The report was published earlier this morning and was swiftly followed by the Government's response to the Forum's recommendations.
I am pleased to say that the Forum and Government have taken on board some of the views that we submitted on your behalf during the consultation period. It's great to see a strong focus on the role of employers in driving the new system and this provides an opportunity to link the planning and development of the workforce with local patient needs and future service delivery.
Throughout the consultation period, we have stressed the importance of making sure that the needs of the whole workforce, including those of support staff, are considered in the new arrangements. I'm pleased to report that specific recommendations to allow national funding to be used to invest in developing all staff have been accepted by the Government.
The Future Forum made 27 recommendations in all. The main ones for employers include:
1). The DH and HEE should assure themselves, through the authorisation criteria, that LETB's have robust and transparent governance in place to deliver strong partnerships across healthcare providers, academia, education and professions with the appropriate skills to serve the functions of the LETB.
2). LETB's must be able to demonstrate that they have the governance and partnership arrangements in place to deliver recommendation 1, including how the work and functions the deaneries will be transitioned, working with the royal colleges and the GMC.
3). DH and HEE should ensure that the development of LETB's allows flexibility to evolve as the wider system matures, so that local organisations are able to take opportunities to work in new ways across the service.
4). Education and training organisations, including higher education institutions, NHS Foundation Trusts and GP practices, should be able to demonstrate that patients and the public have been engaged in their training programmes.
5). LETB's should only commission from institutions that select students and trainees in partnership with employers.
6). DH, and in the future, HEE, should develop a system which rewards high quality education and training at all levels and for all professions. This should include development of a quality premium for teaching which would be paid to organisations that demonstrate quality outcomes in learning.
7). LETB's must be able to provide assurance that they have sought proper evaluation of the local education and training provision, including:
• ensuring the on-going, necessary specialty based expertise has been obtained and considered
• demonstrating that local providers have clear quality control mechanisms in place and offer value for money
• putting systems in place to address any conflicts of interest that might arise
8). Clinical commissioning groups (CCGs) must demonstrate a commitment to commissioning from service providers who are able to show evidence that high quality education and training is at the heart of their service.
9) The DH, and in the future HEE, should set out how it will embed training for team working, leadership development and the principles and values of the NHS Constitution at every level of the training and educational process.
10). The DH, and in the future HEE, should work with regulators to develop guidance to support programmes of appraisal and continuing development for healthcare workers. This should include a systematic approach to appraisal and personal development plans with an expectation that a minimum percentage of staff have plans.
11). LETBs should agree and allocate a minimum percentage of funding for continuing professional development. Employers will need to demonstrate how that money has been spent.
12). The General Medical Council should lead discussions on the desirability of implementing a national exam in medicine that would support alignment of registration and qualification.
13). LETBs should lead work with local partners, including professional representatives, to develop the quality of nurse and midwife training locally. This should be replicated for all clinical training programmes.
14). CCGs must work with LETBs to develop their community services to deliver the movement of care to the community including increasing the provision of community placements for trainee nurses, midwives, allied health professionals and other appropriate professionals.
15). The DH should establish a transparent approach to funding flows for education and training monies, with a clear implementation plan for HEE, once established. In doing this, as part of the MPET review the DH should:
a. Consider how to take forward the principle of having a fair tariff for trainees, money following the trainee and how to take account of outcomes not just volumes
b. Provide clarity for the future direction on fair funding to all training providers
c. Include clarification of the funding for professional development (CPD) and the expectations on employers to resource professional development.
16). Establish transparent systems with robust accountability to make sure that organisations in receipt of education and training money are held to account for using it for the education and training of the NHS workforce.
Turning to some of the specific recommendations:
As expected, the Future Forum and Government support the creation of Healthcare Education England (HEE) in shadow form and as a special health authority from June 2012, with full functionality from April 2013 as the lead body with responsibility for education and training in the NHS in England. The first task for HEE is to recruit the Board and they are intending this to happen in the next few months.
They also confirm the creation of Local Education and Training Boards (LETBs) in their shadow form. Initially, these will be as a SHA sub-committee from April 2012, with authorisation being obtained from HEE between October 2012 and March 2013, so that they can be operational in April 2013.
The employment model will be that HEE will employ staff supporting the LETB and the Deaneries will operate as part of the LETBs.
Local Education and Training Boards will take on the responsibility for commissioning education and training places - a role currently carried out by strategic health authorities, and will be a forum for developing the whole health and public health workforce. They will also identify and agree local priorities for education and training. LETBs should agree and allocate a minimum percentage of funding for continuing professional development and employers will need to demonstrate how that money will be spent. This would need to be supported by local challenge mechanisms and publication of the information in their annual report.
They will have their own board with an independent chair and will hold resources with the aim to give employers a lead role in education and training decisions.
The Government is proposing that to ensure accountability, LETBs be hosted by HEE from April 2013. They also support the idea of an authorisation process to ensure that LETBs are ready to take on their new responsibilities.
You will be pleased to see that there is scope for LETBs to progress at their own pace and there is flexibility to enable them to be creative and innovative to meet local needs.
In addition, to the existing duties on employers and the pledges set out in the NHS Constitution, the Government response details three proposed duties that employers will need to consider, and work within the LETB structure to carry out. These new duties are subject to approval in the Health and Social Care Bill but are:
• to consult on workforce plans
• to provide data on the current workforce and future needs
• to co-operate in planning the workforce and the provision of education and training.
There are also proposals for the creation of an education outcomes framework which will set the expected outcomes of the quality of education and training provision across the NHS in England. A draft framework is expected by March this year and we are working with the Department on the development of the framework to ensure that the needs of employers are represented.
The forum also wants HEE to consider developing a quality premium to "reward excellence in training". This will build on plans being developed by the Department of Health to develop a commissioning for quality and innovation (CQUIN) payment for education and could be achieved by allowing LETBs to top-slice NHS providers' training budgets. According to the forum, this money would be released when organisations have demonstrated, using metrics including patient and trainee experience measures, that they deliver high quality training.
There is clear ambition to move to a tariff based system. This will start with a phased approach to tariffs for non-medical education and training and undergraduate placements for medical students in hospitals from April 2013. The ultimate aim is to set education and training tariffs alongside service tariffs. This will require significant employer input and we will work with you to ensure that your views are gathered over the coming months and are fed into this process.
A more detailed summary of the proposals is on our education and training web pages and we will be adding to these as further plans are announced.
I'd welcome any comments or feedback on how we can help and support you. You can contact me at deanroyles@nhsemployers.org.
You can also follow us on Twitter and join my LinkedIn page where I will be posting regular updates.
For more information on this and similar issues, please see our workforce leader web pages.
With best wishes,
Dean
Dean Royles
Director, NHS Employers