COUNCIL OF HEADS OF MEDICALSCHOOLS
AND DEANSOF UK FACULTIES OF MEDICINE
1. Theconcept of improving the educational opportunities and achievements of the NHSstaff is a laudable and welcome one.
2. Themain area of benefit will be in providing educational opportunities for staffwhose school education has been limited.Thus, Foundation Courses will be of great value, partly as a finaldegree and partly as a stepping-stone to further education. Focus on skills of numeracy and literacy andon particular skills relevant to different jobs (IT, engineering, management,communication skills, etc.) will also be particularly valuable. Such in-job training and education aresorely needed, especially if available as transferable modules or diplomas.
3. Similarly,the proposed Clinical Fellowships are welcome, but care will need to be takento ensure that there is a proper competitive process, which will requiresignificant administration. Also,integration with pre-existing fellowships (research council, charities, NHSR&D, etc.) will require careful planning.It may be that the process can be jointly managed with the MRC, ratherlike the NHS R&D clinician scientist awards.
4. However,there seems to be potential for considerable confusion and dysfunction inseveral areas, unless early clarity is achieved. Thus, the document suggests little real grasp of the enormousscale of what is being proposed. Giventhere is no spare capacity in the NHS at present (indeed much teachingis either not being done, or is being done inadequately because of time,clinical and financial pressures), some serious modelling of the time, staff,physical and financial needs must be done.Otherwise the aspirations will completely outweigh the capacity and thewhole enterprise will potentially lose momentum and direction. A realistic approach would be to focus oncertain areas (particularly in-job training of relevance) and pilot these.
5. Theaspiration to be a full university is incompatible with being a corporateuniversity and being owned by the NHS.A university must be independent.However, the recent White Paper on The Future of Higher Education maymake acquisition of the title of university easier, for instance by basing thecriteria on taught degree awarding powers.
6. Muchof the function of the Learning Needs Observatory appears to be currently therole of the NHS Workforce Development Confederations (WDCs) and StrategicHealth Authorities (StHAs) (and indeedsome aspects hint at the role of UCAS).Unless clear understanding of the respective responsibilities is quicklyachieved, there is potential for great confusion.
7. There is real lackof clarity about the respective roles in R&D of the NHSU and the Departmentof Health Research, Analysis and Information Directorate. It is said in the document that the NHSUwill take over agreed areas of R&D, but it is not clear why this isnecessary. The NHS R&D system hasbeen going through a major re-organisation and is beginning to implement itsnew structures. It is important torealise that there is an enormous need for relative stability of funding anddirection in research and this proposal could provoke much unnecessaryuncertainty.
8. Thealmost-complete absence of financial information is of concern. This relates not only to worries on overallcostings and the sources of funding (new or re-distribution), but absence ofany information about fees (or lack of), including, for example, impact on FundingCouncil income streams for universities.
2.1 Whatdo you think of the proposed overall vision of the NHSU?
It appears to be aimed primarily atfurther/in-job education and as such is highly welcomed. If done properly, it will be a majorcontribution to helping to combat the shortcomings of primary and secondaryeducation.
2.2 What is missing from the proposed vision?
There is little or no sense of scale, financialrequirements or how to balance performance pressures with educational needs.
2.3 What do you believe the main focus of the NHSUshould be?
a) Raising the educational skills of the workforce,especially those who were badly served by schools.
b) In-job training and education for transferableskills.
c) The foundation degree course concept is welcomedand should also be a focus, as it will provide a mechanism for staff toprogress in higher education.
d) Training of technical staff, allowing recruitmentand retention, is a key priority.
2.4 What will be the main challenges to securing fulluniversity status?
(SeeGeneral Comments paragraph 5 above.)
2.5 How should NHSU include the needs of social carestaff working within and alongside healthcare staff?
Nocomment.
3.1 What do you think of the proposed NHSU guidingprinciples?
These are satisfactory.
3.2 Which principles will constitute the biggestchallenges?
Embedding education in everything the NHS does isan excellent idea. The sign-postconcept is also an excellent idea.However, achieving these aspirations will be an enormous challenge giventhe complexity and capacity constraints currently present. (See GeneralComments paragraph 4 above.)
3.3 How can the NHSU best meet the challenges?
Through focus and piloting (see 2.3 above).
4.1 What do you think of NHSUs proposedestablishment of a Learning Needs Observatory?
While this is a good idea, the scale of theproposal is enormous, particularly if this is to be a countrywidedatabase. There are already manycatalogues of courses provided by institutes and re-duplication will need to beavoided. The difference will presumablybe that the learners needs will be the basis of the NHSU database, rather thancatalogues of the institutes provision which is what currently exists. However, having a structured,comprehensible, accessible database from many thousands of different needs willbe an interesting challenge.Furthermore, this role is currently a WDC role and there is potentialfor over-lap and confusion.
4.2 How do you think the Learning Needs Observatorycan be made most effective?
By establishing appropriate networks withWorkforce Development Confederations and patient groups.
4.3 In what ways can learning be better built intothe everyday work of healthcare staff?
Money, leadership, commitment, planning from thetop, and co-operation with WDCs.
5.1 How can NHSU best support learners?
(See paragraph 4.3 above.)
5.2 What guidelines do you think should beestablished to clarify the entitlements and responsibilities of NHSU learners?
Every employee should be subject to some form ofannual appraisal plan, which identifies their specific learning needs if theyare to progress and contribute maximally to the NHS. It should be the individuals responsibility to work with theirappraiser to identify their needs and ambitions.
5.3 What role should patients have in the design anddelivery of NHSU learning and in becoming NHSU learners?
The involvement of patients is to be welcomed,but it is difficult to believe that many patients will have the time andexpertise to fulfil these roles.Research on how best to obtain and to utilise such involvement isgreatly needed.
5.4 What challenges do you envisage with establishingNHSUs support for learners?
Providing the time, funding and trained staff.
6.1 Whatlearning and development do you think should be a priority for the NHS?
Practical skills and knowledge appropriate forindividuals and their jobs.
6.2 What is your view on NHSU establishing thefollowing:
An NHSU Academic Strategy Board
An NHSU Learning Advisory Group
Both seem sensible, although there will be a needto avoid overlap.
7.1 What are your views on learning and supportsystems being proposed?
All are in principle fine. However, the biggest problem will be findingtime for people to act in the various roles, in addition to their currentjobs. Has there been any modelling ofthe additional time/staff needed? Whileit is possible that some facilities have spare capacity, much of the currentlibrary, IT, seminar rooms, lecture theatres, etc, are fully used. IT-based learning is much more expensive intime and skill than is recognised and needs continual up-grade and maintenance.
7.2 What do you think of the idea of a LearnersCharter?
In principle, fine.
7.3 What do you think is the appropriate balancebetween computer-based learning and other forms of delivery, e.g. face-to-facetutorials and correspondence courses?
Computer-based learning is not a replacement forface-to-face teaching. The OpenUniversity and the London School of Hygiene and Tropical Medicine (amongstmany) have extensive experience in this area and their advice should be sought.
7.4 How can the capacity to support and superviselearning in the NHS best be strengthened by NHSU?
By specifically identifying individuals withthese tasks and giving them the time and tools to do the job. This will need to be in addition to currentstaffing roles.
7.5 What should the NHSU learning advice serviceoffer?
No comment.
8.1 Whatdo you think will be the greatest challenge in seeking to work in partnershipand collaboration?
Seeking to do too much, too soon and without sufficientclarity of respective roles and benefits.
8.2 Howcan these challenges be met?
By establishing realistic, focussed andtransparent goals for the NHSU and by recognising the legitimate needs andconcerns of the proposed partners.
8.3 Howdo you think the partnerships between NHSU and the NHS Workforce DevelopmentConfederations should develop?
It will be necessary to define each othersrole. The crucial issue will be todetermine whether the WDC is to be the agent of the NHSU.
8.4 Whatother sorts of organisations and learning providers should NHSU seek to workwith and how?
The obvious collaborators are local HE/FEinstitutes. Links with local secondaryschools should be considered.
9.1 How can NHSU ensure all workplace learning isrecognised?
It will need an externally validated, effectivemonitoring system for content, participation and assessment. Universities currently devote considerabletime and resource to this quality assurance process, which is difficult to doeven in the relatively controlled environment of a conventionaluniversity. The NHSU should consult theOpen University. Internally, the annualappraisal exercise should be used to ensure recognition.
9.2 What do you think are the challenges for the NHSUin delivering rigorous quality process and standards?
- defining what it wishes tomeasure this has proved difficult in many areas (QAA, GMC, etc.). Focussing on learning outcomes rather thanprocess is vital;
- providing time forstaff/learners to participate;
- handling the volume ofdata in an effective manner.
10.1 How should NHSU get involved in high-qualityresearch and development? How importantis this?
There may be a case for some research on how todevelop a learning culture in the NHS and how to involve patients effectively,but much research on educational theory and methodology already exists. Social and healthcare outcome research alsocurrently exists and, indeed, some such budgets are under-spent due to lack ofsufficient high-quality applications.The danger of pursuing research of no/limited value should beavoided. R&D should not be a mainfocus for the NHSU and, indeed, would prove a distraction from its main role ofeducation.
10.2 Which aspects of research and development shouldNHSU focus on?
(See paragraph 10.1 above.)
10.3 How can we measure the impact of NHSU learning onimprovements in the delivery of patient care?
This is an extremely complex and long-termissue. There would need to be clearlydefined outcomes and prospective measurements. Use of pilot sites would allowcontrols for comparisons.
11.1 What sort of relationship would you like yourorganisation to have with NHSU?
Clearly defined, identifying areas of mutualbenefit, providing a forum for interaction and discussion.
11.2 Do you think NHSU has got the balance rightbetween local and national functions?
It is not possible to comment, as there is noreal detail in the document.
11.3 How can NHSU best develop and maintain itsengagement with stakeholders?
By engaging in clear agreements, recognisingcurrent activities and sensitivities.
12.1 Who should pay for which elements, levels ortypes of learning undertaken through the NHSU?
This depends on what is being done, by whom, who,where, etc. Presumably there could be amix of student and employer payment depending on the courses. If the NHSU role were exclusively in-jobtraining, this should be funded fully by the NHS employers. Courses, which primarily benefit thestudent, should be paid for by students themselves, although the danger of feesdeterring low-paid individuals would be a major problem.
12.2 Whatother issues do you think the NHSU needs to consider?
With the recent White Paper on the Future ofHigher Education, the map of educational institutes is likely to changerapidly. Many of the proposed changeswould appear to suit the purposes of the NHSU and it may be that these willallow it to seek independence from the NHS sooner than might otherwise havebeen possible.
February 2003