Experts argue that it is time for training to return to NHS employers' agenda, claiming cost-effective learning improves organisational performance. Stuart Shepherd reports

Last year's deficits hit spending hard, with the squeeze felt particularly keenly across training and development.

So much so, according to Jon Skewes, Royal College of Midwives employment relations and development director, that in some midwifery teams the training budget was effectively reduced to zero.

Signs of a recovery are in evidence, although Richard Griffin - former associate director of the widening participation in learning strategy unit at the Department of Health - thinks the damage may have already been done.

In their joint presentation at this month's NHS Employers conference, 'Training without breaking the budget', Jon and Richard will examine how cost-effective training contributes to increases in positive outcomes for patients.

'The evidence that learning buy-in can improve organisational performance is strong,' says Richard.

'Figures suggest productivity improvements of up to 10 per cent. This is not just about money though.

'There is real potential for gains in patient satisfaction. But while there are examples of success, my view is that overall the NHS is not getting it right,' he says.

The impact of training cuts on staff motivation and development, as well as productivity, can be significant, argues Richard. Equally important, however, in an organisation spending£5-£6m annually on training, is the poor assessment of its real impact.

Local healthcare managers have struggled to demonstrate improved productivity as a result of training spend, says Jon.

'The traditional manufacturing emphasis doesn't give the right kind of metrics. We want discussion about what the right kinds of local measurements might be, relating patient experience and health outcomes over time,' he says.

'Learning is often the missing link when trusts are thinking about outcomes,' says Richard. 'Some trusts, however, recognise staff learning needs once they set new service outcome targets, involve staff representation and can demonstrate substantial high performance gains.'