As the final report on Lord Darzi's next stage review draws close, Cynthia Bower examines how Skills for Health is already helping to drive change at a local level

Being a Skills for Health board member has brought an added dimension to my reflections on the Darzi review. The importance of locally led change is emphasised throughout and it strikes me this is mirrored in the approach Skills for Health has adopted ever since its inception in April 2002.

Four years on, following intensive consultation with employers and stakeholders, the first sector skills agreements for health, which identify and prioritise future skills and workforce needs, were published for England and Scotland. Constantly evolving to reflect the pace of change, these comprehensive agreements between employers, stakeholders and Skills for Health set out a blueprint for addressing skills needs across the UK healthcare sector.

With these solid foundations, work has continued in the regions to build on the agreements locally. The East of England has already published its own agreement and the consultation process is under way and/or nearing completion across the rest of England. Each agreement will examine local skills needs; outline existing education and training provision; and put forward strategies for transforming the healthcare workforce in line with patient need.

The importance Skills for Health places on this type of local approach is highlighted in its organisational structure, which was changed at the beginning of this year to give more support to employers and to strengthen local influence. The refocused structure reflects Skills for Health's shift of emphasis from developing products and services into supporting their implementation and giving local employers a stronger voice in determining programmes of work.

Regional role

Skills for Health's regional directors have a central role in supporting initiatives such as the regional joint investment frameworks, which have already resulted in£100m of additional funds being delivered annually into the health service in England to tackle skills gaps and shortages.

Under the new structure - in addition to the directors already in place in Northern Ireland, Scotland and Wales - a director is now based in each English government region. The overarching remit for each one is to build relationships with stakeholders in health, education and economic development; strengthen partnership working; and respond to employer need in order to help deliver improved services and better patient care.

There is an element of "spreading the word" too. Having spent the past few years building the tools and frameworks necessary to help create a flexible, competence-based healthcare workforce, Skills for Health's future emphasis will be on helping employers make the most of these tools. Regional directors and their teams will play a critical role in helping to make this happen.

This is good news indeed for those of us in the NHS who are involved in workforce development. Frankly, we need all the help we can get. The NHS is characterised by its increasing complexity and constant change. By drawing on a nationally recognised bank of competences we can start to reconfigure the NHS workforce and help build the infrastructure needed to flexibly address future patient need.

As health minister Lord Darzi identifies: "Meeting the challenge of being a universal service means the NHS must meet the different needs of everyone. Universal is not the same as uniform. Different places have different and changing needs - and local needs are best met by local solutions."

However, local needs and local solutions require local skills. First and foremost, we need to know where to find those skills within a workforce. Transparency and transferability are the key words, which is why a competence-based approach to workforce development is the best way forward - nationally, regionally and locally. It is consistent, it is flexible, and it works.

I speak from experience. In my own strategic health authority, Skills for Health has been supporting us in our efforts to develop a competence-based workforce. As a result, four exemplar projects are already well under way. And we are not alone. There are examples across the country. In Manchester, waiting times in certain diagnostic areas have been reduced from 35 to 19 weeks. In Berkshire, patient safety at night has been improved. In the Forth Valley, the balance of care in rehabilitation and intermediate has been shifted from acute to community hospitals. The list goes on.

Perhaps, by this time next year, your organisation could be added to that list.

The building blocks are in place. By strengthening its regional presence, Skills for Health will be able to work more closely with stakeholders and employers to help develop practical solutions to workforce issues; solutions that will benefit their organisations, the individuals working for them, and the communities they serve.

I will be doing everything I can to support them. I hope you will too.