Liberating Talent: Learning, Skills, Personal Development & Cultural Transformation in UK Health Services

1. Liberating Talent: Learning, Skills, Personal Development & Cultural Transformation in UK Health Services Professor Bob Fryer CBE Chief Executive NHSU Bob.Fryer@nhsu.org.uk

2. Brief Agenda • Why ‘hidden talents’? • The UK NHS & its workforce • The policy framework • The barriers to learning • The ‘Big Issue’ • Current participation in learning • The core purposes of NHSU • Eight core operating principles • E-enablement through NHSU

3. Discovering the hidden treasurein us all "None of the talents which are hidden like buried treasure in every person must be left untapped …memory, reasoning power, imagination, physical ability, aesthetic sense, the aptitude to communicate with others and the natural charisma of the group leader, which again goes to improve the need for greater self-knowledge." Jacques Delors, UNESCO, 1997

4. The UK NHS and its workforce 1 • Largest employer of staff in Europe & third largest in the world • Total budget of >£60 billion, rising to £100 billion • Total of 1.3 million staff in NHS - further million plus in social care • A highly professionally qualified staff • NHS alone spends >£3.5 billion on learning annually • 1 million health consultations every 36 hours

5. The UK NHS and its workforce 2 • Total of 1.2 million staff • 630k professionally qualified staff in NHS • 104k Doctors • 367k qualified nurses • 116k therapists, technicians & scientists • 15k qualified ambulance/paramedical staff • 19k ‘infrastructure support’ staff • 75k current job vacancies • 130k new starters annually

6. Where do health and social care staff work? • In more than 600 NHS employing organisations - ‘Trusts’ • In 1,600 acute & general hospitals • In ’primary care’ • In 12,000 local ‘General Practices’ (family doctors) • In more than 30,000 care and residential homes • In ambulance services & ‘walk-in’ centres • With 17,000 dentists & 7,000 opticians & 27,000 pharmacists • In the community at large

7. 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 differentway, 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

8. UK public & private sector workforces

9. Main reasons for leaving/stress People join the NHS because of their value commitment, to ‘make a difference’ and to work with people. They leave or are stressed because of: • Bureaucracy, paperwork & targets • Workload & too few resources • Lack of autonomy • Feeling undervalued by Government, managers & the general public • Pay not ‘felt to be fair’ • Inadequate career ‘progression’ • Change agenda feels imposed & irrelevant

10. Challenges facing the UK health service • Sheer growth of demand for services • Changing lifestyles, demography & health needs • Rising patient & public expectations • Stringent targets for improved service delivery • Critical public opinion & staff morale • Greater patient choice & involvement - choice & ‘personalisation’ • Problems of staff recruitment & retention • Requirements for inter-professional, multi-disciplinary & team working • Changing patterns of work organisation • New collective agreements & contracts

11. 10 Barriers to learning & for learners • Patchy & uneven provision • Variable management support for learning • Unequal access to learning opportunities & facilities, including ICT • Insufficient time for learning • Lack of funding/resources for learning • Problems/costs of staff ‘cover’ or availability to release learners from work

12. 10 Barriers to learning & for learners • Inadequate information & advice • Uneven capacity for learner support • No common frameworks for quality or accreditation &little ‘portability’ of credit • Insufficient opportunities to apply learning & progress in job

13. What NHS staff dislike about their learning Q Which, if any, of the following would you say is particularly poor about your current learning? Lack of staff cover - 69% Lack of time within working hours - 58% Lack of funding - 53% Source: MORI

14. “Well, ward clerk is a bit like, you’re capped off, you can’t really go any higher unless you come out of that and do something completely different, so I don’t know how to progress further.” Ward Clerk Focussing on ‘ancillary’ staff…. Common themes are: • Access • Time • Relevance • Lack of recognition • Lack of career “Even though mine’s a clerical based job, I’m still talking to doctors and things about x-rays and about different blood things. They’re always saying to me what does that mean, but because I haven’t had the training on it I don’t know.” Source: MORI AdministrativeAssistant

15. “You’ve always got to find out who co-ordinates the course and find out where they work and ring them up and try and get a date” Senior nurse - London National charity “I think it could add enormous value to the work that we do, giving us another point of contact that is capable of filtering down to levels that we can’t reach” Provide a single entry point - one stop shop A further way to address inconsistency is to provide a central resource for information & guidance on learning Source: MORI

16. “Establishing standards for training, course content, making sure that all staff that are trained in the same areas to the same standards” Common standards needed GP PCT “The main focus of NHSU’s work should be in ensuring a coherent pulling together of what already exists” Help co-ordinate Chief Exec SHA “I think it is a good idea because everybody will be trained to a certain standard - everybody will be on a par, so you could move if you needed to” • Ancillary staff - South Co-ordinate & accredit learning - tackle inconsistency Greater transferability Source: MORI

17. The 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)

18. NHSU's mission & core purpose “To contribute to radical change and improvement in health and social care through the transformation of learning.”

19. Three strategic aims for NHSU • To create coherent learning environments • To enhance learning opportunities • To lead research into learning needs and outcomes Underpinned by two Supporting Aims • To work in partnership with others, creating active learning cultures in health & social care • To become a ‘learning organisation’, working efficiently & effectively, learning continuously from partners & practice

20. What do ‘radical change’ & ‘transformation’ entail? Radical change in service delivery for health & social care: increasingly patient-centred, team based, multi-professional, outcomes driven, evidence-based, de-centralised, giving choice & more publicly accountable Transformation of learning opportunities in health & social care: promoting skills enhancement, capacity and personal development through more learner engagement, wider participation, new modes of learning, and higher levels of learner attainment, achievement & progression

21. Current UK adult participation in learning & future intentions, by social class

22. British Adult Literacy Levels: Prose, Documents & Quantification (IALS)

23. Class Differences in UK HE Age Participation Rates by Socio-Economic Group (class) Source: DfES/HEFCE

24. UK Employees Receiving Job-related Training in Last Month by Occupation & Location of Training

25. Access - available to everyone in healthcare Relevance- designed to secure benefits for patients & staff alongside improvements in healthcare Choice - delivered in innovative ways that suit individual learners Support - world class systems to help learners Equity- tackling the barriers to fair opportunity & creating opportunities for inclusive learning Multidisciplinary &multi-professional - towards common learning Partnership- working with others, recognising good work already being done Quality- commitment to excellence in all that we do Eight guiding principles

26. What kind of an organisation/university will NHSU be? • Definitely a ‘new kind’ of university • Learning from the very best of the ‘corporate universities’ worldwide • But with a difference - full university title & powers • With a distributed structure for delivery • Focussed on work-based learning • Utilising ‘blended’ e-learning • Working in partnership • Using, brokerage, commissioning & co-development before direct provision

27. NHSU Virtual Campus & Learning Environment Learning Programmes & Services (Curriculum Development, Blended e-learning, courseware design, learning cultures & communities, assessment) Distributed Learning (E-enabled distance, distributed and work-based learning, Learner Support, Widening participation & Public Involvement ) Corporate Services (Strategic Information Systems, knowledge management, quality & standards, registration & tracking, data bases) Chief Executive’s Group (Finance & Planning, Strategy & Policy, Implementation)

28. How will NHSU be organised to support learning and learners? • A coherent picture of learning needs • A comprehensive information & advice service ‘U-i’ • Working closely with ‘affiliated’ health & social care organisations • Training & supporting work-based tutors • Designing high quality courseware • An inclusive accreditation framework • Through the NHSU ‘Virtual campus’ • Creating & sustaining ‘learning cultures’ & communities of learning

29. “Only the well educated will be able to act effectively in the Information Society.” “The key to the Learning Society is to seek the learning potential in everyday situations… A ‘learning culture’ must, after all mean finding learning in the most unlikely places…” Michael Barber, The Learning Game