Beyond Inequality: Widening participation in learning in Healthcare

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Beyond InequalityWidening participation in
learning in Healthcare

• Professor Bob Fryer CBE
• Chief Learning Advisor
• Department of Health
• Bob.Fryer_at_dh.gsi.gov.uk
• www.wideningparticipation.nhs.uk

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The NHS and its workforce

• Largest employer of staff in Europe third
  largest in the world
• Total budget of c100 billion, still rising
• Total of 1.3 million staff in NHS - a further
  1.5 in social care
• A highly professionally qualified staff 55 Level
  4 or above
• NHS alone spends gt5 billion on learning annually

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Recent Context of Challenge Turbulence

• Three-quarters way thro the NHS Plan
• Five years of real increases in finance (7
  year-on-year, but recent serious financial
  challenges
• Fewer but still very demanding output targets
• Creating a so-called Patient-led NHS
• New focus on Improvement, Patient Choice,
  provider contestability, Chronic/Long-term
  conditions Public Health
• System Reform PBR, (practice-based)
  commissioning, Connecting for Health
• Fitness for purpose recent reconfiguration of
  boundaries functions of SHAs PCTs
• New Interfaces between health social care,
  public
• private, statutory voluntary, patient
  service provider
• Next Stage Review, led by Lord Ara Darzi

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Our NHS, Our Future

• Fair (equally equitable to all, taking full
  account of personal circumstances and diversity
• Personalised (tailored to individual need, with
  access and choice)
• Effective (clinical outcomes among the best in
  the world
• Safe (with patients confident of the care they
  receive)
• Locally accountable (staff empowered to lead
  change locally based on clinical evidence and the
  product of patient and public engagement)

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Increased net demand for health care
occupations 2002-2012 (Plus 50 of current health
social care sector workforce!)
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Some policy headline messages.

• The NHS depends on its staff. It needs a
  workforce which has the skills and flexibility
  to deliver the right care at the right time to
  those who need it.
• This report is about how we make sure we have
  the staff we need to deliver this new kind of
  service. It is about looking at the workforce
  in a different way, as teams of people rather
  than as different tribes. . For too long we have
  planned and trained staff in a uni-professional
• and uni-disciplinary way.
• A Health Service of all the Talents Developing
  the NHS workforce. DH, April 2000

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Working Together - Learning Together

• The aim of this framework document, according to
  the then Secretary of State for Health, Alan
  Milburn, was to
• help make a reality of the concept of the
  Golden Trust - an organisation which recruits,
  retains and sustains the morale and productivity
  of its staff, with measurable benefits to
  patients, their carers and families.

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Results from the 2006 NHS Staff Survey
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Some recent evidence on learning opportunities in
the NHS ()
Source NHS Staff Survey 2003
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Engaged in learning at work in previous 13 weeks
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NHS staff qualifications by pay per hour
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The Literacy Numeracy Challenge in Health
Social Care
Source NIACE, 2004
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Literacy numeracy by age group, general
population and health social care compared
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Support Staff the least well trained
The NHS and social care sectors spend more than
5 billion annually on training and developing
staff. Only a small fraction is targeted at staff
working in support roles the least qualified
dont get the opportunity to participate in
learning and development. It is not acceptable
that some of the most dependent people in our
communities are cared for by the least well
trained. Our health, Our care, Our say a new
direction for community services, January 2006,
Cm 6737
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Poor Skills for Life the risks
This situation constitutes a potentially very
serious problem indeed, in limiting staff's
ability to handle some aspects of their jobs
effectively, including fully understanding
written instructions on the use of equipment or
materials, or to deal properly with printed
health and safety regulations. In certain
situations, such as supporting or helping
dependent patients or service users with their
drug and other treatment regimes (whether
formally or informally), it could also represent
a serious potential risk to their wellbeing, or
even to their safety. This is especially crucial
in social care, where half of all staff are
estimated to be employed directly in the
provision of services. Learning for a Change
in Healthcare (Fryer Report, December 2006,
paragraph113
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The (persistent!) big issue

• Access to education, training and development
  opportunities depends on where you work, who you
  are and what you do, as much as on individual or
  service needs.
• (Hidden Talents, Audit Commission, 2001)

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So, whats the real problem for these groups of
staff?

• Simply get overlooked, in the focus on medical
  staff the clinical professionally qualified
  workforce generally
• Get fine words of praise rhetoric heaped upon
  them, but little practical follow-through
• Even where good schemes for these groups are
  implemented, they are often too short-term to a
  real shift
• Funding for their learning always vulnerable to
  financial cuts or other priorities
• No serious (detailed) evaluation of their current
  likely future contribution to healthcare
  provision the promotion of health
• Even good machinery/processes (e.g. annual review
  discussion of individual learning plans) very
  patchily utilised
• Good practice (and some certainly exists) is
  poorly spread or generalised
• Successive reorganisations re-configurations
  seriously damage the support knowledge
  infrastructure

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Healthcare Work is Knowledge Work
Perhaps more than in any other field
of employment, healthcare work is mainly
about the effective and continuous development
and application of knowledge through people,
to improve health and promote better health.
That has implications for the continuous learning
and development of all healthcare staff, and not
just those in senior positions exercising the
highest level clinical and managerial
skills. Learning for a Change in Healthcare,
(Fryer Report, December 2006