Liberating the NHS: Developing the Healthcare Workforce

Transcription

1 Liberating the NHS: Developing the Healthcare Workforce From Design to Delivery

2 DH INFORMATION READER BOX Policy Clinical Estates HR / Workforce Commissioner Development IM & T Management Provider Development Finance Planning / Performance Improvement and Efficiency Social Care / Partnership Document Purpose Policy Gateway Reference Title Liberating the NHS: Developing the Healthcare Workforce From Design to Delivery Author DH Publication Date 10 January 2012 Target Audience PCT Cluster CEs, NHS Trust CEs, SHA Cluster CEs, Care Trust CEs, Foundation Trust CEs, Medical Directors, Directors of PH, Directors of Nursing, Local Authority CEs, Directors of Adult SSs, PCT Cluster Chairs, NHS Trust Board Chairs, Special HA CEs, Directors of HR, Directors of Finance, Allied Health Professionals, GPs, Communications Leads Circulation List #VALUE! Description Liberating the NHS: Developing the Healthcare Workforce - From Design to Delivery sets out the policy framework for a new approach to workforce planning and the education and training of the health and public health workforce. It builds on the responses to earlier public consultation and the advice of the NHS Future Forum. Cross Ref Superseded Docs Action Required Timing Contact Details Education and Training- A report from the NHS Future Forum NA NA NA Jonathan Firth Quarry House 0 Leeds LS2 7UE For Recipient's Use 2

3 Contents Contents Foreword by Secretary of State...5 Executive Summary An effective education and training system... 9 Securing an Effective Education and Training System Education Outcomes Framework key domains Improving the Quality of Education and Training The Shape of the Medical Workforce Training for General Practitioners Training the dental workforce...15 Training for Nurses and Midwives Training for pharmacy Modernising Scientific Careers Developing the Wider Healthcare Team The Public Health Workforce Integrated Planning Allied Health Professional Education and Training Health Education England Purpose and Functions Governance and Advisory Structure Operating Model and Key Relationships Strategic Education Operating Framework National Relationships Relationships with LETBs Authorisation and Accountability Framework Local Education and Training Boards Purpose and core functions of Local Education and Training Boards Governance and Advisory Structure Duties on Providers Ensuring a Stable and Phased Transition Management costs for LETBs Accountability for Quality Partnership working and key relationships Partnering for innovation

4 Contents Continuing professional development Health Interface with Education and Research Key areas of interaction Research and Innovation Funding Flows...40 Scope of the central education and training budget Moving to a tariff-based system for education and training Raising the education and training budget through a levy on providers Improving Workforce Information and Planning Transition Plan Annex A: Glossary

5 Foreword by Secretary of State In December 2010 we set out our vision for a new system for developing the healthcare workforce. One that would ensure employers supported by clinicians were placed at the heart of the decision-making process, with the opportunity to design the shape of their workforce and the way in which they develop the people they employ. The NHS in England is one of the best healthcare systems in the world and that is down to the dedication of the workforce. However, while the NHS currently delivers excellent care, in some areas outcomes for patients still lag behind the top countries in the international league. As we strive to improve the NHS to deliver world-class health outcomes for patients, we need also to improve the way we develop the healthcare and public health workforce. The people who work in health services, whatever the sector, need to be well supported to attain the right professional and clinical skills, as well as providing care with compassion, kindness, and respect for people. Today s health workers must also be able to cope with everchanging patient and public needs and adapt quickly to innovation in service models. We are setting up a new system that can produce the flexible workforce we need to address future challenges, that aspires to excellence in training as well as a better educational experience for trainees, and is supported by a fairer and more responsive funding system. This presents a unique opportunity to strengthen partnerships between all providers of services and the professionals who deliver them, as well as fully harnessing the natural partnerships with research and innovation to improve health outcomes. Making these changes work is all about placing accountabilities in the right place. Locally, with providers supported by professionals who understand the local needs of their workforce, and nationally with Health Education England to interpret workforce intelligence and planning and then lead in support, guidance and oversight for the commissioning of education and training. The Education Outcomes Framework will directly link education and learning to improvements in patient outcomes. By providing a clear line of sight and improvement to patient outcomes, it will help address variation in standards and ensure excellence in innovation through high quality education and training. 5

6 Since we first published these plans, a great deal of progress has been made. We have consulted widely and used the work of the NHS Future Forum, whose second report has shaped our thinking. We have listened to your comments and ideas and believe this document presents the right steps forward for the successful implementation of our proposals. Now is the time to focus on making this work. Health employers, with their professional leaders, universities and the education and research sectors need to come together and work to ensure a carefully managed transition into the new system - a system that will have a positive outcome for both patients and staff. Andrew Lansley Secretary of State for Health 6

7 Executive Summary 1. The shape and skills of the future health and public health workforce need to evolve constantly if we are to sustain high quality health services and continue to improve health in the face of demographic and technological change. 2. To keep up with these changes, the NHS and public health system is changing and therefore the way in which we educate and train our workforce must also change - the needs of patients and the public must be served by a workforce that has the skills and knowledge to provide safe, effective and compassionate care at all times. 3. Here we set out a new education and training system that will do just that, building on responses to our consultation and the advice of the Future Forum. It puts employers, and professionals in the driving seat and gives them the national support they need to identify and anticipate the key workforce challenges, and to be flexible and responsive in planning and developing their workforce. We believe these provider-led arrangements offer the best assurance for future-proofing the way we develop the health and public health workforce so we can meet the aspirations set out in the NHS Constitution - to bring the highest levels of human knowledge and skill to save lives and improve health. 4. There are two central planks to the new system - Health Education England (HEE) and the Local Education and Training Boards (LETBs). 5. HEE will provide national leadership and oversight on strategic planning and development of the health and public health workforce, and allocate education and training resources. HEE will promote high quality education and training that is responsive to the changing needs of patients and local communities - including responsibility for ensuring the effective delivery of important national functions, such as medical trainee recruitment. Once the new education and training system is fully established, HEE will be able to consider to what extent they can be devolved. 6. The LETBs will be the vehicle for providers and professionals to work with HEE to improve the quality of education and training outcomes so that they meet the needs of service providers, patients and the public. Through HEE, health and public health providers will have strong input into the development of national strategies and priorities so education and training can adapt quickly to new ways of working and new models of service. LETBs may also take on specific leadership roles for particular professional groups, such as the smaller professions and commissioning specialist skills. 7. The Department will set the education and training outcomes for the system as a whole, securing the resources necessary and continuing to set the regulatory, policy and legal framework. It will hold the HEE Board to account for delivery of its strategic objectives. 8. HEE s role will be to ensure greater transparency in the education and training investments employers make in their workforce. LETBs will have flexibility to invest in education, training and ongoing professional development to support innovation and development of the wider health team. LETBs will also be able to ensure that funding in the new system follows the student/trainee on the basis of quality education and training outcomes. Proposals to raise the education and training budget through a levy on providers will be developed for consultation. 7

8 9. Local education providers, universities, colleges and employers, will remain directly responsible for the provision and quality control of education at a local level. This framework will be maintained in the new system, with the LETBs assuming responsibility for the quality management role at local level and for meeting standards required by national frameworks and the regulators. 10.The continuing success of the healthcare and public health systems is dependent on partnerships with higher and further education. Many educators, often working in close partnership with the health service, undertake excellent, cutting-edge research and innovation that underpins continuing improvements in health and public health in the UK and across the world. Therefore the mutual dependence between health, education and research means a strong working relationship is essential. 11.Education and training is an important factor in translating new developments and technologies into practice. LETBs will work closely with the new Academic Health Science Networks (AHSNs) to realise the ambition set out in Innovation, Health and Wealth for an NHS defined by its commitment to innovation and the rapid diffusion of transformative ideas and practice. They will together exploit the potential for high quality care and innovation through the integration of clinical, research and educational functions. 12.Given the importance of education and training and the competing pressures across the wider system, it is vital that we ensure a safe and stable transition and a pace of change that is led by local priorities and capacity. We are taking a deliberate and cautious approach so that we can secure continuity and a safe transfer of essential skills and staff from Strategic Health Authorities (SHAs) and protect individuals currently undertaking training. HEE will be established as a Special Health Authority in June 2012, with a view to commencing operations from October 2012, taking on full functionality when the SHAs close in April In due course, we plan to consolidate HEE by establishing it in primary legislation as a Non Departmental Public Body (NDPB). This will enable HEE to operate on a permanent statutory basis at arms-length from the Department of Health, whilst remaining accountable to the Secretary of State. We intend to publish draft clauses for pre-legislative scrutiny in the second Parliamentary session. We then intend to legislate to establish the NDPB as soon as Parliamentary time allows. 14.The outcome of these changes will be a better education, training and workforce planning system for health and public health, one that is clearly focused on continually improving the health of the public and services for patients. 8

9 1. An effective education and training system 1. The driving principle for reforming the education and training system is to improve care and outcomes for patients. Excellent health and healthcare depends on a highly skilled and educated workforce, working together with compassion and respect for people. The new system aims to be responsive to patient and public needs and changing service models, such that our investment in the capacity and skills of current and future staff reflects the needs of patients, carers and local communities. That is why we want healthcare and public health providers to have greater responsibility for planning and developing the workforce they employ. 2. The Government has consulted widely on a new system for planning and commissioning education and training for the health workforce. The NHS Future Forum found continued support for a system that will be more responsive to the needs of patients and employers, professionally informed and underpinned by strong academic links. The responses to the consultation Liberating the NHS: Developing the Healthcare Workforce and the recommendations from the NHS Future Forum have informed the design of the new education and training framework. Subject to the passage of the Health and Social Care Bill, we are now ready to move from design into developing the world class health education and training system that is essential, alongside excellent research and innovation, to deliver world class healthcare and public health. 3. This system builds on the advice of the Future Forum, following design principles developed through consultation: greater accountability for all providers to plan and develop their workforce, whilst being professionally informed and underpinned by strong academic links; aspiring to excellence in training and a better experience for patients, students and trainees; supporting NHS values and behaviours to provide person-centred care; supporting the development of the whole workforce, within a multi-professional and UK-wide context; supporting innovation, research and quality improvement; providing greater transparency, fairness and efficiency to the investment made in education and training; reflecting the proposed, explicit duty of the Secretary of State to secure an effective system for education and training. 4. Developing the education and training system will take time, and the system will need to evolve as the rest of the NHS and public health system matures. The new system needs to have the flexibility to respond and adapt to future challenges and seize opportunities to work in new ways across the NHS, the public health system and with education, innovation and research partners. The partnerships between employers, professions and with the education and research sectors, locally and nationally, will be critically important to this. 9

10 5. New capabilities and relationships will be required as we look to plan for the whole workforce, it is equally important that we build on the skills and knowledge we already have. A safe transition is needed to secure business continuity and maintain current training programmes. It is also important that we minimise the financial risks to the system so changes to the way we fund education and training will be done carefully and at the right pace. Securing an Effective Education and Training System 6. The education and training system will remain accountable to the Secretary of State. The Government has introduced an amendment to the Health and Social Care Bill to place a duty on the Secretary of State to exercise his functions so as to secure an effective system for education and training, for people who are employed or who will be employed in the health service and public health system in the future. The Secretary of State already has broad powers for education and training. The purpose of this duty is not to grant new powers to intervene. Our aim is to ensure the new education and training system is set up to deliver a greater level of local accountability and responsibility for decision-making: a system that aspires to excellence and supports the values of the NHS. 7. Local Education and Training Boards (LETBs) will be set up so that local partnerships, with healthcare and public health providers at their centre, can take on the functions of Strategic Health Authorities (SHAs), including the postgraduate deaneries. Health Education England (HEE) will be established as a Special Health Authority (SpHA) to provide national leadership and oversight. This is a central feature of these reforms: that greater responsibility and accountability for decision making will be delegated to employers who are best placed to understand the communities they serve and the needs of their own workforce. Clinical Commissioning Groups will have an important role to play in providing clear and timely commissioning intentions which support the development of education and training plans. 8. While the new NHS and public health system is taking shape and maturing the LETBs will be hosted by HEE from April HEE will have a clear scheme of delegation to the LETBs in accordance with the aim of the education & training system being led by providers of NHS and public health services, working in partnership with the professions, education and research institutions. 9. The role of the Department of Health is to maximise the health and wellbeing gain for the population through its stewardship of the NHS, adult social care and public health systems. It does this by setting strategic outcomes for the whole system, securing resources, setting the regulatory, policy and legal framework and by providing oversight and leadership across all three systems. The Department will set the education and training outcomes for the system as a whole. It will secure the resources necessary for an effective education and training system and continue to set the regulatory, policy and legal framework. It will set the strategic objectives for HEE and hold the HEE Board to account for their delivery. 10. Applying innovative approaches to delivering healthcare and public health must be integral to the way the NHS and public health system does business. The shape and skills of the future health workforce need to evolve constantly if we are to sustain high quality, health services and continue to improve health in the face of demographic and technological change. There are big challenges: to tackle obesity; improve maternity care; release savings; empower people with long-term conditions to manage their own care and provide people in later life with better support through more integrated, community based services. 10

11 The way we educate and develop the workforce needs to support innovation and research while helping accelerate the adoption and diffusion of new patterns of care, treatments and drugs. 11.The new education and training system described here puts employers and professionals in the driving seat. In partnership with the education sector, they will have the national support they need to identify and anticipate the key workforce challenges, and be much more flexible and responsive in planning their workforce and developing the skills needed. We believe these employer-led arrangements offer the best assurance for future-proofing the way we develop the health and public health workforce so we can meet the aspirations set out in the NHS Constitution - bringing the highest levels of human knowledge and skill to save lives and improve health. Education and Training System Secretary of State Secretary of State Duty to maintain an effective system of education and training as part of comprehensive health service Department of Health Set Education Outcomes Framework Sponsor for HEE Hold system to account, via HEE Public Health England Department of Health NHS Commissioning Board Health Education England Accountable to SofS, via DH Compliant with DH Education Outcomes and Performance Assurance Frameworks Accountable to DH for allocation of education and training funding Set strategic Education Operating Framework (responding to input from Public Health England (PHE) and NHS Commissioning Board (NHSCB)) Health Education England NHS Commissioning Board Local Education and Training Boards Input service commissioning priorities to HEE strategic Education Operating Framework Public Health England Education & Research Health Service Providers Local Stakeholders Input public health priorities to HEE strategic Education Operating Framework Local Education and Training Boards Bring together Health, Education and Research sectors Accountable to HEE for delivery against Education Operating Framework Assessed against Education Outcomes Framework and Professional Regulators Figure 1: Education and Training System Education Outcomes Framework key domains 12.Building on the objectives set out in the consultation document that were strongly supported, an education and training outcomes framework is being developed. Setting clear outcomes for the education and training system will enable the allocation of education and training resources to be linked to quantifiable, quality outcomes. These in turn will support delivery of the outcomes set for the NHS Commissioning Board and Public Health England. 13.High level outcomes are set out in figure 2 page 12. There will be further work to develop and provide a detailed framework and the metrics to support its use nationally and locally. 11

12 The Education Outcomes Framework will set expectations across the whole education and training system so that investment in developing the health and public health workforce supports the delivery of excellent healthcare and health improvement. LETBs and HEE will use the Education Outcomes Framework as the basis for developing the operating model and working arrangements with partners. 14.The NHS Future Forum welcomed the development of an Education Outcomes Framework to provide a comprehensive system of quality governance and explicit educational outcomes, which support the delivery of improved patient care and public health outcomes, and advised developing the detail as soon as possible. Working with employers, clinicians and education providers, the Department, LETBs and HEE will develop a suite of metrics so that the system can demonstrate at all levels education quality outcomes as they impact on patient experience, care and safety. This includes testing new questions for the independent staff survey on the availability, effectiveness and relevance of education as part of assessing the priority employers give to education and training and education outcomes achieved at all levels of the system. Education Outcomes Framework 1. Excellent education Excellent experience for staff (inc. students / trainees) and patients Ensure the health workforce has the right skills, behaviours and training, available in the right numbers, to support the delivery of excellent healthcare and health improvement 2. Competent and capable staff 3. Adaptable and flexible workforce 4. NHS values and behaviours Effectiveness Safety 5. Widening participation Aim Domains Quality Figure 2: Education Outcomes Framework 12

13 1. Excellent education Education and training is commissioned and provided to the highest standards, ensuring learners have an excellent experience and that all elements of education and training are delivered in a safe environment for patients, staff and learners. 2. Competent and capable staff There are sufficient health staff educated and trained, aligned to service and changing care needs, to ensure that people are cared for by staff who are properly inducted, trained and qualified, who have the required knowledge and skills to do the jobs the service needs, whilst working effectively in a team. 3. Adaptable and flexible workforce The workforce is educated to be responsive to changing service models and responsive to innovation and new technologies with knowledge about best practice, research and innovation, that promotes adoption and dissemination of better quality service delivery to reduces variability and poor practice. 4. NHS values and behaviours Healthcare staff have the necessary compassion, values and behaviours to provide person centred care and enhance the quality of the patient experience through education, training and regular Continuing Personal and Professional Development (CPPD), that instils respect for patients. 5. Widening participation Talent and leadership flourishes free from discrimination with fair opportunities to progress & everyone can participate to fulfil their potential, recognising individual as well as group differences, treating people as individuals, and placing positive value on diversity in the workforce and there are opportunities to progress across the five leadership framework domains. Figure 3: Education Outcomes Framework - Domains Improving the Quality of Education and Training 15.There are many changes to education and training that LETBs and HEE will inherit and need to take forward. Pharmacy education and training is being reviewed. New education and training programmes which have quality and patient outcomes at their core have been introduced across some 45 healthcare science specialisms. The National Allied Health Professional Advisory Board is using lay representatives to drive changes in the training for these professions. There are also a number of specific challenges that the NHS Future Forum raised where action is needed. 16.The NHS Future Forum report identified widespread concerns about the quality of education and training programmes and the individuals who are trained. Better leadership and a greater focus on outcomes and flexibility will help services to be more responsive. We agree with the NHS Future Forum that learning to understand what people want from their health professionals and care teams in terms of empathy, compassion and dignity should be at the core of all education and training. We are aware of our duty in relation to the Public Sector Equality Duty to pay due regard to the needs of populations with protected characteristics. We will take proportionate action to systematically build in and embed equality assurance into the new education and training system. The Education Outcomes Framework and the expectations across the new system to involve patients and the public in planning education and training will reinforce this approach. Addressing these issues, alongside building positive relationships with the professional regulators, will be early objectives for LETBs and HEE. The Shape of the Medical Workforce 17.The balance to be struck between training and service is a continuing question in the training of doctors. Sir John Temple s Time for Training called for a better use of the expanded consultant workforce, not only to improve training for doctors but also in terms of 13

14 better efficiency and enhanced safety and quality of care for patients. Professor John Collins Foundation for Excellence evaluated the Foundation Programme for newly qualified doctors and his findings also highlighted concerns that in some cases very junior doctors were being asked to practice beyond their level of competence and without adequate supervision. The most recent trainee survey from the General Medical Council (GMC) confirms these findings. 18.Medical Education England (MEE) is leading the Better Training Better Care programme to take forward the recommendations from the Collins and Temple reports. Primary responsibility for implementing the recommendations rests with employers and the Better Training Better Care programme will support this at a national level by providing evidenced based examples of good practices, by refining the quality metrics HEE will use and taking action at a national level. In due course, HEE will take on this task from MEE and evidence of improvement in this area will be a critical part of HEE and LETB quality assessments. HEE will also be well placed to lead discussion about the more general question the NHS Future Forum raises about whether all institutions should train doctors and develop their healthcare workforce. This is an important issue when considering the training of small specialist professions within the healthcare workforce and the future requirements of the public health system. LETBs will be able to ensure that funding in the new system follows the student/trainee on the basis of quality education and training outcomes. 19.The NHS Future Forum have also cast doubt on whether the structure of postgraduate medical training achieves the best outcomes. The current model based on more than sixty specialties and forty sub-specialties, drives a degree of specialisation that does not fit with the needs of a population that is living longer with more long-term disease and comorbidities. A more flexible model, beginning with patient and service needs, that encompasses Higher Education Institutions (HEIs), that has trainees working in the community as well as in acute settings and provides better supervision, particularly at nights and weekends, would address the NHS Future Forum s concerns. MEE is working with the GMC, Wales, Scotland and Northern Ireland to establish an independent review of the shape of medical education and training to ensure we continue to produce doctors of the highest calibre who are able to respond to the rapidly changing health needs of the population. HEE will take forward this work in collaboration with the GMC, professional bodies, employers and the relevant UK bodies to consider the best strategic fit to give greatest flexibility with other professions. It will take this opportunity to put in place a model that builds on the principles of the Tooke report, is sustainable for the future and which takes into account developments in other professions. Training for General Practitioners 20.The Royal College of General Practitioners (RCGP) proposes an extension to the length of training for General Practitioners (GPs) and the NHS Future Forum has been persuaded by their arguments. It is in all our interests to ensure that the next generation of GPs receive the comprehensive and high quality training that they need and the current training schedule is tight. It is important that any changes to their training programme are affordable and sustainable financially, as well as the right thing to do educationally and in the interests of patients. Any changes to the training programme will also need to be discussed with commissioners and providers to understand the impact on services. The Department is working with the RCGP to develop its case for extending training. This will 14

15 be considered by the Medical Programme Board, to make recommendations to MEE in the Spring of Training the dental workforce 21.The nature of the dental services required by the population is changing as a result of significant and sustained improvements in oral health. Accordingly the role of the dental team is evolving from the treatment of disease to a greater emphasis on supporting patients maintain their oral health. The workforce planning and education implications of this change offer scope for increased skill mix/team working and a greater need for continuing professional development to enable dentists and dental care professionals (DCPs) to extend the scope of their practice. These training needs have to be viewed in the context of the organisation of NHS dentistry with over 90% of all NHS dentists working as independent contractors in primary care. 22.HEE will need to build on the work of the Dental Programme Board of Medical Education England to address these issues. The Dental Programme Board has recently completed a review of skill mix in dentistry and is collaborating with the Centre for Workforce Intelligence on a review of the dental workforce whereby the supply of dentists and DCPs will be compared to forecast demand to inform a review of undergraduate numbers in dentistry. Training for Nurses and Midwives 23.Nurses are the largest single profession within the health service and critical to providing care of the highest standard there is hardly an intervention, treatment or healthcare programme where they do not play a significant part. So it is important that we align education to the service vision and educate nurses, midwives and health visitors to use their professional judgment about what is right for patients and families. We need to give them the skills and confidence to work effectively in an increasingly complex working environment and take on specialist roles. New education standards, including degree-level registration will ensure future nurses, midwives and health visitors continue to be equipped to work in a modern healthcare and public health system. 24.The NHS Future Forum found excellent examples of high quality education and training for these groups but raised concerns about the variation in quality and wanted to reinforce the importance of preceptorships and continuing access to training. The new system for education and training will tackle these variations in quality standards and assure greater consistency in access to employer-led continuing professional development and new professional, educational initiatives. We expect LETBs to address inconsistencies in their locality, using all the levers at their disposal including resources, and for HEE to hold LETBs to account for doing so through the Education Outcomes Framework. HEE will also support the Nursing and Midwifery Council (NMC) in taking forward the NHS Future Forum s recommendation to develop properly structured, post-qualification career pathways. 15

16 Training for pharmacy 25.Pharmacist education and training has been reviewed by the Modernising Pharmacy Careers (MPC) Board. The affordability of proposals for reform of the current four year degree programme and one-year pre-registration training is being considered to determine whether a funding mechanism that is both sustainable and cost neutral across government can be delivered. HEE will play a significant role in the implementation of any agreed reforms to pharmacist pre-registration education and training. 26.The MPC Programme Board is completing its initial review to develop flexible career pathways in pharmacy. This covers both pharmacists and pharmacy technicians and takes into consideration the wider pharmacy workforce, including assistants working at Agenda for Change bands 1-4 in the NHS and equivalent staff in community pharmacy e.g. medicines counter assistants and dispensing assistants. HEE will have the opportunity to take forward their recommendations in a multi-disciplinary context, considering the interaction with nursing, public health and medical career pathways. Modernising Scientific Careers 27.As recognised in the UK strategy for the Life Sciences published in December 2011, the Modernising Scientific Careers (MSC) programme is ensuring that the NHS attracts, develops and retains some of the best and brightest science graduates and young people in the UK with an interest in Science, Technology, Engineering and Mathematics (STEM) subjects. This programme is ensuring that the NHS and public health services have a specialist scientific workforce that can use its skills more broadly through a clear focus on innovation, research and development. This collaborative approach to development - with professionals, patients, employers, education, industry and other representatives - will continue in the new system with the introduction of comprehensive academic science in health-based programmes from vocational awards to doctoral level qualifications, combined with co-ordinated workplace training. 28.The establishment of a lead commissioner has been important in gaining economies of scale which the LETBs and HEE will be able to maintain to sustain the supply of small specialist professions for the health and social care system. Developing the Wider Healthcare Team 29.A frequent response to the consultation which was picked up by the NHS Future Forum is the need to invest in the whole healthcare or public health team. We have recognised this wider approach in setting the remit for HEE and in our approach to funding and in drafting the EOF. The NHS Future Forum also welcomed the recent announcement that Skills for Health and Skills for Care would take forward the development of a code of conduct and establish minimum standards for training the wider healthcare team working in support roles. LETBs will provide the forum in which employers can review their investment in this part of the workforce and how this is best supported by central funding. 16

17 The Public Health Workforce 30.The Department of Health will be consulting on a public health workforce strategy. Whilst there will be a focus on public health consultants, the consultation will acknowledge that public health is everyone s business and will include proposals for building capacity and embedding public health skills amongst practitioners, the wider workforces, such as housing officers, and within local communities. It will set out how the public health workforce can access high quality education and training to deliver positive outcomes across the three domains of public health health protection, health improvement and healthcare public health and at all levels of the new public health system. 31. Workforce planning, education and training for those professional and clinical workforces that will move from the NHS and form part of the new public health system will remain integrated within this new system, informed by the new employers and the public health professional workforce. This will ensure that, regardless of sector or employer, all public health workforces that are currently the responsibility of the NHS education and training system will have continuing oversight through HEE and delivery via LETBs. 32.The Department agrees that it is essential that all public health specialists are suitable for the role for which they are appointed. We are exploring options, including the option of compulsory statutory regulation, for assuring the quality of those appointed as public health specialists. Ministers recently asked for further evidence that might support a case for compulsory statutory regulation. We are currently considering this evidence and we will bring forward proposals very shortly. Integrated Planning 33.Developments in the role and training of any one staff group or profession can have an impact on the whole healthcare team. Healthcare providers and the LETBs will be wellplaced to understand the interactions and take a holistic view across planning for the whole health workforce. Taking a multi-disciplinary approach to workforce planning will be supported by the Centre for Workforce Intelligence (CfWI) and is an integral part of the remit for LETBs and HEE. Allied Health Professional Education and Training 34.The 12 allied health professions make a significant contribution to delivering high quality services for patients and the public, from assessment and diagnosis through to rehabilitation and reablement. HEE will look to build on the work of the National Allied Health Professional Advisory Board and Patients' Forum to continue to demonstrate the contribution the AHP workforce makes to leading and transforming patient-led health care services through delivering better health outcomes and improvements in productivity. 35.The Future Forum has recognised the need to continue to support newly qualified allied health professionals to make the transition from student to practitioner through preceptorship programmes. They have also recognised the role of continued professional development in identifying the leaders of the future and in delivering the clinical research capacity necessary to ensure a robust academic workforce. With this in mind, the National Allied Health Professional Advisory Board will work with the professional bodies 17

18 representing allied health towards a shared framework for post-qualification learning to meet the needs of patients, employers and professionals alike. 18

19 2. Health Education England 36.The NHS Future Forum confirmed that the creation of HEE to provide leadership and oversight to the new education and training system is widely welcomed. There is also general support for HEE s early establishment as an effective organisation, so that it can lead the development of the new arrangements for shaping the health and public health workforce, and form strong partnerships with all the relevant parties. HEE will be established as a Special Health Authority (SpHA) in June 2012, taking on some functions in October 2012 and ready to take on full operational functions from April In due course, we plan to consolidate HEE by establishing it in primary legislation as a Non Departmental Public Body (NDPB). This will enable HEE to operate on a permanent statutory basis at arms-length from the Department of Health, whilst remaining accountable to the Secretary of State. We intend to publish draft clauses for pre-legislative scrutiny in the second Parliamentary session. We then intend to legislate to establish the NDPB as soon as Parliamentary time allows. 38.This section sets out: a description of HEE s main functions the approach to governance and the advisory structure, its operating model and key relationships the authorisation and accountability framework for HEE s work with the LETBs. Purpose and Functions 39.The purpose of HEE is: To ensure that the health workforce has the right skills, behaviours and training, and is available in the right numbers, to support the delivery of excellent healthcare and health improvement. 40.The key national functions for HEE are summarised as follows: providing national leadership on planning and developing the healthcare and public health workforce; authorising and supporting the development of LETBs; promoting high quality education and training responsive to the changing needs of patients and local communities. This includes responsibility for ensuring the effective delivery of important national functions such as medical trainee recruitment; allocating and accounting for NHS education and training resources and the outcomes achieved; ensuring the security of supply of the professionally qualified clinical workforce. 19

20 41.In describing the functions of HEE, it is important to state that it is being established in the context of a new system in which local freedom and real provider leadership are crucial. There needs to be a proper balance of national and local leadership and decision making. As part of its formal agreement with the Department, HEE will be required to support and enable greater local responsibility and accountability for decision making, in order to build a system that is responsive to the needs of employers, the public and the service at local level. Local autonomy will need to reflect HEE s role to ensure value for money, the quality of education and training, and the longer-term sustainability, both nationally and locally, of the supply of healthcare and public health professionals. 42.In its national leadership role, HEE will lead on workforce planning nationally and managing funding flows. HEE s task will be to bring together the interests of healthcare providers, patients, commissioners, the education sector, the professions and staff to oversee and shape the development of the public health and healthcare workforce. Its primary focus will be on professionally qualified healthcare and public health staff whose education and training is funded through the 4.9b Multi-professional Education and Training (MPET) budget. HEE will be accountable for securing the best outcomes from this investment to improve the quality and responsiveness of the professional workforce. 43.The scope of HEE, in terms of the range of staff covered, includes the key clinical professions who support and provide services in health and public health. The Department will retain responsibility for oversight of the development of the adult social care workforce. The Department and HEE will work together to ensure that workforce development across health, public health and social care is integrated and that social care services have access to the clinical skills they need, sourced from the health workforce. HEE will include representatives from public health and social care in its advisory structure and ensure that LETBs secure similar advice so that workforce development across the three systems is integrated and complementary. 44.It is essential that the development and shaping of the professional workforce takes place within the overall context of the whole workforce. The NHS Future Forum reiterated messages from the consultation on the new system of the importance of developing the whole health workforce, through integrated planning and investment in lifelong learning and development, in order to support effective team working. This message was also stressed by stakeholders during the consultation. HEE will therefore take a wider leadership role in relation to the development of the whole health workforce engaged in the delivery of healthcare and public health. 45.As the NHS Constitution states, employers have responsibility for investment in the skills and development of the people they employ. HEE s role will be to provide leadership and ensure greater transparency in the investment employers make in their workforce. HEE will also have scope to allocate a limited amount of central funding for LETBs to invest in Continuing Professional Development (CPD) to support innovation and in developing the wider healthcare team, particularly those employed at Agenda for Change bands 1-4 in the NHS and equivalent staff employed as of part of primary care teams in general practice, community pharmacy and other community based employers. 46.HEE will also be responsible for certain national education and support functions. These will include oversight of recruitment to some education programmes, including medical recruitment. It will also have responsibility for the development of UK wide commissioning and recruitment arrangements; for example for healthcare scientists as well as for some 20

21 other small professions; NHS Careers; and access to national content for e-learning and national commissioning and quality monitoring arrangements for small specialist groups in the workforce. These are all areas that require national oversight and direction and where there is significant support from the professions, employers, staff and students for a national approach. Once the new education and training system is fully established, HEE will be able to consider to what extent they can be devolved. Governance and Advisory Structure 47.HEE will operate as a SpHA in the first instance, fully operational from April 2013, and accountable to the Secretary of State. HEE will need strong financial systems and governance in place to oversee and account for the investment and allocation of the MPET budget. 48.Central to HEE s success will be a strong partnership with employers, through the LETBs. The expertise, leadership and input of the health and public health professions will also be crucial. Equally, commissioners, patients and service users must all have an effective voice in the development of professional education and training and workforce planning. HEE s governance is being developed to reflect this and enable it to carry the confidence of all its stakeholders. 49.The HEE Board will be relatively small and constituted in line with usual arrangements for a SpHA with a significant budget. HEE will have a chief executive and a Board chair with at least 5 non-executive members. Their key purpose will be to ensure effective governance, consistent with Nolan Principles; to hold HEE executives to account; and to contribute to the success of HEE s key external relationships. The chair and non-executive members of the HEE Board will be independently appointed on the basis of their expertise and skills and will not be there to represent particular organisations or professions. 50.As part of its working relationship with the LETBs, HEE will work with them to jointly create a partnership group at national level that brings LETB representatives together. This will provide a forum for collaborative work to develop joint action and responses to national issues so that there is complete alignment between local focus on workforce development and needs of providers on the one hand and the national overview and activities on the other. 51.Building on the progress made by MEE and its Programme Boards, and by the Professional Advisory Boards (PABs), HEE will also set up a similar advisory structure to provide professional input and bring together all the stakeholder groups, including significant membership by providers of NHS and public health funded services. This comprehensive advisory structure will involve representation from the service and education sector, alongside lay and staff representatives, the professional bodies, regulators, educators and service commissioners. 52.The experience of working with MEE and the PABs has demonstrated the value that is added by the input of lay representatives and their perspectives on the education and training of the workforce. Alongside the professional advisory structure, it is therefore proposed that a lay/patients forum is created to advise HEE, whose members will provide input to the range of its new advisory structures. 21