Affecting around 1 million NHS staff on Agenda for Change terms and conditions, the Knowledge and Skills Framework is now helping many NHS trusts to achieve their workforce priorities. It supports them in re-designing their services, as well as in developing and retaining their workforce and engaging with their staff. In addition, the KSF enables employers to link the work their organisation does with the skills and competencies of their staff. By ensuring staff are competent, the KSF provides an audit process that supports effective clinical and corporate governance.

The benefits for staff of the KSF are also great. The KSF ensures individual career and pay progression and can also improve morale and teamwork by giving staff a clearer understanding of how they fit into the organisation and how they affect its performance. It shows staff what they have been employed to do, reviews their knowledge and skills and identifies any gaps to be addressed as part of an annual system of review and development.

But uptake of the KSF has been patchy, despite an obligation on all NHS organisations to have the KSF fully operational by October 2006. NHS Employers and trade unions have raised concerns about the extent and effectiveness of the application of the KSF. This issue was also reflected a report by the King’s Fund, Realising The Benefits? - Assessing the implementation of agenda for change which concluded that the benefits of Agenda for Change were being jeopardised by the failure to apply the KSF effectively and that there was a perception by some employers that the KSF was too complicated and resource intensive.

It appears that there are a number of reasons for the difficulties with implementing the KSF across the service. 2006 was a particularly difficult year for training and development, which meant that this had been given a lower priority when budgets were tight. Also support for the KSF (in terms of resources, organisational priority and management buy-in) had reduced as Agenda for Change was seen to be ‘completed’. In addition, reconfiguration of strategic health authorities in England had decreased capacity resulting in the depletion of KSF networks, nationally and locally.

It also appeared that some parts of the service were put off by what they believed to be a complex process to implement the KSF across their organisations. This was in spite of the fact that other NHS organisations were successfully applying the KSF in the development of staff and services, linking it to their organisational objectives and therefore reaping the benefits. In fact the organisations that reported successful application were finding that this was because they were keeping the process simple, linking it to their organisational objectives and working in partnership from the outset.

As a result, a national KSF project group was established to raise the profile of the KSF with representatives from across the NHS, the KSF group, trade unions, the Staff Council Executive, the Department of Health and NHS Employers. Ten events took place in each of the English Strategic Health Authority areas to raise the profile of the KSF at a senior level and to share best practice. A range of materials were also produced to help NHS boards and staff to understand the KSF and its benefits. It is early days but we await with interest the impact of this initiative on the implementation of the KSF.

For 2008 the challenge for NHS Employers and the KSF group is to continue to support NHS organisations with their application of the KSF. We need to keep driving the message to NHS boards that the KSF is a tool that should be used to help them deal effectively with the clinical and corporate governance challenges they face in the coming year. We also need to ensure that all staff covered by Agenda for Change receive an annual review and a personal development plan so that they too can reap the many rewards of the KSF.

Bill McMillan is the Knowledge & Skills Framework project manager at NHS Employers. Contributions from KSF group members Gary Theobald and Gary Kirwan.

The new KSF materials are available to download from the NHS Employers web site at www.