Public sector austerity is not an excuse to cut back on training and appraisals but a reason to forge ahead with them and make organisations stronger, writes Alison Moore

The climate may be cold but investing in training and development could be one of the ways NHS organisations weather the financial storm of the next few years.

“If you want well motivated staff they need to understand that their organisation values them”

Geoff Winnard, head of Agenda for Change and non-medical pay at NHS Employers, says training budgets should not be seen as an easy target for savings.

“Training and development opportunities can pay dividends in terms of motivating staff in difficult times, especially when there may not be much in terms of pay awards. Employers need to learn the lessons of the past - there is a business case for continuing to invest in training and development. That will help them through the challenges to come.”

With new roles likely to develop within healthcare teams, and new ways of working such as offering care closer to the patient, existing staff will need support to develop skills and confidence to cope with these changes and deliver better care more efficiently. And at a time when NHS recruitment is likely to be limited, “growing” the existing workforce will be important in retention. It can be attractive to potential recruits in a labour market where the NHS will have to compete with private companies which are beginning to emerge from the recession.

Mr Winnard says board leadership is important in keeping training and development on the agenda. “If the board is committed to this, it happens. There is a need for leadership in organisations to deliver this,” he argues.

Training and development is also a key part of the NHS constitution, which commits the health service to:

  • providing all staff with personal development, access to appropriate training for their jobs and line management support to succeed;
  • giving staff clear roles and responsibilities.

Mr Winnard says training and development should be available to all staff and those in Agenda for Change grades one to four should not be forgotten. They are the people whose roles can be developed to take on work previously done by fully qualified healthcare professionals, freeing up their time.

He stresses the importance of thinking about what skills will be needed in future - as well as those needed more immediately - and how they will be supplied.

Beyond the tick-box

“Employers have a responsibility to ensure their staff have attitudes and skills to deliver care in a safe and appropriate manner,” he says.

A key part of training and development is the appraisal system, which allows for the identification of training needs and agreement on a personal development plan (PDP) for each member of staff. While the NHS has traditionally struggled to ensure that all staff are appraised, the 2009 staff survey showed a rise in the percentage of staff appraised from 64 per cent the year before to 69 per cent. PDPs covered 60 per cent of staff, up from 55 per cent.

“It’s fair to say that some organisations need to do more in terms of getting their levels of appraisals high enough,” he says.

“In the past, a number of organisations have struggled with this one. They have suggested that the knowledge and skills framework is complex and bureaucratic. NHS Employers has worked with unions to simplify this. We are hopeful this work will make it less onerous for organisations to achieve their appraisal targets.

“There is an evidence base that appraisals can lead to better staff satisfaction and probably better patient outcomes,” he says. “There is a connection between all of these things. If you want to have a well motivated, content and skilled staff they need to understand that their organisation values them and is taking their needs seriously.”

He urges employers to make appraisals more than a “tick box” system. “Assessing the training needs of your organisation is a core part of how employers should manage training and development,” he says. This should identify the gaps in skills which may need to be filled as part of an organisation’s strategic plans.

Success at Salford Royal Foundation Trust

Salford Royal Foundation Trust has seen its appraisal rate rise from 48 to 78 per cent over three years - putting it definitively in the top tier of trusts.

Staff satisfaction has also risen in the last two NHS staff surveys, and the percentage of staff with a personal development plan leaped from 46 to 64 per cent. Most staff now say their appraisal and personal development plan helps them do their job better.

But this has not come about by accident. The trust has greatly simplified the knowledge and skills framework to help it embed staff training and development in the appraisal process. The trust produces monthly reports on appraisal compliance rates, which are circulated to the board and posted on the trust’s intranet.

In addition to this, the trust has developed a list of training options which are linked to the four knowledge and skills framework areas - attitude, safety, communication and quality.

For example, the options for communication range from support on literacy and numeracy to stress management training for managers. These options are meant to support discussions during appraisal sessions, with practice development and practice trainer teams who can offer guidance.

Most of the trust’s staff training is delivered through “blended” learning programmes comprising elements such as paper based workbooks, e-learning, class based sessions and local competency assessment. This gives staff flexibility on how and when they access training, and helps reduce their time away from the front line.

In addition, an online system allows staff and managers to check training, including mandatory training requirements.

Mary Douglas, head of learning and development at the trust, says the approach has had a direct impact on improving patient services. Investing in developing the assistant and advanced practitioners roles, and improving the prescribing skills of nurses and pharmacists, has freed up clinical time to deliver more effective and efficient patient care.