The sector skills agreement is the mechanism by which employers, stakeholders and funding will be harnessed together to raise workforce standards. We look at how this is happening in health

Health is everybody's business: the wide range of stakeholders is just one facet of its complexity. The government-led sector skills agreements are designed to assist every employment sector to secure the skills for increased productivity at internationally competitive levels.

In health, sector skills agreements between stakeholders are promoting a strategy for transforming the workforce, using nationally recognised competences to support improved healthcare services.

In getting the agreement strategy off the ground in the UK, the task for Skills for Health has been to engage systematically with NHS employers, independent and voluntary organisations, professional bodies and unions - before starting to plan for the flexible workforce the sector requires.

"That was a big challenge," says policy and planning director Helen Fields. "We needed to make contact and send out a clear message about our purpose to a lot of groups. At times the process all seemed very lengthy and bureaucratic - but it gave us a direction of travel for determining the strategic plan for the future."

The need for flexibility and change is driven by increases in long-term conditions, remodelling of service provision and more care closer to home, greater responsiveness to public expectation, and workforce, career and regulatory changes.

To produce the agreements, current and future skills needs in the UK countries have been assessed interactively over five stages: reviewing existing education and training; a supply and demand gap analysis; a stakeholder assessment of opportunities for collaboration to tackle skills deficits; development of an agreements action plan; and agreement between partners.

In England and Scotland the agreements are now published and in place. The process in Wales and Northern Ireland is taking a little longer.

"The agreements are about what Skills for Health can do to set the strategic direction for workforce change," says Ms Fields, "as well as what we can broker on behalf of organisations looking to take that change forward. The outcomes of the agreement, its objectives, are embedded into strategic and operational plans with the emphasis on robust intelligence and evidence, and strong partnerships."

Now Skills for Health is implementing the agreements through initiatives of its own and with partners. These include a workforce solutions team, which will assist regional authorities and employers to systematically use the competences identified by Skills for Health, and application tools it has created for this.

Action plan

Skills for Health is also, in Ms Fields' view, committed to producing labour market intelligence reports for the sector, at both country and regional level, in a manner that makes it more digestible not just to employers but to those in education, commissioning and workforce development too.

Also, an information, advice and guidance service model for learning and careers in health is being introduced regionally across the UK to consolidate and improve routes into the sector.

"In England we have also started to develop regional agreements, not duplicating but rather translating the national sector skills agreements to fit with local workforce needs and plans," says Ms Fields. "The momentum of good stakeholder engagement is being maintained and while the England-wide agreement gave the overall direction and objectives, what is now emerging, two years down the line, are the nitty-gritty actions."

Another feature of the agreements' outcomes is the joint investment framework. This came into effect in September 2007 and upholds the agreements' central aims to develop a skilled workforce for raising the quality of care. It is a major step towards the demand-led skills system the Leitch report called for.

The framework pulls together the strategic health authorities, Skills for Health and the Learning and Skills Council, who bring in a promise of up to£50m per year to match equal investment by the health sector during the three-year agreement. It focuses on skills development and qualifications at levels 2, 3 and 4 across Agenda for Change bands 1-4 or equivalent.

"The new framework allows for the necessary flexibility we didn't have in the past. The problem until recently has been that the LSC, while it brought lots of money to education, had its own government-set targets to meet for people without a level 2 NVQ," says Fionnuala Palmer, joint framework programme manager at Skills for Health. "But what the health sector has been needing is unit based qualifications where funding is available for units as well as full NVQs, or support for level 3 qualifications and above."

A lot of people come to health having worked in another sector, she continues, with a level 2 NVQ, in a area which, even though it might have little bearing on their new job requirements, has left them ineligible for LSC funding. "Now though we have a real partnership and each body - health or the LSC - will fund what the other cannot, to give the average employee a much more complete funding picture."

Ms Palmer says the programme has been able to do things like flag up the increase in the drive for apprenticeships in the health sector, "as well as the need to offer targeted support with skills for life - language, literacy and numeracy - to this pre-professional section of the workforce."

Extra funding

The East of England regional sector skills agreement for health was launched in November 2007, describing the skills gaps in the sector and how stakeholders could tackle them. This agreement gives direction to the joint investment framework programme - which over three years will bring in£22.2m of training investment for bands 1-4 - in a region where investment has been extremely scarce over an extended period.

Furthermore, extra funding brought in by the framework in the North West has seen more than 6,700 additional training places being agreed.

"While the funding has been approved for three years, we always emphasise the rolling nature of the deal," says Ms Palmer. "This is not a case of 'here today, gone tomorrow'. This is the start of a long-term process and the great thing is that having got used to so much short-term money, some regions are now looking at how they embed framework funding."

Health employers - NHS, independent or voluntary - are strongly advised to sign up to the skills pledge. This is a voluntary commitment to workforce development across an entire organisation. By signing up, employers agree to support all employees to develop basic skills to at least level 2 - the same as five good GCSEs - with some support available at level 3.

Employers first demonstrate their pledge commitment to the employees through a statement of intent. Then they assess the skill needs and workforce priorities before moving on to an action plan, highlighting the skills and qualifications needed, numbers and a timetable for progress. With this in place the employer signs the pledge and then gets on with meeting the commitment. Progress is reviewed and reported on annually.

Making the pledge at Surrey and Borders Partnership foundation trust was seen as a focused way of bringing its large numbers of bands 1-4 staff into the learning and development strategy. Basic skills and support with language and literacy were identified as early priorities. "Skills for life" were embedded in an NVQ that incorporated on-the-job learning.

Trust support worker Margaret Emmerson recently completed her NVQ level 2 in health and social care. She was glad of the chance to learn more about food and nutrition and refresh her familiarity with health and safety.

"Although you should be doing good practice all the time, it doesn't hurt to have things emphasised," she says. "The course highlighted why things are done the way they are."

The trust has had some good feedback about its approach to the skills pledge and won the recruitment and retention category of the 2007 Healthcare People Management Awards.

One thing Skills for Health does not have is huge sums of money for workforce development. That is all held with the funding bodies and agencies. But the sector skills agreement has provided some evidence for influencing change.

"We can already see evidence of success in some initiatives," says Ms Fields, "but we need to work with partners in the longer term to understand the real difference this makes - and that will be about better evaluation and impact measures.

"Now that we have the national skills strategies across each of the UK countries the sector skills agreement has to stay alive and dynamic. There are differences in each of the national strategies and the skills landscape keeps evolving so our SSAs must remain flexible and able to respond."

East Midlands agreement

In early April, Pippa Hodgson, regional director for Skills for Health in the East Midlands, hosted an event to launch discussions on a regional version of the national sector skills agreement.

During the morning session, attended by minister for the East Midlands Phil Hope and several NHS chief executives, Ms Hodgson spoke about Skills for Health, implementing the national agreement and some of the national strategy work. Later in the day local participants voted on what should be included in an action plan for the region.

"What I don't want to do is replicate the weighty national agreement," says Ms Hodgson. "Better to have a three or four page plan that shows what joint pieces of work we have agreed to take forward in order to benefit the health sector. The voting gave me some pointers for that, and what was superb was that throughout the day people made the links between the national initiatives, which went on to be validated by the regional solutions they themselves came up with."

Part of Ms Hodgson's work over the next 12 months will be developing the actions with partners so everybody knows what it means when, for example, they talk about more involvement for the voluntary and independent sectors.

"It is really important for health to engage with all of its providers," says Ms Hodgson. "Government initiatives are going to see the workforce belonging to an increasingly diverse employer group. This, as well as the voting particularly on new roles and career pathways and the high level of commitment shown to skills transformation, has all given me a lot of information to go and talk about and plan with senior people and partners.

"Another key lesson for me on the day," she continues, "was discovering employers hadn't realised that for virtually all the national initiatives I showcased we had at least one regional pilot site - such as the work in Derbyshire looking at assistant practitioners in mental health and stroke rehabilitation.

"All in all this is the beginning of what should be an interesting and iterative process."

Information and advice on careers in healthcare

For younger people and adult learners alike good access to information is sometimes the only difference between choosing one career path or another.

It was this realisation that initiated Skills for Health's work in partnership with learndirect scotland to ensure all appropriate learning provision in the sector is available on its national database of learning opportunities.

It has been made as simple as possible for individuals and employers to easily identify appropriate training opportunities in the sector.

The idea is reinforced in the Scottish government's skills strategy, Skills for Scotland, which highlights that the database can become a more effective national resource to promote lifelong learning.

"There are over 300 different jobs in the sector and the relevant courses are not always health related," says Annette Clark, Skills for Health information, advice and guidance manager. "The online database will allow individuals to search through thousands of courses and training providers throughout Scotland to best meet their needs."

The partners are also looking at launching a response service, so that people can access the database through mobile phones and ask for more details to be sent. This could be ready this summer.