Council of Deans of Health – follow up response to NHS future forum on
education and training
1.
The Council of Deans of Health is the representative voice of UK
University health faculties providing education and research for
healthcare professionals.
2.
The Council plays an influential leadership role in improving health
outcomes through its integral role in developing an expert health
professional workforce (including nurses, midwives and Allied health
professionals) utilising its collective expertise to inform innovative
educational practice and translational research.
3.
The Council of Deans of Health aims to Lead and inform health, higher
education and research policies that impact on the development of an
expert healthcare professional workforce and improved health
outcomes across the UK and internationally. We represent the 85
Universities delivering health professional education in the UK.
4.
The Council of Deans of Health welcomes the opportunity to provide
further input into the future forums deliberations on education. It is right
that education and training continues to be seen as a key element of
the Government health reforms.
5.
Our understanding is that the future education and training proposals,
in response to both the consultation in the year and the future forums
deliberations, will be published in the autumn. We assume that this will
be a period of time after October 18th which is of course the deadline to
respond to these questions.
6.
Before turning to specific questions, the Council of Deans of Health
would emphasise that the consultation and engagement process
should not end when the autumn documentation is published. It is likely
that the proposals will introduce significant changes to workforce
planning, education and training contracting and commissioning, CPD,
quality outcomes for education, tariff and levy as well as establishing
new local education and training boards and HEE. This system will
take time to bed down and will not become fully operational for another
18 months. Therefore it will be vital that HEIs, as key co-producers of
the NHS workforce as significant employers of health and social care
professionals and as generators of vital translational research are able
to have a central role in developing and commenting on future
proposals beyond the autumn and throughout the transition stages.
7.
We would also want to take this opportunity to note the recent press
coverage (particularly in The Times) in relation to nursing education
and concerns about nurses receiving too much academic content and
not enough practical experience during their pre registration courses.
We would emphasise that universities ensure that students entering
the profession have the appropriate blend of personal attributes such
as caring along with the necessary knowledge and skills to deliver high
quality evidenced-based nursing care for patients. In considering
nursing education and training more broadly, we would advocate the
need to consider the post qualification pathways for recently registered
nurses and the importance of continued professional development.
Education and training must not stop at the point of registration and to
ensure that we develop a well educated and compassionate workforce
it will be vital that the new system of education and training can
encourage
7.
The forum has asked the overarching question ‘how can we make sure
that we have the right incentives and accountabilities for developing the
healthcare workforce to enable the delivery of world class, patientcentred healthcare’ and sets out a number of sub questions. We have
therefore tried to address this central question within our responses to
these questions.
8.
We have also set out the 6 key principles that we consider are vital for
the new system of education and training in England. We hope that the
education and training forum will be able to reflect on these key
principles with their deliberations. These principle are elaborated upon
within our responses to the individual questions but are set out below;
Council of Deans of Health – Key principles for new education and
training system

Agreement on a statement of effective partnership between the NHS
and Universities, advocating the role of university led health
professional education in improving patient outcomes through coproduction of the workforce. This would be renewed every five years,
agreed at national level and would form an integral part of the
monitoring arrangements between HEE and LETBs. (drawing on
HENSE partnership document)

Workforce planning at a local and national level must be truly multiprofessional and avoid professional silos, both in relation to funding
and the structures and governance arrangements that underpin
workforce planning.

Sustainable education commissioning informed by evidence-based,
medium to long term workforce planning and which includes funding
and administration for clinical academic and research pathways at a
national level.

Representation of both non medical and medical education on the
board of LETBs to ensure effective co-production of the healthcare
workforce. To avoid conflicts of interests (which will apply to teaching
hospitals as well as Universities), commissioning sub committees
should be set up to deal with commissioning issues within LETBs.

The development of non-medical post-registration career pathways, to
facilitate a continuous culture of learning and development and to
support the delivery of new pathways of care.

Ring-fenced funding of the overall health education and training budget
and a continuation of a nationally negotiated benchmark price for
health professional education.
9.
If you wish to discuss this paper further please contact Matthew
Hamilton on 0207 210 5421
Council of Deans of Health
28th October 2011
Council of Deans of Health – response to individual questions from
Education and Training Forum
How can we ensure that education and training in the new system is
flexible and fit-for-purpose for the new way that care is delivered and
enables training beyond the job, for example stimulating a culture of
continuing professional development or academic and research
development?
One of the fundamental challenges for the new education and training system
will be whether it can truly ensure the co-production of a workforce which can
deliver ‘the new way that care is delivered’. The nature of care is changing,
with an increased focus on care being delivered in community settings and in
ensuring prevention and improved patients outcomes. With increasing
numbers of individuals managing long term conditions and more patients
rightly wanting to take an increased role in their own care, it will be vital that
the future workforce can mirror the increasing focus on public health. The
Council of Deans of Health would emphasise the importance of the new
education and training system being multi-professional, both in the systems
that are set up and in the structures and governance arrangements that will
underpin the system. If decisions on workforce planning and education are
made in professional silos, then it will not be possible for the education and
training system to be flexible and fit for purpose.
In relation to stimulating a culture of continuing professional development, the
Council of Deans of Health believes that there should be clear definition of
what is meant by continuing professional development (CPD) as well as post
qualification education. If MPET is to continue to fund junior doctors salaries
and postgraduate placements/training then this should also extend to non
medical education in areas such as postgraduate training and preceptorships
Funding arrangements for CPD and postgraduate education will therefore be
crucial in stimulating a culture of CPD. Consideration must be given as to the
funding of postgraduate programmes for non medical programmes being part
of a central bundle of funding, which is administered centrally. Additionally
there are many aspects of traditional CPD funding which we consider must be
captured centrally within the MPET.
These include post registration career pathways for non medical education
which are crucial in developing the educators of tomorrow. There must be
funding for non-medical post-registration career pathways and HEIs need to
be involved in the structuring of these pathways. For example, Diagnostic
radiographers currently work in a variety of screening programmes, such as
breast, foetal anomaly/Downs and aortic aneurysm screening, where
radiographers and sonographers play major parts; and bowel and physical
examination of newborns, where they have roles in secondary screening
procedures. The diagnostic radiographers involved in these screening
programmes work across screening and symptomatic services. The funding
for post-registration career pathways that allow diagnostic radiographers to
take part in such programmes is currently provided by SHAs. We are very
concerned that the funding for such programmes would be lost in transition. It
is essential that the funding for non-medical post-registration pathways such
as these is reflected in new multi-professional funding arrangements just as
the funding for the medical careers is equally protected and distinct from CPD
funding.
More widely we believe that professional development for healthcare
professionals, which is a core part of ensuring safe high quality care with
improved patients outcomes, must be funded through MPET to ensure that
the continued professional development of the professions is not lost. A
specific example of what needs to be captured via MPET is independent
prescribing for nurses. We would consider that nationally it is strategically
important for the numbers of nurse prescribers to increase and therefore it is
appropriate that such training is funded at a national level rather than relying
on pockets of funding for certain areas of the country. There are many other
examples and we therefore feel that the definition of MPET should be broad
enough to capture centrally funded CPD, where there is a strategic national
need to.
In addition to ensure equity, preceptorships should also be funded nationally
for non medical education graduates to ensure principles of equity and multiprofessionalism can be upheld if postgraduate medicine remains part of
MPET.
We welcome the commitment that there must be a duty on the SofS to
promote a comprehensive education and training system. We would
additionally recommend that this duty should make reference to the SofS
having a duty to promote CPD and postgraduate education and that this duty
should also extend to NHS Foundation Trusts and Health and well being
boards.
How can we ensure the right balance of responsibilities and
accountability and line of sight throughout the new system (for example,
Health Education England and the provider-led networks, employers /
professions / education sector, whole workforce) including for research
training?
The proposed relationship between HEE and local skills networks is at
present unclear. There could be a tension between the short-to-medium term
priorities that LSNs would see as their responsibility and the medium-to-longer
term perspective that HEE should take. If HEE is to have a medium-to-long
term view of workforce planning (which we fully support) then there must be
greater clarification over the powers that HEE will have over local skills
networks. For example, if the 4,200 health visitor target was not being
delivered through the local skill network commissioning plans, what powers
would HEE have to ensure that this was delivered? The Council of Deans of
Health would advocate a power of direction for HEE over local skills networks
to ensure that wider workforce needs can be met. HEE will need to exercise
strong and consistent governance. There will also be a need for HEE to
review the performance of local skills networks and that this should include
considering the effectiveness of partnership arrangements.
HEE must also be equipped to take forward issues at a national level which
are appropriate for them to do so (such as national funding/commissioning of
smaller professions and clinical academic pathways).
How do we best ensure an effective partnership with health, education
and research at a local level?
A true partnership must be manifest in all elements of the new system, from
the operation and constitution of Health Education England (HEE) to the
mechanics of contracts and commissioning. Equally this should extend to the
commissioning of NHS services through consortia and the NHS
Commissioning Board. We would also advocate that HEIs should be an
integral part of LETBs rather than just being held to account by them.
HEIs are not simply providers of education programmes but also co-producers
of the workforce through their wider role in research, innovation, releasing
social capital, and the globalisation of health care which is integral to the
development of advanced clinical care, service redesign and workforce
planning. HEIs should work in co-production with the NHS to ensure the
delivery of high quality education and training and then be held to account by
HEE. By ensuring HEIs are part of the LETB, this will facilitate effective
partnerships and improved quality outcomes.
Universities must therefore continue to play an integral and leading part in the
new system, working in co-production with NHS providers to co-design,
deliver and develop an expert workforce that can meet the future care
challenges and deliver high quality care for patients.
The education and training proposals offer a real opportunity to establish
effective and wide ranging partnerships between health, social care,
education and research at a local level. Instead of maintaining the old
fashioned provider/commissioner split between the NHS and Universities
there is a real opportunity to ensure the development of more effective
partnerships through co-production of the workforce. We would therefore
advocate the following specific proposals in order to ensure effective
partnership;
a)
Agreement on a statement of effective partnership principles between
the NHS and Universities, renewed every five years which would be agreed at
a national level and would form part of the monitoring arrangements between
HEE and LETBS and . This would draw on the HENSE collaboration
document agreed in 2010.
b)
Representation of both non medical and medical education on the
board of LETBs. To avoid conflicts of interests (which will apply to teaching
hospitals as well as Universities), commissioning sub committees should be
set up to deal with commissioning issues.
c)
local education and training boards could be renamed local education,
research and training boards to emphasise the importance of research in new
partnerships
How can we ensure appropriate and effective patient and public
engagement in the new system?
The Council of Deans of Health would welcome patient and public
engagement within the education and training system. This is particularly
important in giving a voice to the local population to hold local education and
training board (LETB) to account in ensuring that the local population has the
right numbers of NHS health professional staff to support healthcare within
the locality of the LETB. They should also be held to account to ensure
effective continued professional development and postgraduate education as
appropriate.
To ensure effective patient and public engagement at a local level we would
recommend that there is a patient representative on the board of HEE, who
will be responsible for overseeing the suitability and performance of LETBs.
How can we improve information on the quality of education and
training and what should be the roles and accountabilities of the key
players in this?
Information of the quality of education and training should focus on outcomes
and be able to measure the competence of staff of all professional
backgrounds. The Council of Deans of Health would strongly advocate one
clear and consistent framework for information on quality of education and
training which is used by all LETBs to ensure meaningful comparison and to
avoid unnecessary duplication. We therefore support the development of an
education outcomes framework providing this can utilise existing information
where-ever possible. We have set our response to the informal consultation
on draft Education and Training Outcomes framework in more detail in Annex
A.
ANNEX A
Council of Deans of Health (CODH) response to the informal
consultation on the Draft Education Outcomes Framework
1. The Council of Deans of Health is the representative voice of the UK
university health faculties providing education and research for
healthcare professionals. The Council plays an influential leadership
role in improving health outcomes through its integral role in developing
an expert health professional workforce and utilises its collective
expertise to inform innovative educational practice and translational
research.
2. We welcome the opportunity to comment on the draft outcomes
framework at this early stage. We will continue to feed into the
framework via the reference group and we would encourage those
leading on this important work-stream to continue the regular
consultation and feedback during the transition period to the new
system.
3. The Council of Deans of Health welcomes, in principle, the concept of
an Education Outcomes Framework. We agree that the ongoing
education and training of the whole workforce is a crucial element of
improving patient outcomes. By focusing on outcomes the framework
will help to embed the notion of the importance of education and
training in improving the quality of care. Going forward it be will be
important to clarify exactly how outcomes will be measured within the
new system and how the framework will capture all those responsible
for education and training.
4. There is much to welcome within the draft. We particularly welcome the
fact that the draft domains refer to the importance of ‘promoting
professional development and research’, ‘effective team and
interdisciplinary working’ and respond to changing service domains’
and excellence of student learning experience. All of these are
fundamental in developing a multi-professional education and training
system which also recognises the importance and benefit of research
and innovation. Equally we welcome the alignment of the high level
education outcomes with the patient outcomes for public health NHS
and social care. This .reflects the need for education and training to
prepare a flexible workforce which can promotes health outcomes and
ensures high quality person /patient focused care across the interfaces
of health and social care. This is particularly case for those professions
that the CODH represents, which are increasingly employed and
deliver interventions in diverse agencies across health and social care
5. In relation to our response to this informal consultation, we have set out
a number of high level principles in relation to the draft framework and
reflected how the framework may best reflect these. These are
followed by some specific commentary on the slides and
accompanying documentation.
6. Responsibilities of both HEIs and the NHS in education provision
In order for the new education and training system to be effective it will
be crucial that the future and existing workforce is able to continuously
improve. HEIs have a vital role in this, which is reflected in the
education and outcomes framework. However currently we feel that the
framework is drafted in a way that only considers education and
training in relation to the preparation of individuals to provide high
quality care. The framework could therefore better reflect whether
those individuals are part of an NHS organisation which fosters a
learning environment in which the continuous development and
improvement of both individuals and high performing teams is valued
and in which clear post-qualification career pathways are identified for
all professions. Separately, we would stress the importance of there
being a clear articulation of how clinical academic pathways will be
taken forward within the new system as this will be a key issue in
delivering the overarching ambition of the education outcomes
framework without which this will be difficult to achieve.
Equally in relation to both Continuing Professional Development and
practice placements a great deal of education and training is carried
out within NHS settings. Currently Slide 6 suggests that LETBs will
hold just education providers to account. We would emphasise the
importance of this extending to service providers and that this should
factor in the culture of education and training within a specific NHS
organisation. The draft framework refers to one potential indicator,
being board level engagement in education and training, which is to be
welcomed but we would recommend that this is extended to cultural
issues such as shared ownership and partnership working with HEIs as
well as process issues.
7. Putting University and NHS partnerships at the heart of the
education and outcomes framework
The consultation document on education and training, as well as the
future forum response, emphasises the importance of effective
partnership and engagement between the NHS and HEIs in ensuring
education quality. We would agree. Currently the draft domains that
HEE would use to hold LETBs to account do not refer to evidence of
effective partnership working between the NHS and HEIs. This will be
crucial if the new system is to be successful. The CODH would
advocate that there should be a specific domain for these partnerships,
utilising an updated version of the HENSE protocol as a way of
measuring performance within this area and that this partnership is
inherent at all levels of the new education and training system.
We would also advocate that HEIs should be part of the LETBs rather
than just being held to account by them. HEIs are not simply providers
of education programmes but also co-producers of the workforce
through their wider role in research, innovation, releasing social capital,
and the globalisation of health care which is integral to the
development of advanced clinical care, service redesign and workforce
planning. HEIs should work in co-production with the NHS to ensure
the delivery of high quality education and training and then be held to
account by HEE. By ensuring HEIs are part of the LETB will facilitate
effective partnerships and improved quality outcomes.
HEE will also be held to account in relation to the outcomes by the
Secretary of State. A vital outcome will be to ensure the sustainability
of the University sector both in relation to teaching and research which
should be reflected within the outcomes.
8. Avoiding duplication and ensuring value for money
Whilst the framework has a logical structure and is clearly linked to
clinical outcomes, it will be vital that we use this opportunity to end
duplication of reporting once and for all. Universities delivering health
professional education currently undergo internal QAA, annual
performance monitoring by regulators and approval events through the
regulators for all regulated courses. The education and training
consultation emphasised the importance of ensuring value for money
within the system and this needs to be reflected in the monitoring
arrangements with an emphasis on streamlining existing QA
requirement and avoiding duplication.
The new education outcomes framework should not just be overlaid
onto the existing system of reporting. It will be important that there is a
systematic review of standards, monitoring and indicators to ensure
that there is no duplication and that each element for which an HEI is
held to account is at the appropriate level. For example, it will be
important to clarify how the professional regulator’s role in monitoring
standards and the domain measurement to ‘meet standards set by
independent regulatory/statutory bodies’ would work in practice.
Equally as the NHS will be key partners in education in relation to the
delivery of practice based education, it will also be important to reflect
on the QAA requirements of the framework for the NHS and how they
interact with other NHS QA and regulatory requirements in relation to
CQC, Monitor etc.
More broadly we would welcome clarification that the education
outcomes framework should be the way in which HEIs are held to
account. There is a danger, with the introduction of more LETBs, that
HEIs may be held to account in different ways leading to a further
information burden. If HEE is to be able to hold LETBS to account then
there does need to be consistency of approach within the framework
and all partners involved in healthcare education need to be clear
about the respective QA frameworks and the interactions between
them.
9. Fostering a multi-professional approach to education and training
A key success criterion for the outcomes framework will be the extent
to which it encourages a multi-professional approach to education and
training. We therefore welcome the focus on the domains to promote
interdisciplinary working and the need to respond to changing service
needs. The outcomes measurement refers to ‘individuals and
professional groups aligned to workforce demand’. This is somewhat
unclear and it would be helpful, in line with the importance set out in
previous document to ensure a multi-professional approach, if there
was a direct reference to promoting a multi-professional approach.
10. Specific text proposals
We would make the following specific text proposals
Aim
The aim should refer to a patient centred multi-professional
workforce
Outcomes

The outcomes refer to competent and capable staff, but the aim
only refers to capable. There should be consistency and
references to both in the competent and capable.

The outcomes individual and professional group aligned to
workforce demand should be clarified in relation to multiprofessional groups aligned to workforce demand

There should be an additional outcome in relation to HEE being
held to account for the sustainability of the health professional
education sector.
Domains


Effective partnership working between the NHS and HEIs should
be an additional domain
The second outcome should be revised to say promote
professional development, professional and clinical academic
career pathways, research and innovation
The domain ‘promote effective team and interdisciplinary working should be
revised to say ‘ multi-professional working’ to ensure a whole workforce
approach