Found wanting

Published: 21/02/2002, Volume II2, No. 5792 Page 7 9

The NHS plan seemed to offer a new era in which staff, rather than money or structures, would be the focus of attention.

Yet just 18 months later, money is a hotter topic than ever, the NHS is in the throes of the biggest structural upheaval in its history and real progress on staff issues is hard to find.

Some training-related promises seem to have simply fallen off the agenda. Who now remembers that all staff were to show competence in communication skills as a 'pre-condition of qualification to deliver patient care in the NHS' by this April?

Others have yet to deliver much that is tangible. For example, the NHS plan said that all NHS organisations should have pledged to achieve the Improving Working Lives standard by April last year.

Trusts met the deadline for pledging to meet the standard, but organisations facing 'major reorganisation' were given more time. All NHS employer organisations are supposed to implement the standard by next April.

NHS Confederation policy manager Alastair Henderson says there is some anecdotal evidence that trusts implementing the Improving Working Lives standard and flexible working are seeing benefits in terms of staff retention. But strategic health authorities and fledgling primary care trusts are 'acutely aware of the tight deadlines'.

'Training and development issues are no more but no less at risk than other initiatives when there are pressures on resources, as there are in PCTs, ' Mr Henderson says.

'We have been saying all along that management capacity is severely lacking.'

Meanwhile, the latest strategy to emerge from the Department of Health says they should also hold, or be pursuing, Investors in People accreditation and a raft of other initiatives (see box).

The human resources strategy that followed the NHS plan said all staff should have training and personal development plans linked to a system of appraisal by April last year. The DoH claims 'most' professional staff have PDPs and it now wants all staff to have them by the end of this year. Martin Lewis, who speaks for the Association of Healthcare Human Resource Management on training and development issues, says there are 'historical' reasons for slow progress on PDPs.

'Historically, PDPs were very much something for the individual and the individual's professional body, ' he says. 'It is only because of the new agenda that they are being seen as a management issue and it has taken a little time for the message to get through.

'We [North Bristol Healthcare trust, where Mr Lewis is training and development manager] have found that the number of appraisals has increased, and some areas are getting near 100 per cent. Our assumption is that if appraisals are happening, PDPs are following on behind.'

PDPs are only part of the picture, however. The government wants to see a 'skills escalator' developed, along which staff can progress throughout their careers.

But this concept needs to be linked to the NHS-wide job evaluation scheme, that in turn is linked to the overall reform of NHS pay.

And further progress on a new pay structure for the NHS now depends on the government's latest comprehensive spending review: which will not report until later this year.

Complicating the picture further is performance-related pay, which the government seems to want to link to teams, rather than individuals.

'Team' has yet to be defined.

Anne Eaton, Royal College of Nursing vocational qualifications and education adviser, says the whole area is a 'minefield'.

One of the big promises made in the NHS plan was that all staff without professional qualifications would get access to national vocational qualifications to level two and three, or an individual learning account worth£150.

ILAs were a Department for Education and Employment (now Department for Education and Skills) initiative. It was abandoned in November as the police were called in to 'investigate alleged theft and fraud'.

A DoH spokesperson said that the NHS version - now called NHS Learning Accounts - has been set up 'in a different manner, taking account of what happened'.

However, Ms Eaton says NHS staff who have tried to access ILAs have found that£150 does not buy much and there can be 'inappropriate limitations' on what it can be used for. The whole idea needs to be rethought, she suggests - starting with people's learning needs.

NVQs themselves, meanwhile, are under review.

The Working Together, Learning Together strategy says the DoH is working with health and social care national training organisations to make them simpler and more relevant.

Communication remains one of the 'core skills and knowledge' that the strategy wants the NHS University to develop - but it will not be established until 2003.

The Leadership Centre for Health, promised by the NHS plan to target 'people running service departments', has been set up but seems to have spent most of the year establishing 'core values' and working out how it sits alongside the NHS University. A further set-back came just before Christmas, when director Barbara Harris announced she was standing down after a period on leave that followed a critical Commission for Health Improvement report on leadership at her former trust.

Indeed, one of the most tangible things to emerge over the past 18 months is the strategy Working Together, Learning Together. Billed as a five-year strategy for lifelong learning, this attracted little attention, even though it is undoubtedly ambitious and sets tight deadlines.

Mr Lewis is optimistic about training and development in general. 'There has been progress, ' he says.

'Because of the NHS plan and continuing professional development, there is an agenda for staff development that is closely linked to the big agenda for the first time.

'The requirements are substantial - we all have a challenging workload - but what we are doing is much more closely focused on the big picture than it was in the past.'

He is even more enthusiastic about the lifelong learning strategy, describing it as 'comprehensive', a 'whole systems approach' and 'genuinely joined up'.

'I am particularly keen on the idea of a skills escalator, ' he adds. 'Some of our future nurses are certainly among our current auxiliary staff. We have to be able to train all our staff equitably. It is a moral, as well as an economic and business, issue.'

But there are plenty of questions to be answered.

For example, the strategy talks about the NHS - yet 25 per cent of registered nurses work outside the NHS, in nursing homes and other settings. Are they going to be included? And what about staff working for contractedout organisations, private hospitals or even foreign hospitals, where NHS patients can now be treated?

Will there be managerial, financial and time support for people wanting to take advantage of lifelong learning opportunities? And is the government's reliance on new technology to deliver these realistic?

'It assumes people have IT skills and not everybody does, ' says Ms Eaton. 'More people are getting these skills, but we have to be realistic.'

A touch of class: lifelong learning in the NHS Working Together, Learning Together, the 'first ever strategy for lifelong learning in the NHS', contains a mixture of old and new promises and new targets for employer organisations.

By July 2002: they should have 'a clear organisational strategy and annual plan for education, training and development' linked to the modernisation and clinical governance agendas and local workforce planning.

By December 2002: they should have appraised staff, put personal development plans in place, published 'comparative information' on education and training, demonstrated that staff have 'equitable' and 'flexible' access to learning and library resources, be promoting national adult literacy and numeracy targets and have developed a five-year e-learning strategy.

By 2003: they should hold Improving Working Lives and hold or be working towards Investors in People accreditation, provide 'comprehensive and corporate induction training', ensure 'in so far as is practicable' that contract and agency staff get the same opportunities as their own staff and ensure that all staff can develop IT skills.

By 2004: they should be operating the 'skills escalator' in which staff can acquire new skills and competencies - and see their careers and pay progress as they do so.

The Department of Health, strategic health authorities, education providers and other organisations are given specific tasks, such as establishing the NHSU. Individuals are urged to 'seek opportunities' to participate in personal learning, agree personal development plans with their line managers and 'take responsibility' for supporting others.

www. doh. gov. uk/lifelonglearning/