Spring follows winter. Night follows day. The very predictability offers comfort in a changing world. In the same way, it would be a slightly unsettling report by the Audit Commission that did not make generous use of the word 'variation'.
The latest report on training for healthcare staff - out today - is not about to break with form. It found the investment in education, training and development for non-medical staff in trusts was patchy.
Hidden Talents reports a fivefold variation in spending on education, training and development, with one-third of staff reporting that their needs in this area were not identified. Half of staff did not have a personal development plan.
One in five trusts use less than three-quarters of the post-qualification nurse training available to them and there is a tenfold variation in nurses' access to higher education-based training.
Audit Commission project manager Zoe Cohen says: 'We were expecting to find some variation, but we were surprised to find it was as great as it was. ' She adds: 'This level of variation is not explained by some of the factors you would expect; part of it appears to be explained by history and cultural factors. '
She says that often budgets have not changed for years, although training needs may have grown and that culturally there may be issues about whether a trust values education and training.
In addition, she says there are concerns about certain groups of staff missing out because they are part-time or because of their status in the organisation.
'Part-time staff are an increasingly important part of the workforce, ' says Ms Cohen. 'We highlight that there are concerns about the amount of training that part-time staff undertake. Trusts with a high proportion of parttime staff need to review what they're spending - and on whom. '
The Audit Commission looked at whether there were any regional variations in expenditure on education, training and development and found the higher expenditure in London and the South East was due to higher costs rather than more training.
One of the problems trusts have with training is being able to release staff from work. St Mary's trust in London has developed single-day sessions to cover mandatory training in resuscitation, manual handling and fire procedures.
Deputy director, training and development, Sheila Jones says:
'It is much simpler. Previously, managers had to look at releasing staff for three or four separate sessions. It is easier to pull it together in one day.
'By branding it as mandatory It is changed the way that managers look at it. I have a responsibility as a manager to make sure that my staff attend these things. '
The Audit Commission calls for commitment to staff education and training at trust board level.
Ms Cohen says: 'Training and development targets and priorities can become part of the wider monitoring and performance in the organisation. '
In a separate report from the National Audit Office, also published today, the training needs of non-medical student staff are examined in England andWales.
Karen Taylor says: 'Our report is really focused on the relationship between the NHS as a purchaser of education and training and the higher education institutions as a provider. '
The purchaser-provider split encouraged the NHS to see itself solely as a purchaser of education and training. 'There was little recognition that the NHS had a role and responsibility for practice placement and also recruitment of students, ' says Mrs Taylor.
The report recommends that these two bodies work in partnership to improve education and training facilities. It looks at whether pre-registration training offers value for money, and found a wide variation in price. For instance, the cost of training a nurse ranged from£2,500 to£10,000 in different parts of the country. The report recommends that cost for training be benchmarked.
Mrs Taylor says there is already much going on to try to meet the target in the NHS plan of 5,500 more student nurses by 2004, including increasing the number of students, increasing the number of return-to-practice programmes, and stepping up overseas recruitment.
Hidden Talents: room for improvement
Trust boards and senior managers should make explicit the roles and responsibilities of individuals, managers and the board in getting the best from training and development.
They should periodically review the overall strategy, policies and processes and get regular update reports. Trust boards should use formal performance measures to make sure directorates'training and development policies and spending on them is under review.