EDUCATION

Published: 24/02/2005, Volume II5, No. 5944 Page 3 5 7

The swift rise and fall of NHSU stands as a stark warning of the complexities and pitfalls of catering for the training needs of 1.3 million employees. Sally Flood looks at the lessons learned - and what the future holds

Even its very name was a problem from the beginning. Launched in December 2003 amid great fanfare, one of the first things to become obvious about the NHS University, or NHSU, was that it had no right to call itself a university. A retreat to an acronym was not a promising start, and it proved an accurate omen of future problems.

The institution promised to put learning at the heart of the health service and offer training to more than 25,000 NHS employees. A little over a year and£50m later and that mission is in tatters following the announcement by junior health minister Lord Warner that it will cease to exist as an independent body in July.

The announcement was made as part of the government's drive to reduce arm's-length bodies by half. The NHSU will be merged with the Modernisation Agency to form the NHS Institute for Learning, Skills and Innovation (NILSI), employing 300 staff rather than the current 1,500. Some of the NHSU's work will be continued by the new agency, while other projects will be transferred or discontinued.

Confusion over roles and responsibilities Health secretary John Reid said the NHSU no longer met the health and social care needs of today or the future, and there were too many overlapping functions and roles between the two agencies. At a press conference in December, he said: 'This is a vital step in the NHS's long-term programme of reform to improve efficiency and reduce bureaucracy.' The NHSU was the first training body to try to manage NHS training, development and learning needs. Previously, training was provided through relationships with 65 different universities and colleges, together with private training providers and consultants. It also promised to exploit modern technologies to deliver training more cheaply and to more people than ever before.

The NHSU's e-learning was among the best available in the world, says Devrim Celal, head of e-learning services at consulting firm Sapient. Mr Celal believes it was obvious that the NHSU had consulted widely with the industry to ensure that training met the needs of all employees.

'There was a lot of emphasis on making sure things were tailored for all users, from the GP or surgeon to the porter. The development team also took time to really speak with stakeholders and get detailed ethnographic information about them to tailor the content, ' he says.

One of the most important things the NHSU set out to achieve was to open training and development opportunities to junior, clerical and support staff who were previously overlooked by training managers. In the year before the NHSU was set up, 40 per cent of NHS support staff had received no such support.

'I think we have gone a long way to addressing that issue, ' says NHSU communications director Catherine Hastings. 'By providing support workers with skills, they are able to take on new responsibilities and free up nurses to develop their own skills. It is increasing skills, motivation and retention across the NHS.' With the announcement of the NHSU, lowpaid and junior NHS professionals could access training and development for the first time, adds Unison national health secretary Karen Jennings.

'Training in the NHS was traditionally limited to middle and senior managers, but the NHSU offered real equality of access for the first time, ' she says. 'We hope very strongly that the new institute will restate that aim and maintain that commitment in the future.' Certainly, the NHSU's training remit was broad: courses on offer included NHS induction, literacy and language skills, IT awareness, all the way up to specific courses on cleaning and infection control, new surgical techniques and academic qualifications such as special NHS foundation degrees and master's degrees in NHS administration. All NHS staff had the option of 'protected' time off work to study.

A huge and varied task However, the challenges facing the NHSU were enormous. The NHS workforce is not just big - It is diverse. Of 1.3 million employees, nearly a quarter of a million are managers and administrators.

Some 60,000 work in maintenance, 80,000 in scientific services and 20,000 are ambulance staff. Nearly 360,000 new nurses join the NHS every year, and many of its staff come from mixed educational backgrounds: this year 90,000 NHS workers will be offered literacy, numeracy and English skills education, for example.

The challenges of size, infrastructure and funding have combined to create a patchy quality of training across the NHS, says Ms Hastings. 'It is difficult to reach people because so many things cross their desks, if they even have desks, and sometimes you're relying on the most basic of technologies, ' she says.

Some observers doubted the ability of the NHSU to meet the needs of this audience from the outset. 'It was always going to be a major challenge to satisfy such a varied audience, without a doubt, ' says Neil Bindemann, managing director of Primed Communications, a supplier of online medical education packages.

Delivering training within the NHS is particularly challenging because, like many organisations, it is riddled with internal politics, argues Tim Savage, director of training consultancy Toltec Network. Toltec has provided training services to a number of NHS trusts, including Royal Brompton and Harefield, where the firm recently ran a series of programmes on teamwork, communication and crisis management.

'I have always found barriers between departments and functions in the NHS, ' says Mr Savage. 'If you ask people what their roles are, they tend to have quite a narrow view, and do not consider they are part of a wider service that aims to help patients get better and return home.' Another challenge for the NHS is in devising training that meets the needs of staff.

Often, training agendas are set from the top down, and do not take account of less well-trained employees, says Ms Jennings. 'A director at a trust might not see why it is important to provide transforming courses to support workers, such as health and safety, communication and so on, ' she says. 'The NHS has also been poor at organising training that doesn't require people to sacrifice their home or social life to access that service.' The NHSU also faced opposition from some universities and training providers, who feared that an internal training resource would deprive them of lucrative NHS training budgets. 'The NHSU was a big threat to some professional groups and universities, ' argues Ms Jennings.

'There were a lot of people who saw this as 'their' territory and resented the NHSU getting involved.' NHSU staff certainly faced some 'resistance' from universities, Ms Hastings admits. 'There was a question mark over how much the NHSU would upset the market, ' she says. 'But I think people misunderstood what we were doing - we were never going to be some massive organisation taking away their revenues.' So how will the arrival of NILSI in July change training for the NHS's 1.3 million employees?

At present, the NHSU and the Department of Health are not providing any details on what NILSI will look like, or which of the current NHSU projects will be continuing. Any training that is due to take place before July 2005 will go ahead as planned. 'Details of the transition process and key milestones will be published as they are developed, ' according to the DoH. This information is still being negotiated by NILSI's transition team, which is led by Dorset and Somerset strategic health authority chief executive Sir Ian Carruthers and includes representatives from key stakeholders.

The DoH will say that the new agency will improve on the work of the NHSU by providing the NHS with a single agency responsible for service, technology and personnel development. A spokesperson explains: 'The institute will build on the achievements and strengths of the organisations it brings together. The advantages of a new single organisation are that it will allow greater integration of initiatives, and be able to develop a way of working which fits how the NHS will operate in future, not the way it did in the past.' Industry observers hope the agency will continue some of the work started by the NHSU, particularly in providing broad training to junior and support staff. Unison is also pushing for standardised training for emerging NHS professions, to help protect the career paths of NHS employees.

'As the service modernises, We are seeing the emergence of a number of new professions, from physicians' assistants to paramedics, and It is vital that the skills and development in one part of the country have validity nationally, ' says Ms Jennings. 'That is the responsibility of a national training body, and needs to be a priority.' The NILSI project will be headed by former NHSU chief executive Professor Bob Fryer, who will become the DoH's national director for widening participation in learning.

Unison also hopes the new institute will retain independence from individual health authorities.

Returning responsibility for training to individual trusts and health authorities would be catastrophic, Jennings argues. 'One of our biggest concerns about the demise of the NHSU is who will take over responsibility for monitoring how SHAs use their funding, particularly when it comes to discretionary training budgets, ' she says.

'The people who lose out if that is not controlled will be the lower-paid people who are supposed to be being supported and targeted.'

LEARNING THE HARD WAY LIFECYCLE OF THE NHSU

2001 Labour's election manifesto promises a university for the NHS. In November the Department of Health publishes its five-year strategy for training, Working Together, Learning Together.

February 2002 Professor Bob Fryer formally begins his appointment as the NHSU's chief executive.

December 2003 NHSU goes live.

September 2004 HSJ reports that Professor Fryer has written to staff preparing them for a full-scale reorganisation of its 'structures, process and people' as part of the DoH's review of arm'slength bodies.

HSJ reports criticism from a number of workforce development confederations about how the NHSU has operated.

November 2004 Dorset and Somerset strategic health authority chief executive Sir Ian Carruthers is appointed to oversee the creation of a new NHS Institute for Learning, Skills and Innovation by July 2005. Professor Fryer is named as the DoH's national director for widening participation in learning.

The merger of the NHSU and the Modernisation Agency cuts the total staff headcount from 1,500 to 300.

January 2005 The institute's advisory group of 'internationally recognised experts', led by Motorola chair Sir David Brown, meets for the first time.

March 2005 Interim chief executive Sir Ian Carruthers is expected to set out the blueprint for the new institute, with Leadership Centre director Penny Humphris and Modernisation Agency interim director Michael Scott are both involved.

CONTINUING EDUCATION WHAT THE NHSU DID FOR YOUNG PEOPLE

One of the key aims of the NHSU was to encourage people to set out on careers in health and social care. One of the projects created to achieve this goal was Open Road, a junior scholarship providing young people with information and advice on career opportunities in the NHS.

One of the first to take part was 16-year-old Katie Middleton, who used the scheme to learn more about becoming a midwife.

It provided her with an opportunity to see what the job involved, and what skills and qualifications were needed.

'Open Road sounded like a good way to find out more about nursing generally, and I went for an interview, ' says Katie.

Several weeks later, she was offered the opportunity to spend a week on the cardiothoracic ward at Newcastle's Freeman Hospital, developing skills that she couldn't have learned in the classroom.

'I worked with different nurses every day and learned how to make beds, put on bandages and bathe the patients, ' she adds. 'I also observed nurses doing their jobs.' All students taking part in the Open Road programme are assigned mentors, which can make a real difference to the value of the experience.

Mentors will also guide students in finding information in libraries and accessing careers officers and human resources departments.

Since taking part in the programme, Katie says she has a much better understanding of what is involved in a nursing career, and she has learned things that would not have been possible without the programme. 'In a work environment It is totally different, you learn things like the importance of giving people dignity, which you can't learn any other way, ' she says.

The programme has also given Katie more confidence, and she now hopes to build on her experiences by arranging new work placements.

'I still would like to be a midwife, and I think if I do work experience I will be able to make up my mind about what sort of nursing I want to do, ' she says. 'It will make it easier to make the right decision.'

Key points

To cut bureaucracy and costs, the NHSU is merging with the Modernisation Agency to form the NHS Institute for Learning, Skills and Innovation.

The NHSU set out to offer training to all staff, not just clinicians, but the NHS's size and infrastructure made the quality of training patchy.

The DoH says NILSI will provide the NHS with a single body responsible for service, technology and personnel development.