A good investment

Will training budgets survive the NHS financial downturn? They were first to go last time in 2005-6 when the rush to balance the NHS books meant that many Trusts cut where they easily could, rather than where they probably should. A recent paper from the NHS Confederation ‘Dealing with the downturn’, however, argues that now NHS organisations have time to prepare so that short-termism such as training budget cuts, shouldn’t be necessary if managers rise to this leadership challenge.  
    
It is of course the professions and the educational institutions which squeal the loudest when training numbers are cut: the impact further down the line is less visible. Yet, it could be argued, these cuts are at least as damaging for the service as a whole because access to training opportunities for those on the lower grades has always been more limited.

Training for all
One strategic health authority which has recently set out to bring training opportunities to those down the line is NHS East Midlands. Julie Bellm, who manages a major training initiative for the region, comments: “Everyone knows that the NHS invests large amounts in training but often people assume that this is only on the clinical side – doctors, specialists and so on. Of course this is true but we are keen to ensure that everyone involved in the NHS, at every level, is offered training. In short, if we are to live up to our ambition of offering high quality care, we have to ensure all our people are trained and developed, and have the right breadth and depth of skills and experiences.”
    
The initiative is entitled the Joint Investment Framework (or JIF) which is a rather bureaucratic title for an exciting scheme to promote throughout the region training opportunities for staff working at Pay Bands 1-4. JIF is focused on Skills for Life, National Vocational Qualifications at levels 2, 3 and 4, and Apprenticeships. The JIF, a partnership between NHS East Midlands with the Learning and Skills Council (LSC) and Skills for Health, uses funds drawn from different sources to maximise investment against identified and planned workforce needs. In Julie’s words: “It provides a means through which to identify and deliver innovative ways of offering sustainable employment with a real opportunity for progression.”
    
In its first year the JIF Partnership has funded over £5m worth of training and there is still more to do. “Training options available are many and varied,” says Trish Knight, deputy director of workforce at NHS East Midlands. “We have Level 1 courses available in numeracy, literacy and IT and Level 2 courses that cover accounting, clinical laboratory support, play work and team leading. Level 3 courses cover business administration, dental services, health and social care for adults, children and young people, and library and information services. Level 4 courses include catering, learning and development, foundation degrees in imaging and pathology and, BTECs in pharmaceutical sciences, for example.
    
NHS East Midlands is one of several strategy health authorities that have taken up the government’s drive to increase the number of NHS apprenticeships. And the pressure from the centre is being sustained: in late July the Department of Health announced a target of 5,000 new NHS apprenticeships by March next year funded by an extra £25 million. This is part of the Prime Minister’s commitment made in February 2009 to increase the number of apprenticeships by 21,000 across the public sector, expanding and strengthening apprenticeships as a mainstream option for young people and adults. There are around 1,200 NHS apprenticeships at the moment.
    
East Midlands have used a top-down approach but invested heavily in communicating and promoting learning opportunities, and not left it to chance. The trade union learning representative initiative, however, uses a bottom-up approach, encouraging and fostering a learning culture through accredited representatives who have time off to analyse needs, promote the value of training and arrange training provision.
    
Has this worked out as envisaged in the 2002 Employment Act? Do learning reps have a strong enough toe-hold in the NHS to help prevent an attack on training budgets? The Union Learning Fund, which has had its fair share of attacks as a quango which funds union leaders’ pet projects, gets £15million a year to fund projects to help unions encourage lifelong learning among members. Yet the impact of this initiative is still very patchy and it is difficult to see how a delegation of learning reps would have NHS Trust boards quaking in their boots when they are considering where the axe should fall.

Knowledge for skills framework
Perhaps the meeting ground for the top-down versus the bottom-up approach should be the Knowledge and Skills Framework, the part of Agenda for Change, which was often overlooked in the relief that followed the implementation of the pay and banding part of the deal. So why hasn’t the Knowledge and Skills Framework done more to embed a learning culture and change ways of working throughout the NHS? The recent National Audit Office report on NHS Pay Modernisation criticised Trusts’ slowness to implement the KSF, despite several urgings from the Department of Health.  
    
A review of the KSF is now underway, under the auspices of NHS Employers, to try to find a way of improving take-up and increasing the numbers of staff who have an appraisal or development review. If the KSF can be simplified so that it becomes a working tool, NHS Trusts stand a good chance of being able to make sense of a development plan which covers all their staff, marrying the needs of the employee with the strategic needs of the organisation and thereby helping the safeguard training spend.
    
At GateHouse we see all these approaches to training or learning in healthcare organisations. The best see their training needs analysis as a key part of workforce development which in turn is integral to their organisational strategy. They are focused in the way they commission training and measure and evaluate its outcomes. The worst either buy training in a piecemeal, incoherent way with only faintest nod towards evaluation; or they never actually complete the training needs analysis so the budget goes unspent.
    
So will training budgets survive the difficult times ahead? They can do if managers start now to prepare for financial constraints and protect the means they have at their fingertips to develop the skills of all staff to deliver services that are cost-effective. 

Case study – apprenticeship success in Nottinghamshire
Nottinghamshire Health and Social Care Community Workforce Team (NHSCCWT) has recruited a cohort of ten apprentices across NHS Nottinghamshire County and Bassetlaw Primary Care Trust (PCT), and have welcomed one of them into their own team.
   
Jo Beckwith, widening participation manager, helped develop the pilot to recruit the ten apprentices. Jo and the team felt that in order to encourage other teams to recruit apprentices, they would first gain the knowledge and experience of doing it themselves.
   
“We found that the normal HR recruitment process didn’t fully support the recruitment of apprentices, because they often have no previous experience, no references from previous employment and know little about the NHS. Under normal circumstances they wouldn’t even have been shortlisted for interview!
   
“Candidates were asked more informal interview questions, and therefore we asked them to tell us about themselves.”
   
They decided to recruit apprentices because the local health community was under represented in the age group of 19 years and under. It was an ideal opportunity to take on young people and be able to support them to grow into the future workforce.
   
Scott, the apprentice in the team is 18 years old and is already proving to be a success. He helps with general administrative tasks, attends careers events in schools actively getting involved in activities with the children and has taken on the task of collating information for the team’s annual report outlining their successes over the past year.
   
Scott commented: “On leaving school I wasn’t sure what I wanted to do with my career so I did AS Levels for a small period of time and then started an electrician apprenticeship and didn’t enjoy that either. I know the NHS is a well established organisation to work for and thought that doing a Business Admin Apprenticeship would give me the experience I need to go as far as I possibly can in my career. I am enjoying working on a variety of things and the team here really make me feel more valued.”

GateHouse is the training division of Chamberlain Dunn.

For more information
www.GateHouseCourses.com
http://www.apprenticeships.org.uk/

References:
Dealing with the downturn, NHS Confederation, June 2009
www.nhsconfed.org/leadership