Your views: Education and training

How can we make sure that NHS staff in the future have the right skills to meet changing patient needs? Are the arrangements we have proposed for education and training the best ones to ensure this?

We are interested in your views on this area, including:

  • Will the proposed changes to the education and training system support the aims of the modernisation process?
  • How can health professionals themselves take greater ownership of the education and training of their own professions, whilst meeting the needs of healthcare employers?
  • How can we ensure that the values of the NHS are placed at the heart of our education and training arrangements?
  • How can we best combine local and national knowledge and expertise to improve staff training and education?
In Conversations, Listening exercise: Get involved, NHS Future Forum: Pausing, listening, reflecting, improving | Tagged ,

55 Responses to Your views: Education and training

  1. ruth butterfield says:

    education of all health professionals should reflect the realities of practice as closely as possible, while making training more academic is important to raise the profile and to allow a greater degree of accountability for a professional, caution is required to ensure the universities are in touch with the ‘real world’ of practice.

    an effective health professional is more than someone with academic abiltity the most fundamental skill they require is the ability to relate to and communicate with their patients, without this skill their academic achievements are meaningless!

    • Dr Julian Sims says:

      Academic practice must also reflect evidence based practice – the Health Care postgrads I supervised at a previous institution were advised not to gather primary data because it was too time-consuming and difficult to get permission. This was the students first opportunity to gather data and make evidence-based decisions, this MUST be encouraged for all medical students, both doctors and nurses.

    • james vibert says:

      I wish to add that all professionals should be involved in their practice with ” a part of themselves shared” with the patients and others and not be cloistered in their “professionalism”. A true meaning for all individuals within OUR NhS. This sharing ensures part of the humanitarian approach; and is excellent practice.

  2. Judith Usiskin says:

    Training in ‘customer care’ is vital along with the other technical skills

    • Chris says:

      Patients aren’t customers and to view them as such completely alters the ethos of the NHS. We are taught from a very early stage how to communicate with patients, how to deal with difficult situations and the entire idea of patient centered medicine. This is from a medical student point of view.

      The current undergraduate medical training requires coordination between large numbers of GPs and secondary and tertiary care care settings that is currently done on a deanery setting. I am wary that removing this central organisation will only put increased pressure on the university at a time when they are shedding costs and create a much more chaotic and unstructured system with over crowding in some hospitals that are better organised to deal with medical students. The current system for undergraduate and early post graduate medical training (although the application system needs reform) works and so why does it need changing?

    • Michael says:

      Patients arn’t Customers. Are you serious?

      Perhaps that explains why many patients feel they arn’t treated with respect and dignity.

      Contrary to your experiances in undergraduate medical training, in my role dealing with staff from all levels and all backgrounds within acute care I can sa supported with a great deal of evidence that the focus of many areas of education is too limited to the theoretical application of knowledge – especially care. Customer Care training is often dismissed as too simplistic to make a real difference. However the opposite is often true, in many cases people are looking for understanding, compassion and empathy in their time of need – not just clinical skills in dealing with the issue. this is an area currently impacting the latest cop of qualified nurses who see thier role rather differently than those trained ‘on the job’.

      I do agree however that there is a measured improvement in the engagement levels of new junior doctors and Consultants accross my Trust, slowly the old guard of ‘Do you know who i am’s’ are being replaced.

      Please though do not underestimate the importance of basic personal communication – Customer Care!

    • Sue Brand says:

      I have worked as a nurse in the NHS for 32 years and I have never referred to a patient as a customer or user, the terms just feel wrong. I am polite, always greet people on arrival, never fail to direct someone who looks lost, and treat patients and relatives as I would want to be treated. So where has, as you call it customer care gone wrong. I am sure like many businesses and services we have all seen a decline in some areas of communication, however medical staff have become much better at communicating and this is reflected in their training. Some of the ground floor services could learn a bit from medical students and junior doctors as they are leading the field when it comes to communication. The reason patients feel they are not being treated with respect and dignity is not because we do not call them customers, but because many have forgotten general rules of courtesey, no training in the world will alter that!

  3. Patrick Carroll says:

    At present the private sector contributes nothing to training but happily recruit both newly trained and very experienced clinicians. How in the “new world” can the public sector compete when it has to bear the costs of training, it’s design and now planning the future workforce? The public sector also has to aspire (quite rightly) to best practice as employers. This doesn’t make a level playing field when it comes to competition in the marketplace.

    • Dr P J G Butler says:

      My wife and I raised exactly this point with Andrew Lansley, as his constituents, and while he acknowledged our letter, saying that he would reply in detail shortly, we have still had no such reply 3 months later.
      I can therefore only conclude that he has not got an answer which he is happy to tell to voters. Despite this, I think that the ‘apprenticeship’ part of medical and nursing training is essential and should continue, with private contractors paying their share of costs as well as the NHS hospitals.

    • jean gaffin says:

      this is exactly the point I wish to make: private providers start from a privileged position as they do not have to pay for training but just hire the health profesionals trained at tax payer’s expense.

  4. Malcolm says:

    Ensuring that people are engaged in the process of education and training means that you must offer reward, it’s do more, get more. Get rid of eKSF and focus on CPD linked to the professional bodies.

  5. Steve Mink says:

    I write simply to endorse the views of Judith Usiskin above. The NHS needs to learn from those organisations which seem to succeed in inculcating the basic values of good customer care in all of their staff.

  6. Jade says:

    Training is key to keeping staff not only up-to date and safe, but motivated and interested. I work in the NHS and we have been informed that from now on, due to the savings our Trust needs to make we will have to use a third of our own leave for any training we do (that is not mandatory) and pay our own travel and expenses. This hardly shows that NHS staff are valued or that there is an interest in helping them to maintain their skills and knowledge base.

    • Julian Sims says:

      This is exactly the kind of short-termism, ‘penny wise pound foolish’ approach that MUST be abolished in the NHS! The sort of cost cutting that requires CPD to be paid for by staff, and taken during staff leave demonstrates that the PCT in question does not value education, training, or professional development. What is more, all the evidence points to the savings of such acts being dwarfed by the increased costs of skills shortages and agency workers.

  7. Professor Paul Bywaters says:

    The current training arrangements work well enough and costly ‘reform’ is unnecessary.
    What would be appropriate would be full cost charging of private sector providers for using taxpayer trained health staff.

    • christine says:

      Where else are the newly qualified nurses and doctors supposed to get jobs. They certainly can’t get a job in the NHS. Unless you know something I don’t

    • Dr Julian Sims says:

      Are we going to ‘charge’ private employers of all graduates then? How many firms, government agencies, or quangos contribute directly to tertiary education? Get real people, society educates our citizens because it is societies responsibility to do so. Those who are trained on the job are trained because it suits the employer to do so.

  8. Barry says:

    I trained in the years of the 2 tier nursing, of the SRN and the SEN. Now is the time to discuss the reintroduction. Not all nurses want to become managers with degrees. The NHS already has nursing assistants, who with planned training, could be better skilled to care for patients.

    • Caroline Terry says:

      We have a national/world wide shortage of registered nursing staff. The more up to date training of Assistant Practitioners completing a Foundation Degree with underpinning theoretical knowledge and skills can be demonstrated in clinical practice as long as on-going learrning and development for CPD is part of the infrastructure in Organisations.
      Have great concerns if taken over by social enterprises or private industry, will they invest in training and development to ensure high quality provision of care. Who will be accountable for ensuring this happens? Who will take them to account if they do not provide?

    • brenda says:

      I too trained as an SEN, then upgraded to SRN then again to a District Nurse a further 6mths. I found the SEN training to be so valuable. We had to pass nasogastric tubes on ourselves, invert our eyelids as a test, inject eachother with sterile water, push eachother around in wheelchairs and do diry tasks without washing hands then place them on an agar plate. I can assure you that having done all of these things I never forgot how a patient feels.

  9. A large number of Healthcare Scientists from a wide range of disciplines have asked to be regulated through the Health Professions Council. Further groups have set up Voluntary Registers. They are termed aspirant groups by HPC. DH has not engaged meaningfully with aspirant groups and Voluntary Registers. Since 2003 no professions have become state regulated. Registration is a valuable tool to recognise staff expertise and competence and serves to protect the public from incompetent practitioners. DH should be pushing forward with registration. DH should value the worth of voluntary registers and give them the means to act against incompetent practitioners.

  10. Helen Bolland says:

    I am an Occupational Therapy student at Derby and want to work for the NHS when I qualify. What I would like to see happen is:

    1. Make all NHS basic bursaries the same, regardless of income, course. Allied healthcare students receive much less than nursing students…how is this fair when we have the same pressures?

    2. My university struggles to get enough placements for cohorts. So make a financial incentive or another incentive for departments or professionals to take on students for placement.

    3. Most students want more on the job training/placement.

    4. Is the way forward perhaps for the NHS to employ students part time as assistants in their chosen profession and educate them part time at university?

  11. Nicky Norriss says:

    With the drastic cuts taking effect, the opportunities for developing our staff are dwindling rapidly. Reasonable support for training and development is essential so that staff can update and develop their skills and to ensure that we can provide the best quality, up to date and evidence based treatments.

    If the present difficulties in obtaining training opportunities continues, this will result in a de-skilling of the workforce.

    • A Kirby says:

      I totaly agree.
      Opportunities to diversify within a specialist role,does not appear to be possible due to financial constraints.
      To the detrement of the patients, and nurses who are keen to learn.

  12. SCC says:

    I have relapsing-remitting multiple sclerosis. Despite my condition being relatively common, My GP or GPs generally have had little idea about MS (some have admitted as much). This also included little knowledge about medications prescribed for MS, and thus I have dealt directly with the specialist nurses and the specialist neurologists. GPs are GENERAL practitioners. They are not specialists.

    There seems to be a common thread going through the minds of the government that the ‘local GP’ knows their patients intimately. The reality is very different, as I have explained above.

  13. Dr Eric Britton says:

    I am PD in London. The plans for the purchaser provider split in Education are needless for GP and are potentially destabilising. Your plans may make sense for specialist run trough training but the will not work for GP. You have a successful network that is delivering ever higher quality and your changes will undermine all he progress made in the last 10 years. The current network could absorb cost reductions without fundamentally changing structures.

  14. Laura says:

    I am a final year physiotherapy student. I would like to re-iterate the comments from the OT student.

    Also, it is states in the new white paper that the gov’t would like to move more finances to the front line. I hope this will support AHP’s, particularly those that are newly qualified. For the gov’t to provide training and bursaries to health professionals and for there to be such a small amount of newly qualified vacancies is a waste of money.

    There needs to be movement in jobs within the NHS to provide these vacancies yet at the moment it seems that managers are freezing posts in order to save money.

  15. richie krueger says:

    Our NHS, publicly run, publicly owned has the capability to keep education and training in-house NHS. Keep Our NHS Public!!

    • Dr Jeremy Platt - GP says:

      SCC – I must take issue – firstly unless you live in Scotland your condition is rare – we have 5 patients in a list of 9 200 with it.

      Secondly – to know your patients in this context means something v specific – ie to know what their needs are, not necessarily to know how to fulfil them. You will be better off in the best GP led commissioning system than you are at the moment. Possibly we can commission your nurse specialist to work nearer where you live, to provide domicilliary visits and so on. We have no such freedom now.

    • Dr Jeremy Platt - GP says:

      Publicly run – you mean like the trains, the phones and the electricity companies? Like British Leyland?

      Last week I had a patient who had heard nothing from a secondary care trust 8 (eight) weeks after a CT scan. The same day I spoke to another who (at a different trust) had heard nothing 4 weeks after a neck node biopsy.

      No private provider would keep their contract doing that sort of thing.

  16. Murmur says:

    As already pointed out, the private sector contributes nothing to clinical training and parasitises on the public sector which trains all clinicians. The proposed legislation will only worsen this situation.

    As for “customer “care: the customers are the commissioners, who are the ones making spending decisions, NOT patients.

    At present NHS training budgets for qualified staff are something of a lottery, subject to whim of local managers: the proposed legislation does not address this.

  17. Olly says:

    Any change should be based on evaluation of understanding what has worked well in the past, what works well now and what needs improving. There are strengths and weaknesses that can be demonstrated from previous and current configurations and systems, yet these are not evident in the planned changes. I would like to see an approach that is far more evidence based rather than change for change sake.

  18. Health Economist says:

    Echo’s the comments from the students, but this needs to be extended to all serving in the NHS.

    And agrees with Chris, patients are not customers (yet), however all patients should be treated with respect, if nothing else it is just good manners. If we cant get that right we have failed the public the NHS an ourseleves.

  19. Concerned allied health professional says:

    At the moment the regionally based Strategic Health Authorities plan for the future workforce needs by funding the number of training places at their local Higher Education Institutions (HEIs), thereby attempting to ensure that the number of nurses, physiotherapists, OTs, speech and language therapists etc required for the future anticipated health provision is adequate. What is not clear to me so far is who in the future will make the decision on the numbers of future staff required? Also, the HEIs are commissioned to train the anticipated numbers for a quite large geographical area – how will GP commissioning work to ensure that appropariate numbers across a large area are trained, or will they just be concerend with their local areas?

  20. Kerry Lawrence says:

    I would like to ensure that all health employees speak and understand English.
    For some roles I think it would be a good idea to have employment based training, as they do with social care so that people could be salaried and do ‘on the job’ training whilst attending university/college paid for with a written agreement that the person will remain employed for 3 / 5 years.
    I would like to see joint training for health and social care and shadowing to understand each others roles.

    • christine says:

      Sounds like a good idea to me. At the moment nurses are going to university and coming out with no job prospects. Following your idea then they would already have a position whilst continuing with their professional development.

  21. mr c carr says:

    NHS managers do not appear to be interested in the level of education and intelligence of their staff. They think guidelines and protocols provide all the answers but people who don’t understand the reasons for what they are expected to do, will not do it properly. One good head is worth a hundred strong hands. NHS managers are usually in the second group.

  22. Jo Buchanan says:

    The current systems for postgraduate medical training are working well to improve standards of training. Dismantling these systems risks reversing these improvements.
    Decisions about the NHS workforce need to be made nationally – without this we would not have had the recent expansion in GP training capacity. The training capacity for primary care as a whole – doctors, nurses and AHPs needs to be further expanded to meet the increasing needs of an ageing population. I do not believe this will be delivered effectively by the proposed systems.

  23. Lucy says:

    As a nurse who has been based in and working with training for a long time, i fully support the need for all our staff members to be accessing and receiving training and education wherever possible.
    However, certainly in my trust this is proving incredibly difficult. We are closing wards and depatments under the transformation programme and many areas are working with a minimal staff who are already stretched to capacity. Therefore, staff are finding it incredibly difficult to attend training during working hours and it seems unreasonable to expect them to come in in their days off whether it is paid or not, but especially if it is unpaid.
    I fear we are expecting things that funding just does not support, which i find very disheartning. In my experience, Nurses are desperate to further their education but are being denied from all sides, for a multitude of reasons.

  24. Graham says:

    Training and education are essential. Take the LD DES, its been around for all of last year but in my PCT no training, as required by the DES has been forth coming. How are GP’s supposed to give the service to patients with Learning Disabilites if the trianing deemed essential by the DES. Is this another way of saving money, set up an impossible task, with out the resources then fail the Practice that does not carry out the DES.

  25. Tamsin Ford says:

    Training should not cease at qualification for practitioners of any discipline – cutting study leave for continuing professional development is extremely short sighted, and not a mistake that those in the private sector would make.

    • Caroline Terry says:

      I agree with the previous comments. E learning has its place in education, but may be seen as a tick box exercise when collating evidence that statutory and mandatory training has been acheived by staff in Trusts. E learning does not demonstrate that effective lerning has taken place which is a big concern. Who is going to assess learning and clinical understanding and reasoning has taken place. Some training cannot be done by e learning. What about academic acreditation and staff wishing to acehieve further CPD? Where do the changes in funding (change to e learning contracts) helps those staff developing to meet their specialist practitioner requirements that are needed for their job role? Strategic thinking in education is all well and good but the operational side needs to be highlighted. This was highlighted Lack of staff to work never mind attend training. Education is way down in the pecking order. it is integral to maintaining and developing the skills of staff at all levels Band 1 – 9

  26. Pete says:

    I see changes all around, monies need to be saved, that I am aware. The thing that totally annoys me is that at this moment in time our Directorate is going through a consulation to reduce staffing levels but at the same time, the same Directorate is going out to tender for a Private company to take over. With the threat of “UP TO” 40 redundencies BEFORE the move away from the N.H.S surely NOT losing the jobs would save the N.H.S. so much more by letting the New company sort out the staffing levels when all have been moved over?

  27. Corinne Camilleri says:

    Can anybody explain to me why Deaneries are being abolished? They work relatively well, are not expensive to run and deliver good postgraduate medical education. why throw it all up in the air? The current proposals could be disastrous, particularly for the smaller specialities.

    • Prof. Woody Caan says:

      I agree absolutely with Dr. Camilleri.
      The NHS needs a good balance of professional skills, within a coherent system of selection and training – leaving these to ad hoc alliances of a few large employers is a recipe for wasted resources and blighted careers.

  28. Rod Whiteley says:

    I partly agree with Ruth. Training should focus much more on the realities of practice, as was illustrated yet again by all the stories of poor treatment by NHS staff in this month’s draft NICE Guideline on Self Harm.

    I can see no case, however, for making training more academic. The measure of academic excellence is the approval of a professor, but the measure of health professionals should be the clinical outcomes for their patients.

  29. Deborah White says:

    Please let health professionals take greater ownership of education and training by listening to us – deaneries have their failings, but regional oversight with national co-ordination is absolutely vital for something like medical education, which requires a long term approach. Employers and other local organisations will not have the interest, nor the expertise, needed.

    Workforce planning also requires national oversight – many medical specialties are just too small for effective local or even regional workforce planning.

    The values of the NHS already are at the heart of medical education and training, as doctors are trained in the NHS by NHS professionals. One of the concerns with the proposed reforms is that other organisations delivering healthcare will not have the same long view and give the same input to education and training of doctors and other healthcare professionals.

  30. Teresa Black says:

    I am very concerned about threats to training especially in Psychiatry which is a real shortage speciality. My psychotherapy service is being decommissioned (we have been told there is no place for long term psychotherapy ie anything longer than about 16 sessions on the NHS) but most concerning is the fact that psychotherapy training for junior psychiatrists which is already at a premium is likely to shrink because of this and other changes. Will the private sector pick up the training shortfall-I don’t think so.

  31. Dr Helen Jones says:

    I agree with many of the previous comments. As a doctor currently training as a registrar with a deanery, I cannot understand these plans to get rid of the deaneries. They work reasonably well at present, I’m sure they could be made a bit more efficient, but I don’t feel that the royal colleges have the capacity to take over their role. What should change is that contracts for the private sector which allow them to treat NHS patients should also specify that they must provide training opportunities for staff eg. trainee surgeons, physios etc. This should then be overseen by the deanery. Apparently the original independent sector contracts given did specify that they should provide training but when our deanery has tried to implement this it has proven impossible, so contracts need to be watertight!

  32. Prof. Woody Caan says:

    It takes many years to develop an Academic teacher in any of the health professions (one can use, say, successive NIHR fellowships from doctoral student up to senior scientist as a benchmark). The health workforce in Higher Education needs parallel development to the larger workforce in NHS practice, but any mechanisms for this academic underpinning of current reforms are absent from the Bill and its related Consultations….

  33. lois orchard says:

    Why are you posing these questions when you know that the NHS will be run by private providers who will make thier own descisions on training ? Are you considering keeping some parts of the NHS out of the hands of private providers ( including FT trusts – private by any other name) . Will you continue the pracitce of baling out the private providers eg through tariff plus – as you do currently ‘ to give them a chance ‘ a pracitce that encourages cherry picking of ‘easy cases’ which results in the local NHS delivering care to the ‘less profitable ‘ cases under tariff . Blinding policy.

  34. jean gaffin says:

    Made a comment but it did not appear. My concern on education and training has been made before but cannot be made often enough. There is no level playing field when private providers just hire trained health professionals leaving NHS to pick up the cost of education and training.

  35. A Christopher says:

    Training of NHS staff has produced some of the most dedicated and expert clinicians in the world, we are envied everywhere. Why oh why meddle?

  36. George C.A. Talbot says:

    This section reflects fear providers selected on narrow cost grounds will not train new staff. The established NHS did this adequately and good managements know the importance of ongoing, local and national, training and education. All managements resolve conflicts between individual and group interests. The problem here is the “modernisation process” which is based on faith in values that are antithetical to those of the NHS.

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