How do trusts know if staff are getting the benefits expected from a training course? Julie Griffiths on moves to assess value better, and the post-Francis shift in training focus


Student trainee nurses at Leeds General Infirmary learning how to take blood pressure.

Learning and development has always been important to the NHS – historically, the health service is one of the sectors with the highest rates of training for staff.

‘Care scandals expose the need for constant vigilance when it comes to investing in training’

When the last recession hit and training levels fell across other sectors, they remained stable in the health service.

In 2012, an assessment by the UK Commission for Employment and Skills showed 86 per cent of health employers had provided training in the previous year, compared with 59 per cent across all other sectors.

Yet care scandals, such as those revealed by the Francis inquiry in 2013, expose the need for constant vigilance when it comes to investment in staff training.

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The 1,800-page Francis report said the NHS had betrayed the public and called for a fundamental culture change to put patients first. So how has training in the NHS changed in the two years that have elapsed since the inquiry? One change is the focus.

Soft focus

The 2012 Health Foundation report Quality Improvement Training for Healthcare Professionals said quality improvement was a concept that underpinned service planning and provision, but not training.

It found there was “scope for major development in this area” because quality improvement courses aimed at managers tended to focus on monitoring and measuring, rather than on leading and managing change.

‘Berwick was seminal in recognising that if you are asking staff to make a difference, they need resilience to do so’

Three years on, Health Foundation fellow Emma Vaux says quality improvement training is viewed very differently. Much progress has been made, not least because Francis had such an impact on what is regarded as fundamentally important in how care is delivered.

Dr Vaux, consultant nephrologist and director of quality improvement at Royal Berkshire Foundation Trust, says the Francis report made it clear that quality improvement and patient care are everyone’s business.

She says the Berwick report, which came out later the same year, has also been influential in how training is viewed.

“Berwick was seminal in recognising that if you are asking staff to make a difference, they need capability and resilience to do so,” says Dr Vaux, who is leading a group at the Academy of Medical Royal Colleges exploring the best ways to share quality improvement training and resources across all colleges, including those for non-medics.

The first meeting took place in December and a series of workstreams are now underway on areas such as improvement maps and multiprofessional working. The group will report in October with recommendations.

Mixed message

Dr Vaux believes that the future of NHS quality improvement training will be multiprofessional. Progress is starting to be made but more needs to be done.

“Gone are the days when you could think about any professional group being autonomous. Delivering care is shared and the most powerful training is when it is multidisciplinary,” she says.

Kevin Croft, president of the Healthcare People Management Association, says the Francis report has refocused minds at senior levels. Patient experience has replaced targets and finance as top priority and, inevitably, this affects training.

‘Delivering care is shared and the most powerful training is when it is multidisciplinary’

“The Francis report has sharpened the focus that training is a key part of patient safety and patient experience. After all, Mid Staffs was all about patient experience and care,” says Mr Croft, who is director of people and organisational development for Epsom and St Helier University Hospitals Trust.

Learning and development post-Francis is about changing behaviours, he says.

“At my trust we’ve launched a Patient First programme, which is about staff engagement and culture change. More and more trusts are doing that kind of training,” says Mr Croft.

Lessons from sheep and cyberspace

I found January’s Learning Technologies Show uplifting. It brought home the sophistication of e-learning developments and their potential to transform the accessibility of workplace learning.

At the same time, I tried to put myself in the shoes of someone working in learning development or organisational development, and think about how I would make sense of the scale and range of provision now available.

Among the high tech learning on offer, there was a stand for an organisation called Raising the Baa, which specialises in using sheep for outdoor team building and leadership development - a welcome and timely reminder that the training and learning available is diverse and not always found in obvious places.

The pressure on budgets is tight and it is only going to intensify. Financial pressures sit alongside calls for an ever greater commitment to training from Francis to Cavendish and beyond.

In these circumstances it is vital to get purchasing or commissioning decisions right. Yet workforce improvement organisation Skills for Health suggests there are numerous examples of poor or inappropriate training being commissioned.

Perhaps this is the result of a lack of training that needs analysis? Quite possibly it is down to nothing more than the convenience of using “normal” suppliers.

Do providers of training and development – whether via a virtual experience or in a field of sheep – find it hard to market their offer to employers and individuals?

Do employers find it hard to know what is on offer and make meaningful and informed decisions about what to source and from whom?

The investment in ever more sophisticated e-learning does not appear to have been accompanied by change in the way we approach training.

Why, when we’re happy to embrace online learning, are we not using digital resources to find learning and training in the first place?

Some forms of learning will, of course, always need specific negotiation of learning outcomes and process. But do they all? It’s time to embrace new approaches to sourcing much of our training.

Keith Mogford is development director of Skills Platform

Goal orientated

Aligning training with changes on the front line is a trend that goes beyond the health service.

A 2014 report from the Chartered Institute of Personnel and Development into learning and development found that, increasingly, organisations try to measure outcomes rather than tot up the number of hours and cost of training.

The number of organisations that measure the return on investment from training had nearly doubled in a year from 26 to 48 per cent. Moreover, nearly half (48 per cent) used the information they gathered to forecast future training needs and plan accordingly.

Yet selecting a training package that delivers the desired outcomes at the right price is an ongoing challenge.

Ruth Warden, assistant director of employment services for NHS Employers, believes such evaluation is hard enough after training, let alone before it.

“Finding evidence for a link between attendance at a course and a shift in behaviour or patient experience is a challenge,” she says.

Budget constraints make it even harder.

“Across the NHS, people have to make really tough decisions about where to spend money and that makes it even more important to get it right,” says Ms Warden.

One-stop shop

Making it easier for employers to see the cost and content of various training at a glance could help them to get it right. This is what is being offered by Skills Platform, a new resource from Skills for Health.

The platform is a one-stop shop based on the Amazon model. Users can find training providers, read reviews of courses from previous trainees and compare content and cost before booking.

Piloted for six months last year in the charity sector, it was launched to the health, charity and social enterprise sectors in January, and there are plans to roll it out across the public sector later this year. It hosts 2,000 training providers but that figure is rising all the time.

‘People can feel that training is a bit of a gamble. The reviews will help provide evidence that it is worth it’

Skills Platform development director Keith Mogford says the model stemmed from feedback from employers and training providers that struggled to find each other in a market dominated by small and medium sized enterprises.

Bringing them together saves the employer time and helps them make a more informed decision by making it easier to compare courses.

“We hope the platform will drive up quality,” says Mr Mogford.

Quality review

Louise Faith, course director of Fundraising Skills, a training provider that uses Skills Platform, believes the reviews will help to reassure prospective customers.

“People can feel that training is a bit of a gamble,” she says. “The reviews will help provide evidence that it is worth it.”

‘If someone is talking about how the course achieved certain objectives, then that’s really valuable’

Ruth Stuart, research adviser in learning and development for the CIPD, agrees but only if reviews go into the right sort of detail.

She believes organisations will be keen to ascertain outcomes.

“If a review is about whether an individual liked it or not, that will be less helpful. But if someone is talking about how the course achieved certain objectives, then that’s really valuable,” says Ms Stuart.