pay per hour

12. The Literacy & Numeracy Challenge in Health & Social Care Source: NIACE, 2004

13. Literacy & numeracy by age group, general population and health & social care compared

14. Support Staff: the least well trained “The NHS and social care sectors spend more than £5 billion annually on training and developing staff. Only a small fraction is targeted at staff working in support roles – the least qualified don’t get the opportunity to participate in learning and development…. It is not acceptable that some of the most dependent people in our communities are cared for by the least well trained.” Our health, Our care, Our say: a new direction for community services, January 2006, Cm 6737

15. Poor Skills for Life – the risks This situation constitutes a potentially very serious problem indeed, in limiting staff's ability to handle some aspects of their jobs effectively, including fully understanding written instructions on the use of equipment or materials, or to deal properly with printed health and safety regulations. In certain situations, such as supporting or helping dependent patients or service users with their drug and other treatment regimes (whether formally or informally), it could also represent a serious potential risk to their wellbeing, or even to their safety. This is especially crucial in social care, where half of all staff are estimated to be employed directly in the provision of services. Learning for a Change in Healthcare (‘Fryer Report’, December 2006, paragraph113

16. The (persistent!) big issue “Access to education, training and development opportunities depends on where you work, who you are and what you do, as much as on individual or service needs.” (Hidden Talents, Audit Commission, 2001 )

17. So, what’s the real problem for these groups of staff?  Simply get overlooked, in the focus on medical staff & the clinical & professionally qualified workforce generally  Get fine words of praise & rhetoric heaped upon them, but little practical follow-through  Even where good schemes for these groups are implemented, they are often too short-term to a real shift  Funding for their learning always vulnerable to financial cuts or other priorities  No serious (detailed) evaluation of their current & likely future contribution to healthcare provision & the promotion of health  Even good machinery/processes (e.g. annual review & discussion of individual learning plans) very patchily utilised  Good practice (and some certainly exists) is poorly spread or generalised  Successive reorganisations & re-configurations seriously damage the support & knowledge infrastructure

18. Healthcare Work is ‘Knowledge Work’ Perhaps more than in any other field of employment, healthcare work is mainly about the effective and continuous development and application of knowledge through people, to improve health and promote better health. That has implications for the continuous learning and development of all healthcare staff, and not just those in senior positions exercising the highest level clinical and managerial skills. Learning for a Change in Healthcare, (‘Fryer’ Report, December 2006