Published: 02/06/2005, Volume II5, No. 5958 Page1 2 3

Skills for Health has changed the landscape of healthcare training, but the sheer breadth of its remit means the journey is just beginning. Lynn Eaton gets the low-down from chief executive John Rogers

The leader of the healthcare training revolution that has taken place over the past year or so did not feel the need to shout about it.

'We didn't want to go out with a burst of publicity saying Skills for Health is going to change the world, ' says John Rogers, a man who clearly enjoys the challenge of winning others over to his point of view. 'We have deliberately kept it low key.' A strategist through and through, he explains that it has wanted to 'manage expectations'.

So That is a relief - it is okay to admit you have never really heard of it - but you will not be able to get away with being so naive for much longer.

Skills for Health, the organisation of which Mr Rogers is chief executive, is growing in size and stature - its staff was 20 this time last year, and now has nearly reached its plan of 95 staff by June.

It has been slowly chipping away some of the old ideas about training for NHS staff for the past couple of years - looking into the structure of the healthcare workforce, finding out who does what, and trying to work out what was really needed in the future. Such changes are essential for the successful implementation of the government's radical shake-up in the NHS skill-mix, outlined in Agenda for Change.

You might, therefore, be forgiven for thinking Skills for Health was entirely a Department of Health invention. Think again. It has been more a happy coincidence that two government departments were thinking along the same track. Fortunately, their paths met midway.

The idea of matching training more closely to employers' needs was, in fact, born in the Department for Education and Skills. Ministers began to realise the need, across the UK as a whole, to shift away from providing education in a vacuum, and the move towards more vocational training driven by the employer.

The idea first emerged in November 2001 and, following an education white paper last year, the government set up a number of so-called 'skills councils' for each sector of industry. These bring together employers, trade unions and professional bodies to work with the government in developing the skills that UK business needs.

It puts employers in the driving seat. All rather handy, really, for the NHS - the biggest employer in the UK - which is juggling limited resources, needs a flexible workforce, and is committed to a health service that delivers patient-friendly services. Training is not only essential for a flexible workforce but to ensure such a fundamental shift in the culture of the organisation.

To date, the sector skills councils cover a wide range of employment areas: leisure, science and engineering, transport (whose council is somewhat amusingly called Go Skills) and even facilities management (theirs is grandiosely called Asset Skills).

Skills for Health works out the most appropriate training needed to give individuals the skills (or 'competencies', as they are called in the business) they need to work in healthcare.

They cover everyone in the sector - from an NHS hospital porter to a senior medical specialist in the NHS - and include the private, independent and voluntary health sectors, not just the NHS.

In theory, training in the NHS should in future operate rather like an Open University degree, where you build credits for each module you take and can move across (within reason) from one professional strand to another. Staff would be able to accumulate 'transferable credits' - say, in communication skills working with elderly people - which could be equally valid in working with people with mental health problems.

Mr Rogers argues such flexibility is essential in a world of uncertainty. His somewhat daunting task is to decide exactly what skills the healthcare sector will need in the years ahead.

'The only thing we can confidently say is that the one thing we need in the future is not what we have now, ' he says.

'Somebody doing medical workforce planning will say 'we need more cardio-thoracic surgeons'.

But it takes seven years to train them. Meanwhile somebody invents statins, which significantly changes the need for the specialty, ' he explains.

Similarly, advances in medical technology have meant jobs that once had to be done by a senior member of staff can now be done by more junior staff, although they must be supervised.

'Technology moves on, ' he says. 'It used to be the case that only specific staff, such as paramedics, could use a defibrillator. Now they are in public places and you or I could use them.' Until now, individual trusts have had to devise their own training packages, often on an ad hoc basis, to cope with new developments. This new organisation changes all that, putting training on a nationwide footing.

'Skills for Health is setting UK-wide competencies - the building blocks that trusts can shape to patients' needs, ' says Mr Rogers.

Since June last year, when it was licensed by the government to act across the whole healthcare sector in setting up a sector skills agreement (see page 9), the pace has quickened.

These agreements set out how productivity will increase in the sector, how the sector will address skills gaps, provide greater skills opportunities and ensure training is more responsive to employment needs.

It is an enormous task and, as Mr Rogers describes the work ahead, it becomes clear his revolution is not going to happen overnight.

So far, they have identified at least 50 areas where they need to develop what they call a 'competence framework'. In layman's language, this is an agreement about what skills the employer and the training organisations accept will be needed to do a particular job.

The framework will provide the basis for future training provision, and will need to reflect the goals of patient empowerment, the use of the voluntary and independent sector and other factors such as improving diagnostic services and reducing waiting.

Fifty areas for future training

The 50 identified areas range from aromatherapy and reiki through to pharmacy, renal transplant and breast screening.

Developing each framework involves talking to professional bodies, to unions, to the employers and - most importantly, as this work is meant to improve the delivery of services - to the patient.

'There are about 31 areas completed so far, ' says Mr Rogers. He admits there is a limit to how many areas they can cover ('it would be a lifetime's work') but the intention is to cover around 95 per cent of the workforce eventually.

Aside from building these training blocks, Skills for Health has 'bigger picture' work to do as well. It has been charged with working with some of the other skills councils outside the immediate health field, including the learning and skills councils (formerly the training and enterprise councils), to ensure they too are working towards the same goals, which have been identified by health sector employers.

The learning and skills councils have a huge -£9bn - annual budget, some of which is, inevitably, being used on health (Skills for Health has a mere£6m budget in comparison).

The question is how much.

'Our task is to clarify the needs of the health sector and work with employers and parties such as learning and councils to ensure these needs are reflected, ' says Mr Rogers.

Work began on the sector skills agreement in January - the mammoth task of negotiation with organisations like this, the national departments of health, SHAs in England, professional bodies and education suppliers. 'We are consulting the world, ' jokes Mr Rogers, in a flippant moment, then adds: 'What we want to do is to get the health sector to own this.' The organisation has, in addition to all this, taken over a number of new functions that have been contracted out to them by the DoH.

These include:

managing and supporting care group workforce teams - these are the groups set up, usually under the auspices of the relevant czar, to provide support on the staffing needs that have emerged from various national service frameworks;

managing the skills escalator programme, a DoH initiative which aims to enable staff to progress through the NHS from one professional group to another;

overseeing the DoH educational quality assurance function, replacing the hotch-potch of bodies that previously checked on standards of training for NHS staff with a single body.

It may all sound like an additional burden, but it should increase the influence, and leverage, of the organisation, argues Mr Rogers. These are key factors at this stage of its development.

'Eighty per cent of it is persuading people it is a good thing to do, ' he says. He is reluctant to point to any one framework as being more successful than others.

'It is okay getting people to sign up to them.

The real key, though, is embedding them throughout the system, and people taking them up and using them.

He cites the framework for public health, which has been used very successfully across the UK. But that was relatively straightforward because there was a clearly identifiable group of staff with their own professional body which was prepared to accept the proposals.

'We are still struggling at practitioner level, ' he admits. The reason is that, although many nurses do public health work, it is not clearly identified in their job description and therefore there is no easy way of identifying who they are.

Nor is it straightforward to identify the courses that need to embrace these new approaches to training.

'Once you have got the 'buy-in' [to the principle] the next issue is whether you have the education mechanism to implement it, ' says Mr Rogers.

No revolution is ever straightforward, nor easy.

But he believes he is gradually getting there, albeit slowly.

'We are winning the intellectual argument - if not quite all the hearts and minds, just yet.

'If I had gone to people five years ago and said I want to talk to you about competency frameworks they would have looked totally blank.

The success we have had is putting competence frameworks on the map. I think we have done exceptionally well with that in the health service. But we are not going to change the world in 12 months.' .

Find out more

www. skillsforhealth. org. uk



What is Skills for Health?

It is the new sector skills council for health. It was granted its official licence from the government on 1 June, although it has been running for about two years. Its key role is to be the focus for the development of skills across the NHS, the independent sector and charities providing social care.

Where do sector skills councils come from?

The plan to reorganise education and training in the UK was originally announced in November 2001 and a white paper on the subject was published by the Department for Education and Skills last summer.

What does it do?

Its main role is to create and disseminate competency frameworks What is it not?

Skills for Health does not provide training directly to individuals or organisations, or publish training materials. In this respect it is a partner to the new NHSU.

What geographical areas does it cover?

Skills for Health covers all four UK countries, and has separate agreements with the health department in each. Its role is broadly the same in each. Its structure will be based on eight regions, working closely with learning and skills councils.

So what is a learning and skills council?

These 55 regional organisations determine how funding for education and training is allocated - amounting to£9bn in total every year. They replaced training and enterprise councils.

And a skills for business network?

This is a network made up of the 23 SSCs, as a way of promoting crosssectorial work on areas like sustainability and IT And the Sector Skills Development Agency?

This is an agency of the DfES, based in Doncaster.

It sets standards for all the SScs and supports the development of their work.