Tony Blair said he wants to turn the NHS into a 21stcentury service: one that puts patients first. But you do not change a 1940s culture overnight.
Turning a workforce that may well be disenchanted with the health service, tired of the bureaucratic systems and cowed by the oldfashioned hierarchy into a bunch of motivated, selfstarting individuals will take time, money - and training.
The government is the first to acknowledge the problems.
The NHS human resources strategy makes development of the workforce a priority, stating that providing 'personal and professional development and training opportunities for staff regardless of their work patterns' is one of six things a 'good' employer will do.
The NHS plan reiterates that it is essential for NHS employers to 'provide opportunities for individual staff to progress their careers'.
The resulting cascade of targets suggests the government hopes working culture in the NHS can be pulled 50 years into the present by initiative and deadline.
The human resources strategy gives employers until April to agree a deadline for all staff to have training and development plans linked to a system of appraisal. They should also be talking to education consortia about specialist training, putting leadership development plans in place and developing 'flexible learning pathways' that encourage teamworking.
The NHS plan promises more medical, nursing and midwifery places, more return-to-practice courses and investment in training and development for existing staff.
Some£140m will be invested by 2003-04, delivering more workplace support for clinical governance and revalidation and access to National Vocational Qualifications and new individual learning accounts. Plus, there will be a new Leadership Centre For Health, targeted at people running service departments.
David Amos, head of NHS employment, believes all this is 'essential if you are going to deliver longer-term cultural changes'. It will be 'crucial' to involve all groups of staff and mix staff groups together. But he says the NHS must not lose sight of the new emphasis on recognising the need for work-life balance.
'Improving Working Lives is saying that staff do have other things to do with their lives, ' says Mr Amos. 'You can have that but at the same time have staff who are as motivated as possible when they are at work. That can come from feeling they are being properly rewarded through to feeling they are respected and have a worthwhile job. It doesn't mean they have to make work their whole life. '
Meeting all the training priorities is a pretty tall order, given the plethora of priorities the NHS now has.
But Sally Storey, president of the Association of Healthcare Human Resource Continued from page 3 Management, is quietly confident. 'It sits very well with the strategies people have being working with over a number of years, ' she says. 'We need to recognise the value this contributes to improving patient care. '
Her trust, Bournewood Community and Mental Health trust in Surrey, is already working to improve training opportunities for care support staff. 'We have set up a network between ourselves, social services and local residential and nursing homes and three local colleges, ' she says. 'We are looking at offering people placements who are on care and related courses. We are also extending our work as an NVQ centre. We are encouraging people to develop themselves, making sure they all have a personal development plan. '
Amid the enthusiasm, a few practical issues need resolving.
Keith Holdaway, chair of the continuing professional development sub-group at the South West London and Epsom education consortium, points out that the consortia are 'completely restructuring and forming confederations'.
New chief executives are due to be appointed by April. 'It is one more thing to worry about and the capacity is not there to deal with it very quickly, ' he admits. On the plus side, the confederations will cover clinical and nonclinical staff. Mr Holdaway feels: 'It is often about repackaging courses that already exist so they appeal to a wider audience, then redesigning them to include multidisciplinary working. '
The link between training and appraisal could be a thornier issue. Paul Marks, Unison national secretary for health, does not want annual training appraisals to lead to performance-related pay. He says: 'The idea that employers should be under an obligation to develop their staff is welcome, but we must not be coercive about that by saying how much money you have at the end of the day depends on what you have done. '
However, Unison backs moves to ensure people are 'constantly learning and developing themselves', particularly those such as ancillary and administrative staff. This could be another thorny issue. Kingsmill Centre for Health Care Services trust, Nottingham, has instigated training for bank nurses, but it is unclear whether such initiatives will be the norm.
Will cleaning companies have to provide training to meet the government's requirements?
Will trusts offer places to agency staff on their courses?
In his introduction to the NHS plan, health secretary Alan Milburn acknowledges it will take time to recruit and train staff. However, the plan pushes home the message that staff must be supported to deliver patient-centred care.
Now the NHS has to deliver.