workforce development

Published: 21/11/2002, Volume II2, No. 5832 Page 24 25 26 27

Despite being responsible for a£3bn training budget and the future staffing of the health service, workforce development confederations remain virtually unknown.

Can they provide the much-needed muscle on which the new NHS will depend? Jeremy Davies reports

Ask most members of the public - or NHS staff, for that matter - to name the first NHS organisation that comes into their heads, and few would plump for a workforce development confederation. But whether or not the people they serve are aware of it, the confederations are set to be crucial to the success or failure of the new NHS.

In its latest priorities and planning framework for 2003-06, the Department of Health has made clear that delivery of its current, ambitious recruitment strategy is 'absolutely central to the achievement of other NHS plan priorities'.

Which leaves workforce development confederations in the unenviable position of leading efforts to ensure the NHS trains, recruits and holds on to an additional 15,000 consultants and GPs, 35,000 nurses, midwives and health visitors and 30,000 allied health professionals by 2008.All in the context of a service, which, at the end of March 2002, had nearly 20,000 posts declared vacant for more than three months (see boxes overleaf ).

There are 27 workforce development confederations across England, 26 of which are coterminous with strategic health authorities and one of which - Kent, Surrey and Sussex - straddles two HA areas. Between them the confederations manage education and training for the entire NHS workforce, controlling a total budget of nearly£3bn. This includes the multi-professional education and training budget - soon to be renamed the health workforce learning and development budget - which pays for all nursing and post-registration medical training in universities and trusts, and funds for individual learning accounts for non-professional staff.

The confederations vary considerably in size, with the largest, Trent, having nearly£174m to spend in 2003-04 and the smallest, Leicestershire, Northamptonshire and Rutland, a mere£785,000.

Originally established in April 2001 on the recommendation of the 2000 Health Service of All the Talents inquiry into workforce planning, the confederations'working agenda was laid out in DoH guidance post-Shifting the Balance of Power, giving them 10 key roles and detailed directions on how to carry them out (see page 27, below).

If they were in any doubt about it during their first 18 months of operation, the confederations should now, thanks to the priorities and planning framework, be clear that their focus on workforce planning is central to their role.

The DoH-level national workforce development board has the final say on undergraduate and postgraduate training numbers, and ministers set workforce targets for the service. But it is the workforce development confederations that must aggregate NHS and other health and social care employers'workforce plans and make sure they align closely with service planning. In doing so, they work closely with the seven multi-disciplinary, multiagency care group workforce teams (CGWT), whose role is to support integrated service and workforce development in the areas of cancer, children and maternity services, coronary heart disease, emergency care, long-term conditions, mental health and older people's services. Each CGWT has a lead confederation, and all must respond to their findings.

They must also take account of the work of the DoH-funded Changing Workforce programme - whose 13 pilot sites examining the potential of new staff roles in a variety of healthcare settings have just reached the end of their first year.

The confederations work as 'partnership organisations', with local NHS membership comprising acute and primary care trusts, ambulance trusts and postgraduate deaneries.Other members include local authority social services departments and other social care employers, further and higher education institutions, learning and skills councils, voluntary sector employers and government bodies with a health provider role, including the Ministry of Defence, prison service and NHS Direct.

The confederations work to a 'business plan agreement'with their strategic health authorities, and a similar contract exists between the confederations and their postgraduate deaneries, which commission, manage and monitor postgraduate medical and dental education.

All must have, as a minimum, a chief executive, director of workforce development and director of finance and are expected to keep management costs within 1.5 per cent of annual turnover. Some of the bigger confederations have a sizeable inhouse staff - North Central London confederation, for example, has around 30 senior managers.

Confederation chief executives are accountable for the education and training budgets they manage, but the SHAs act as paymasters.

The key to success for the confederations, says South Yorkshire confederation chief executive Barbara Walsh, is 'to get things done without really having much power to wield.We are part of the new NHS architecture and what We are about is influencing NHS employers to focus on the right things and in ways that bring maximum benefit to the service as a whole'.

'We have a close relationship with strategic health authorities, but we have operational independence, and That is crucial to the way we get things done, ' adds Shropshire and Staffordshire confederation chief executive Neil McKellar. 'We are collaborative, so There is a real sense that we and our constituent bodies are working towards the same goals.'

So far the confederations have used differing, locally tailored approaches to develop and take forward their strategies. Somerset, Devon and Cornwall confederation, for example, devolves decision-making as much as possible to small, local workforce development groups.

'The workforce is very rural so it wouldn't make sense to have people in the south of Cornwall trying to link up with north Somerset all the time, ' says director of workforce development Clare Armour.

'We give local groups responsibility for how they spend their share of the money, and we feel We have achieved a lot more engagement that way.'

The four London confederations, by contrast, have worked closely on a pan-London approach to many aspects of their work. Improving data on staff migration, turnover and wastage is crucial in the capital. In a bid to improve the situation, the confederations are working, for example, with the King's Fund to produce the first comprehensive analysis of the London healthcare labour market - due to be published in May 2003.

So has the creation of workforce development confederations had the desired effect? Few would dispute that they are part of a much stronger focus on workforce issues, brought about at least in part as a response to the dearth of workforce planning in the early to mid-1990s. Former NHS deputy director of human resources John Rogers, who now works for Dearden Consulting, says the Conservative government's internal market led to half a decade of planning blight: 'Trusts were told to compete with each other - and they did.When they hit financial trouble, one of the first things to go was sensible, long-term investment in workforce development.'

In the early 1990s, responsibility for workforce planning rested with the regional health authorities 'as an afterthought', says Mr Rogers, 'because it was realised that the distribution of costs related to education and training fell unevenly round the system, so they would distort the market'.

But in 1995, after it became obvious that trusts were reaping the 'rewards' of poor planning in the form of severe nurse shortages, the government introduced local education consortia. These 'got more responsive planning done at a level closer to where the demand was, ' says Mr Rogers, and allowed trusts to group together and negotiate more effectively with the universities, who were now providing the bulk of nurse training.

The Health Service of All the Talents review built on these consortia to create the workforce development confederations, which brought together workforce planning for medical, nursing and other staff - at a level beneath the NHS Executive regional offices - for the first time. Shifting the Balance of Power clarified the confederations' role but simultaneously brought them under the wing of the new SHAs.

Most confederations say it took between six and nine months to establish themselves as organisations, and Mr Rogers says they were not helped by the 'chaos' of the 2001-02 NHS reorganisation. 'There is no question that planning at pan-trust level is the right way to go, but they have been very slow to take off, ' he says.

The confederations are now developing what the DoH calls a 'skills escalator' approach, whereby staff at all levels opt in to 'lifelong learning', moving up the escalator as they train. Cadet schemes for support staff akin to Manchester's Developing the Workforce project (see case study) are springing up across the country - a phenomenon now being studied by a DoH-funded team at King's College London.

A total of£9m worth of new training commissions for nursing and the allied health professions have been put in place for 2002-03, including places for 1,000 extra nurses and midwives, more than 600 allied health professionals and nearly 400 healthcare scientists.More than 2,000 additional medical school places - centrally funded via the Higher Education Funding Council for England - will be in place for 2005.

New, more flexible training options are under development in all the healthcare professions to draw in staff who might otherwise have been prevented from study by financial or childcare considerations and as part of a shift towards more competency-based training.

For example, South East London confederation has worked with two other London confederations and both King's College London and South Bank University to develop a part-time, inservice training scheme for physiotherapists, occupational therapists and radiographers.

Even in medicine - which was out on a limb before the creation of the confederations and their unified multi-professional education and training budget - new flexibilities at specialist registrar level mean that confederations can now agree, via postgraduate deans, additional posts at trust level to meet specialty targets.Many are also working with trusts to convert some non-accredited 'trust doctor' posts into senior house officer posts, to allow fast-track entry into GP training.

Ruth Chambers, professor of primary care development at Staffordshire University and national convenor of the Royal College of GPs' accredited professional development programme, says her local confederation has 'built on what was there before, but with more momentum'.

'I do not know how much of it comes down to a big government recruitment panic, but the confederation seems to be pretty far-sighted and has a mature relationship with the deanery, ' she says.

'That helps make the trusts'workforce planning more meaningful rather than it being done on the hoof, and there is a genuine sense of trying to skill people upwards and fulfil their potential rather than just looking at recruitment as staff substitution.'

However, HSJ sources claim new DoH guidance due out before the end of the year will create even closer working relationships between the confederations and their HAs, and at the same time increase confederations'performance management role over NHS and other employers - albeit within the partnership organisation model.

Given the scale of confederations' task, it is perhaps not surprising if the government feels the need to tighten its grip. It may have already hit its 2004 NHS plan target for 20,000 extra nurses, but by September 2001 only a third of the extra consultants had been appointed.A survey of latest progress against GP recruitment targets is underway, but a recent Audit Commission report found that if GP growth remains at its current level of just 0.9 per cent a year, the government will spectacularly miss its target of 2,000 extra GPs by 2004, possibly taking on only 600-odd doctors, many of them part-timers.Overall, the King's Fund has predicted that the DoH will miss its 2008 target of 15,000 extra consultants and GPs by 3,000. By July, the much-publicised overseas recruitment campaign had bagged only 100 doctors.

Around the country, trusts are struggling to find the staff they need to cope with current workloads, let alone take forward the government's planned increases in activity and cope with the full impact of implementing the working-time directive, with its many implications for the workloads of junior doctors and consultants.

The gap between future demand, taking into account the government's proposed staffing increases, and the supply of staff to fill posts, is illustrated by a recent examination of the nursing market by the Greater Manchester confederation.

The number of nurses needed simply to replace those expected to retire or leave the service in 200203 is 1,126 across the confederation.To meet the government's growth targets, a further 569 would be needed. In order to go further and eliminate vacant posts between now and 2006, trusts would have to find another 376 nurses - making the total demand for nurses 2,071.

On the supply side, the confederation expects 732 nurses to complete training in 2002-03, to which it should be able to add 150 'return to practice'nurses and 50 international recruits.Taking into account the extra nurse trainees already coming through the system and assuming a typical 13 per cent attrition rate, the confederation estimates that by 2005-06 it should be able to supply just 1,455 nurses a year.

This is 319 more than is currently needed to replace retirees and leavers, but 240 short of the government's target and 616 less than would be needed to expand the workforce and simultaneously eliminate vacancies.

Manchester responsed to the shortfall by developing a cadet scheme which should produce 2,000 support workers by 2005, allowing nurses and other professionals to 'work smarter', and provide a new pool of potential trainees to meet future targets.

Workforce development confederations might make a name for themselves leading such projects.

Whether they can make a reality of modernising the workforce and meet the government's recruitment targets at the same time remains to be seen. l Greater Manchester: 'We sell this as a 'work, earn and learn'project' Greater Manchester workforce development confederation - which, with a budget of more than£150,000, is one of the five biggest confederations in the country - has gone further than most in developing innovative strategies to address structural shortages in the healthcare workforce.

More than 200 people have already entered the second year of the£48m, Developing the Workforce scheme, which is run by the confederation in acute trusts across the area, and aims to build a new resource of 2,000 healthcare support workers by 2005.

Under the scheme, cadets gain experience in a variety of roles, from nursing to chiropody or pathology, over two years, and on graduation are capable of taking up support roles or of going on to further training in nursing or the allied health professions.Four partnerships between trusts and local colleges joined the first wave of the scheme in 2001-02; another four trusts joined a second wave in September 2002.

Workforce development confederation chief executive John Sargent says the scheme has been aimed mainly at women aged 25-50, who are not registered as unemployed, but because of childcare commitments and lack of formal qualifications are currently excluded from the NHS workforce.

'Visioning is one of our big roles, and our ability to take a pan-Manchester view allows us to address the fact that for many non-professional jobs, the NHS needs to compete with industries offering part time work for local people, ' says Mr Sargent.'We sell this as a 'work, earn and learn'project, and We have found There is a big pool of people out there keen to sign up.'

Greater Manchester: 'We sell this as a 'work, earn and learn'project' Greater Manchester workforce development confederation - which, with a budget of more than£150,000, is one of the five biggest confederations in the country - has gone further than most in developing innovative strategies to address structural shortages in the healthcare workforce.

More than 200 people have already entered the second year of the£48m, Developing the Workforce scheme, which is run by the confederation in acute trusts across the area, and aims to build a new resource of 2,000 healthcare support workers by 2005.

Under the scheme, cadets gain experience in a variety of roles, from nursing to chiropody or pathology, over two years, and on graduation are capable of taking up support roles or of going on to further training in nursing or the allied health professions.Four partnerships between trusts and local colleges joined the first wave of the scheme in 2001-02; another four trusts joined a second wave in September 2002.

Workforce development confederation chief executive John Sargent says the scheme has been aimed mainly at women aged 25-50, who are not registered as unemployed, but because of childcare commitments and lack of formal qualifications are currently excluded from the NHS workforce.

'Visioning is one of our big roles, and our ability to take a pan-Manchester view allows us to address the fact that for many non-professional jobs, the NHS needs to compete with industries offering part time work for local people, ' says Mr Sargent.'We sell this as a 'work, earn and learn'project, and We have found There is a big pool of people out there keen to sign up.'

Greater Manchester: 'We sell this as a 'work, earn and learn'project' Greater Manchester workforce development confederation - which, with a budget of more than£150,000, is one of the five biggest confederations in the country - has gone further than most in developing innovative strategies to address structural shortages in the healthcare workforce.

More than 200 people have already entered the second year of the£48m, Developing the Workforce scheme, which is run by the confederation in acute trusts across the area, and aims to build a new resource of 2,000 healthcare support workers by 2005.

Under the scheme, cadets gain experience in a variety of roles, from nursing to chiropody or pathology, over two years, and on graduation are capable of taking up support roles or of going on to further training in nursing or the allied health professions.Four partnerships between trusts and local colleges joined the first wave of the scheme in 2001-02; another four trusts joined a second wave in September 2002.

Workforce development confederation chief executive John Sargent says the scheme has been aimed mainly at women aged 25-50, who are not registered as unemployed, but because of childcare commitments and lack of formal qualifications are currently excluded from the NHS workforce.

'Visioning is one of our big roles, and our ability to take a pan-Manchester view allows us to address the fact that for many non-professional jobs, the NHS needs to compete with industries offering part time work for local people, ' says Mr Sargent.'We sell this as a 'work, earn and learn'project, and We have found There is a big pool of people out there keen to sign up.'

Greater Manchester: 'We sell this as a 'work, earn and learn'project' Greater Manchester workforce development confederation - which, with a budget of more than£150,000, is one of the five biggest confederations in the country - has gone further than most in developing innovative strategies to address structural shortages in the healthcare workforce.

More than 200 people have already entered the second year of the£48m, Developing the Workforce scheme, which is run by the confederation in acute trusts across the area, and aims to build a new resource of 2,000 healthcare support workers by 2005.

Under the scheme, cadets gain experience in a variety of roles, from nursing to chiropody or pathology, over two years, and on graduation are capable of taking up support roles or of going on to further training in nursing or the allied health professions.Four partnerships between trusts and local colleges joined the first wave of the scheme in 2001-02; another four trusts joined a second wave in September 2002.

Workforce development confederation chief executive John Sargent says the scheme has been aimed mainly at women aged 25-50, who are not registered as unemployed, but because of childcare commitments and lack of formal qualifications are currently excluded from the NHS workforce.

'Visioning is one of our big roles, and our ability to take a pan-Manchester view allows us to address the fact that for many non-professional jobs, the NHS needs to compete with industries offering part time work for local people, ' says Mr Sargent.'We sell this as a 'work, earn and learn'project, and We have found There is a big pool of people out there keen to sign up.'

Sights are set: the latest NHS recruitment targets nIncrease the number of nurses by 20,000 by 2005 (from a 2000 baseline) and plan to achieve an increase of 35,000 by 2008 (from a 2001 baseline).

Increase the number of consultants by 7,500 and the number of GPs by 2,000 by 2004 (from a 1999 baseline); increase the number of GPs and consultants by 10,000 by 2005 (from a 2000 baseline); plan to achieve an increase of 15,000 by 2008 (from a 2001 baseline).This will include 1,000 cancer consultants by 2005, and increasing total numbers of cardiologists to 685 and cardiothoracic surgeons to 217 by 2004 (enabling single-handed cardiologist posts to be eliminated).

Increase the number of therapists and scientists by 6,500 by 2004 (from a 1999 baseline) and plan to achieve an increase of 30,000 by 2008 (from a 2001 baseline).

Increase the number of healthcare assistants by 27,000 by 2005 (from a 2002 baseline).

By 2004, expand the mental health workforce by 1,000 new graduate workers in primary care; 500 community mental health 'gateway'workers; 700 more staff to support carers; 300 prison in-reach staff to ensure prisoners with severe mental illness have an appropriate care plan and care co-ordinator on release; 400 staff to support secure step-down.

By 2006, expand the mental health workforce by 3,000 extra prison in-reach staff, 500 community development workers for black and minority ethnic communities; 200 staff and six outreach teams for personality disorder and training of 3,000 star workers.

Increase workforce capacity and productivity through skill mix and continuing professional development, moving work from doctors to other healthcare professionals and from healthcare professionals to the support workforce, supported by pay modernisation and service redesign.

Source: Improvement, Expansion and Reform: the next three years'priorities and planning framework 2003-06.

Lead time: workforce development confederations' key roles nTake a leading role in 'visioning' the future healthcare workforce.

Develop and lead an integrated approach to workforce planning for health and social care communities.

Take overall responsibility for developing the existing and future healthcare workforce.

Take the lead in developing a shared approach to human resources policy and practice.

Establish robust relationships with the NHS University, and NHS, social care and allied learning organisations.

Negotiate, manage and monitor performance of contracts with education and training providers, and support the modernisation of professional preparation, education and training.

Hold responsibility for practice placements for all students on NHS and Higher Education Funding Council for England-funded healthcare training programmes.

Actively promote patient, carer and student input into the development and delivery of education and training.

Co-ordinate strategic management of local learning facilities in the NHS.

Put systems are in place for financial management of all relevant funding.

Source: Workforce Development Confederations: functions, accountabilities and working relationships, Department of Health, April 2002.