CPD budget cuts were ‘trade-off’ for more nurses

In an in-depth interview with HSJ, Sir David Behan said he did not think it had been made clear that the money was not removed from spending.

“It went to increase the number of nurses in education and contributed to the additional 3,000 nurses that were produced,” he said. “It was a trade-off effectively. That money went from one budget and into another budget and the continuing development of people versus increasing the numbers of people in the workforce.”

He added: “In any period of fixed resource, decisions have got to be made about priorities.”

The budget HEE has to spend on CPD has been cut steadily since 2012 and, in 2017, it fell from £190m to £84m. These cuts have been widely blamed for contributing to NHS staff retention problems.

Sir David said HEE would be looking to invest at least £120m in CPD in 2019-20, but stressed employers also have responsibility for the development of their workforce, with revalidation as an example.

He said: “There is a national responsibility from HEE but there is also the employer’s responsibility and a personal responsibility and I think we need a much more open debate.”

While speaking at the CNO Summit last month, NHS England chief executive Simon Stevens said CPD budgets would be restored, with the funding phased over five years.

Sir David said: “That was about acknowledging how important CPD is. We need a different approach to training and education that is based on life-long learning.”

Speaking about the workforce implementation plan, the former CQC chief executive said it would set out priorities for 2019-20 that could be delivered within current resources.

He said further investment would be a “tough conversation with the Treasury”, as “there will be a lot of competition if there is any resource in the spending review”.

Sir David argued: “If workforce and financial planning are to keep pace with service planning – we need a similar investment in workforce planning over the next period.

“We shouldn’t have to worry about oversupply. We are not going to get in that position.”

He added “one thing HEE was committed to doing between Dido Harding and Julian Hartley” is to show “it is possible to work in a collaborative way and still get the job done”.

He said: “That strikes me as hugely important, that we are able to not just talk about the importance of values but demonstrate them in the way we behave.”

Sir David said “doing more of the same is not going to get [the NHS] in the place we need to be” and argued difficult questions needed to be asked about the future of healthcare professionals.

“There are discussions around, could you have a four year medical degree,” Sir David said. “The debate about nursing associates became quite adversarial at one point and I hope we can have discussions about some of these important issues.”

He added: “We need much more flexibility in our recruitment practices. A lot of public services are insufficiently flexible.”

Sir David also stressed the need to create a workforce which is representative of the community it serves and questioned how to “create better social mobility from within our communities”.

He said the loss of the nursing bursary had affected those who wanted to enter nursing later in life because now they could not afford to study.

“If we want to continue this pipeline of talent, we need to open up different routes into nursing,” he said.

Sir David said the way that science and technology might change care pathways was also a “hugely important debate”, adding: “We need to reflect on how [artificial intelligence] and virtual reality make a contribution to the way people learn in the future… We have a very traditional approach to learning and it will change education pathways as well.”