Towards the Best Together is NHS East of England’s 10 year vision, developed through consultation with clinicians, other NHS staff, patients and the public, for the NHS and the region’s population of 5.6 million.  It is based on an ambition to deliver the best health service in England. 

Through a Staying Healthy implementation plan, there is commitment to make a step change in improving health and reducing unfairness, and closing the gap in life expectancy.

Our focus is on improving health and wellbeing, through better prevention and treatment services for the whole population, and wellbeing services targeted to reduce unfairness. 

Success in these ambitions requires not only the right vision, but also the right workforce.  The effectiveness of the team, its leadership and the individuals within that team are critical factors in realising these ambitions. 

Local investment of interest, energy and confidence in more innovative approaches to workforce planning and development is critical in realising local success and improving productivity while delivering quality services that make the difference to population health.

The model being developed, an apprenticeship in health and wellbeing, seeks to address workforce re-design and the development of a public health career pathway across East of England, and will be piloted from August 2009.

Rationale for development

Consultation with a range of staff from public health and community provider services within the region revealed a range of issues, including the following:

  • Gaps in service provision. “We need people to work at a fundamental level, helping mothers with basic mothering skills, feeding their babies, how to shop for food for the week, how to store food in the fridge and prepare it….” (associate director of public health).
  • Limited/no access to training and work in public health at bands 2 – 5, with specific health and wellbeing knowledge and competence preparation.
  •  Alternative access/route for health trainers in the region. The regional health trainer hub is actively supporting this development as a distinctive opportunity for development and alternative access to work and training route.
  • Feeder route with distinctive knowledge and competence base for progression to band 5 and 6 roles; problems with recruitment at this level. “It’s really difficult to recruit into band 5s in this area” (director of public health). “You recruit into a band 5 smoking cessation post, and there are these big gaps in knowledge, ie the social determinants of health and ill health, this is basic and they don’t know anything about this, there are no standards…” (director of public health).

The journey

The apprenticeship in health and wellbeing is a role that can operate in many environments across health and social care and also the private sector. Key areas of interest expressed to date relate to health and wellbeing in the workplace, where an apprentice may work alongside occupational health to support “shop floor” access to information, activities to support physical and mental health and wellbeing.

Wider health improvement activities include reaching targeted communities through specific team interventions and supporting child health development in schools, working in association with a school nurse. 

Work to date

Scoping work is currently being undertaken in the region to determine infrastructure needs and high impact areas in relation to commissioning needs, and to link these needs with competence and knowledge base and undertake competency mapping against the public health skills and career framework. 

Discussions with a range of stakeholders (e.g. sector skills councils) to develop the model concluded that the existing apprenticeship frameworks could be adapted to meet the needs of promoting health and wellbeing.

The scale and scope of discussions with national bodies: Skills for Health, Skills Active, Skills for Care, the Royal Society of Public Health, the Public Health Resource Unit, the EoE Teaching Public Health Network, COVER, local colleges, our regional health trainer network and the awarding bodies, NAS, EdExcel and City and Guilds have been enormously helpful in determining the best approach and design of the model in ensuring currency, fit and quality and standards, as well as broader interest and opportunity for this role.

The model of apprenticeship in health and wellbeing will operate through a “recommended framework of units/modules”, which map against the fundamentals of public health knowledge, with associated competence at levels 2 and 3. 

This can be achieved through identifying units available from the apprenticeships repertoire in health and social care, and training provision by the Royal Society of Public Health, with the likely development of one additional unit to ensure fundamental knowledge and competence grounding in health and wellbeing.  

Approach to developing the model

A route map was developed to help set up an apprenticeship model in health and wellbeing.  This map provided a number of advantages:

  • It formed a basis for dialogue and engagement with employers, providers and public health colleagues.
  • It placed high quality education provision at the centre of development (i.e. a curriculum fit for purpose).
  • It enabled the working group to identify key stakeholders.
  • It ensured that the pilot was integrated with wider systems change (e.g. the QCF).

The route map sought to combine an employer-led approach with an evidence-based need approach from public health. The approach also reinforced the fact the educational providers would need to be flexible to respond to this unique set of educational dynamics.

The three identified pilot routes - staff and patient health and wellbeing, child health development and health trainer progression - offer significant and sustainable workforce development potential throughout the East of England.

Employers in the region supported this development; they were able to realise a range of potential roles for apprentices in their organisation. There was also significant support and intended commitment from further education providers. The East of England workforce is well placed to benefit from a large number of pro-active colleges. There was learner interest in the content of the apprenticeship and as a basis for potential career development.

The child health development strand

“We are about to advertise two apprenticeships for support posts in our school nursing service, with the title children and young people support educators. We will be looking for applicants who are able to demonstrate a commitment to health and wellbeing through personal development or qualification, so that they can make an immediate contribution from the next school term.

“The opportunity to consider new roles came about because of vacancies for professional nurses. It has proved difficult to recruit qualified school nurses in recent months. The existing workforce establishment could therefore fund the apprentices.

“Previous work looked at design of a new role, map the job description across to the existing apprenticeship in health and social care at level 3, selecting the units of the NVQ to match the duties and responsibilities in the post, and therefore identifying other training necessary to meet those activities not covered by this framework e.g. the training needed for the apprentice to support the health promotion sessions in the personal health, social and education programme run in local secondary schools.

“We would recommend this process to colleagues in other PCTs, and look forward to networking with them as they recruit apprentices to this important area of work.”

Pamela Agapiou, professional head of nursing - Children and Families Services

The health trainer career strand

“We have worked with the SHA to develop the apprenticeship in health and wellbeing to meet the needs of our expanding health trainer workforce. We are currently advertising four youth health trainer posts and seven community health trainers and will be offering all successful applicants the opportunity to undertake an apprenticeship at level 2 or level 3, supplemented by qualifications specific to the role e.g. the City and Guilds Health Trainer Certificate. 

“We have welcomed this opportunity to be the first trust to pilot this apprenticeship in East of England. We feel that this comprehensive training will enable the staff to progress within public health or related careers over time. The applicability of the apprenticeship will be evaluated and shared with the PCTs across the region.”

Shakeela Abid, health improvement specialist, Peterborough PCT

For further information on the model and the roll-out of the pilot email