Affordable methods of training are giving a healthy return on the investment, writes Stuart Shepherd

While last year's deficits had a widespread effect on spending, the squeeze was felt particularly across training and development budgets.

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

Signs of a recovery, it is fair to say, are in evidence. However, for Richard Griffin, the former associate director of the widening participation in learning strategy unit at the Department of Health, the damage could already be done.

In their joint presentation to this year's NHS Employers conference, 'Training without Breaking the Budget', Mr Skewes and Mr Griffin examine how cost-effective training can contribute to increases in positive outcomes for patients.

'The evidence that learning can improve organisational performance is very strong,' says Mr Griffin. 'Some of the figures suggest productivity improvements of up to 10 per cent are possible. This is not just about money.'

He continues: 'There is a real potential for gains in patient satisfaction across a number of areas. While there are some good examples - such as the case of maternity support workers - my view is that the NHS is not getting it right.'

Assessing its impact

The impact of reducing training on staff motivation and skills development, as well as productivity, can be significant, argues Mr Griffin. Equally important, particularly in an organisation spending£5-6m a year on training, is the lack of any assessment of its real impact.

'It has always been difficult for local managers to exemplify improved productivity as a result of training spend in healthcare,' says Mr Skewes. 'The traditional manufacturing emphasis - making more widgets as a return for your investment - doesn't give the right kind of metrics.'

'In our workshop,' he continues, 'we encourage a discussion about what the right kinds of local measurements might be, how they relate to the experience of the patient and their health outcomes over a period of time. It could, for instance, be as simple as asking how you drive up the rates of breastfeeding - a practice that contributes to the child's immediate and long-term health and can also reduce levels of post-natal depression.'

Adapting training to new roles

As services like midwifery look to adapt and modernise, training plays an essential part not only in the further development of qualified professionals but also in the establishment of new roles such as the maternity support worker. A recent King's College study looked at duties appropriate to this post and issues of demarcation and supervision.

'Training and development - not just for the maternity support worker but also the midwife - is crucial to informing all of these points,' says Mr Skewes. 'This was not being looked at sufficiently however. Now the RCM is managing a project on behalf of the widening participation in learning unit at the Department of Health, looking at learning needs across this group.'

Referring to this project in his presentation, Mr Skewes talks about the need to get the interface right between professional groups - in this case midwives - and the new support worker roles.

He also looks at regional variations in approach - in Scotland, for example, the educational needs of the support worker are being pursued through higher education - and what mechanisms such as Agenda for Change and the Knowledge and Skills Framework can bring to training efficiency.

'Learning is often the missing link when trusts are thinking about outcomes,' says Mr Griffin. 'There are examples of trusts that recognise staff learning needs once they set new service outcome targets, who then involve staff representation and can demonstrate substantial high performance gains.'

NHS Employers annual conference and exhibition will take place at the ICC, Birmingham 9-11 October.