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?

This page was closed to comments on 31 May, the last day of the listening exercise. All comments have been fed back to the NHS Future Forum to consider.

The Forum will submit its report to the Prime Minister, Deputy Prime Minister and the Health Secretary in June. The government will consider the Forum’s findings and then publish its official response.

In Conversations, NHS Future Forum, NHS listening exercise | Tagged ,

188 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.

    • chris kempsell says:

      As a long qualified nurse returning to full time acute nursing and sharing preceptorship with newly qualified RGN’s I have been horrified on their behalf to witness how limited they are in terms of practical skills. To qualify as a nurse and yet never to have catheterised a female patient or have any real concept of asceptic technique and yet now expected to supervise HCSW’s, students, and other staff is surely a damning endightment on the university system of developing staff in preparation for what is surely still meant to be a practical role.
      Academia seems to be developing into the be all and end all of nursing practice, no wonder the NHS finds itself plagued with complaints centred around communication issues.

    • Bruce Poole says:

      I feel it is important that we do not lose the ‘talent’ we already have by ring- fencing post within our organisations. For example, why would an FT/PCT/LA recruit to public health posts from a pool of nurses that maybe at risk or who want a change in directions when there is a pool of qualified and experienced staff who are currently not working as a result of efficiencies/restructures and amalgamation of services?

      We should support people who are at risk and have the ‘right’ skills for the job or we risk wasting time, money and resources in trying to fit square pegs into round holes!

    • Thomas STocker says:

      Yes – agree with earlier reply – permission for information gathering needs to be a lot easier – why can’t patients (and obviously health workers, cleaners, managers, admin staf etc.) fill out surveys and write comments in suggestions boxes for academics, DoH staff, regulation bodies and managers to read through – very accomplished people come through the NHS and they might be very sharp with a good eye for what needs to be changed to improve things – this kind of patient-power might also lead to a harder working front-line in the basic things like cleaning, turning people in their beds, pain relief and food improvement.

      Managers can’t be everywhere at once if they need to complete lots of forms and respond to legal problems, someone needs to be on the shop floor and why not the people that are already there?

      Also, a lot of patients suffer unecessarily from poor treatment choices from complacent consultants, and it often comes out that other healthcare workers tried to communicate that there was something the consultant missed but were ignored- if these incidents could be recorded and this information inform service and practice, training and accountability, then we could see some cost-free change!

      Maybe the notes could even by typed up and a couple of tvs in staff rooms around the hospital displaying comments, complaints, suggestions. This is probably too expensive to do butI’m sure you can think of a cheap way of getting people to think about healthcare improvement and then to communicate that to people that can make the change or think further?

    • TB says:

      The problem with bringing nursing to degree level is that it’s been made a plausible career, rather than a vocational calling.

  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!

    • Patients are not customers, they are patients. The role is well defined and understood and different. Doctors don’t have clients, either – they are had as the old saying goes by prostitutes and lawyers. Again the relationships are well-understood, defined, and different.

    • Siobhan says:

      I think we are in some sense arguing semantics here. But I agree whole heartedly that patients are not ‘customers’.This word assumes they are in ‘the driving seat’. Many patients when faced with illness are scared and confused and our role as health professionals is to explain their position in relation to their condition and help them make decisions in their best interests. Many ,when given that oppurtunity, do not want to make those decisions and in that situation I believe that as the patient’s advocate I have a professional responsibility to make that decision for them…and that is part of my role and needs to be acknowledged and acted on with due humility when necessary. Many patients are well informed and keen to be ‘in control’ and that makes life easier for the clinician in many circumstances. But to deny that it is often otherwise is simply ignorance. And to demand of a sick person that they make all decisions themselves can be cruel and an abdication of my responsibility. It is not the same as having a paternalistic approach to patients whereby it is assumed they are incapable of making the decision for themselves.
      I agree with Ann that courtesy and compassion are vital skills. But to refer to patients as ‘customers’ is to fail to recognise the difference.
      Making a decision about how to proceed after a diagnosis of breast cancer or when you are asked what you want to do regarding your terminally ill relative on life support is not the same as making a decision about which sofa to buy.
      One of the main errors politicians have made in this whole mess is to assume that they can simply apply the rules of market economics/supply and demand and ‘the customer is always right’ to a publicly funded healthcare system.

  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.

    • B Jones says:

      I work in a independant sector treatment provider which does help to train medical students and newly qualified medics. It does this in conjunction with the local hospital trust and university. Things don’t have to be as clear cut between the independant and public sectors in the NHS and different interest groups can work together. Maybe in the new NHS, private groups looking to take on NHS work should be contracted to give something back and take on some of the medical training.

    • E Bloch says:

      Patrick is expressing my views! Thanks for putting it so well.

    • Christine Lourenco says:

      I have been working as a Medical Education Manager for several years training doctors and medical students. Admitedly we did see during “Modernising Medical Careers” that we had trained and imported too many doctors but I believe that the balance we have currently is about right. Medical Schools and teaching hospitals expend a great deal of time, money and effort in ensuring that we train our medical students to be some of the best in the world. We provide continuous professional development for our doctors to ensure that they are up to date with the latest advances in medical practice. It is a matter of serious concern to not only myself but other professional educators that patient care will seriously suffer if the new proposals go ahead.

    • Peter Leigh says:

      For me, this issue is the deal-breaker for Mr Lansley’s bill. I favour the abolition of SHAs and the greater influence of clinicians in commissioning. Increased competition amongst NHS providers is acceptable in areas where the patient has a geographically realistic range to choose from (and therefore effectively available only to those living in and near large centres of population); indeed, such a choice is not new. Private providers must not, however, be allowed to cherry-pick straightforward procedures, expect the NHS to manage their complications and contribute little or nothing to educating the health professionals of the future. Any contract with a private provider should include a surcharge payable directly to those hospitals, training practices and other institutions providing the education that private providers cannot or will not deliver.

  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.

    • Dr A Bywater says:

      I totally agree.
      Training and Future Manpower requirements are something that consortia cannot give a National vision on.
      This should be left with Dept Health in discussions with the Royal Coleges and Deaneries.
      Consortias strengths will be in brokering Local services tailored to their local populations and demographics.
      The solutions for Worcs and Herefordshire may not be the same as those for London or Manchester .

  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.

    • Jonathan Carlton says:

      Our Trust was pledging to be in the top 10 for education and training.
      As now with it’s push for Foundation status the purse strings have tightened. The first lot of staff to go were the Ward based Clincal Educators – who are either being made redundant or pulled back into the Clincal numbers.

      This can only have a serious detrimental effect on staff Trainng and development and will have a negative overall effect on patient care. As mentioned earlier this will result in a underskilled workforce due to no training or development opportunities.

  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.

    • Deborah Milburn says:

      You are on a sticky wicket there, Dr Jeremy. I currently work in the community and meet lots of clients currently living in what is hilariously described as ‘supported accommodation,’ run by private providers.

      A broad range of ‘recovery focused’ initiatives are supposedly provided but basically the service user gets bed and board and a reminder to take his medication every day. This is because the provider can make so much more money by hiring staff with no qualifications and an attitude to mental health that probably seemed progressive in 1862! Many of the service users are left to vegetate for years at a very young age basically because that is all there is.

      Frankly there is little difference between what was provided by the old asylums and what private services offer today except they are making lots of money out of it.

      Incidentally, how has privatisation improved the rail service or provision of utilities?

    • Andy Hadley says:

      Oh come on Dr Jeremy, this thinking is exactly why we are so fearful of GP led healthcare.

      Utility companies that make a killing by not passing on savings to customers when their wholesale costs dip.

      Privatised trains that are hopelessly overcrowded and overpriced, and don’t integrate with other modes of transport.

      A privatised car industry now owned by the Chinese and other far eastern interests.

      Interesting to know whether your patients heard nothing from the Trusts because the reports go back to their GP.

  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.

    • Mark says:

      What any health profession needs is

      1. Knowledge
      2. Clinical Skills
      3. Attitude eg Ability to care and respect patients.

      There is a question that has not been answered

      How quickly does a health care professional who has the required skills lose those skills (or they become out of date)?

      There is an assumption that continuing professional development keeps the skills up to date, so why are increasingly complex systems of appraisal and revalidation being constructed? Is it because those systems do not work…

      Complexity theory tells us that the more complex a system the more people will game the system. Rationing of training occurs as Lucy, Graham and Tamsin point out. Formative assessment (where the results ‘form’ the basis of training plan) allows targeted training.

      Modernisation IS necessary but should be simple, universal and efficient not complex, throwing money at for instance IT does not ensure a good system. Having locally based systems is ok as long as the professional does not move…As Pete Shulver says the best candidate is one with the right attitude

      Have the GMC, Royal colleges, NICE and the deaneries lost their way? I find the guidelines issued are usually unworkable in the real world, every health professional I have seen as a patient did not follow at least one guideline – but I recieved better care because of this ‘failure’.

  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.

    • Deborah Milburn says:

      Course they won’t Teresa! Everyone knows that four sessions of CBT over the telephone and a depo injection every month is all that any service user with a mental health diagnosis needs!

  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.

  37. andrea porritt says:

    Education and professional development has been high on the agenda for community nursing for many years. Many opportunities to gain more knowledge to improve the quality of patient care have been encouraged and supported. More recently a lack of funding or time have been issues which have impacted on the enthusiasm for community nurses to engage in further education. Since the same time last year the work load locally has increased by 27%, no further nurses are available to take up some of this work. This does impact on the application to attend educational sessions. Practice educators in the area have tried to fill this gap by bringing educational sessions into the teams. The employing authority and managers are keen for this good practice to continue but without the appropriate funding skills and knowledge will be lost.

    • Community Nurse says:

      This is also the case in my area. Not enough staff resulted in our community team being stretched to breaking point and in raised stress levels! To boot it has impacted on our ability to go on courses!
      Having become a foundation trust has also meant that budget has had to be slimlined!

  38. fay says:

    Ongoing education and training is the only way to maintain a dedicated, up to date & caring workforce. Please care for the carers.

    The values of the NHS should be shared in all training and educating.

    Why not have roving training going from trust to trust thus ensuring uniformity in training and a sense of the common NHS?

    • natalie says:

      I totally agree with the comment that Fay has made – there is far too much variation in the way patients are cared for across the NHS – the idea of having standardised training would go a long way to ensure that care across the board is delivered at high standards and is evidence based.
      There are way too many nurses who are under pressure on their wards due to increased patient acuity and lack of trained staff to meet the educational/development requirements expected of them. If practice educators were supported to provide evidence based standardised training and skills development alot of the complaints that patients make about the standards of care they receive will dissappear.
      community teams need to ensure that the care they deliver is evidence based and up dated regularly – how can they achieve this if they are not given the support to attend update sessions and to improve their knowledge?

  39. Paul says:

    Set a simple percentage of earnings that must be allocated to training and education of staff and students.

    That way if private providers earn from the NHS they have an obligation to reinvest some of that money back into the education system.

    • Andy Hadley says:

      Shall we call it general taxation ?

      The current funding of primary training for healthcare students is very variable between professions, and with the wicked student loan situation, caring professions are likely to loose candidates.

      On further training, CPD and maintaining registration seems to be a mechanism that private organisations understand. But ensuring that this works for nurses, AHPs, technical and managerial roles within healthcare is a struggle.

      I am a clinical scientist turned NHS Informatics professional. There’s a lot more to the NHS than just doctors, nurses and AHPs.

  40. Celia Ralph says:

    The NHS was founded on need not profit.
    All health workers should be treated with respect.
    Nurses were never given the respect they deserved, there was a elitism that doctors were superior.
    From cleaners porters to caterers all were part of the service.
    The values are now being taken away by the market led economy.
    Nurses in the past developed physio through their nursing care.
    There has been a prolonged and hidden vicious attack on these values.
    We must keep our NSH public and involve communities and unions in developing the real values of medical care.
    Only when we have a real public service with respect for staff and patients can we develop our NHS in the way that is needed
    Based on humanity not profit
    Celia Ralph Keep Our NHS Public

  41. Richard Wallace says:

    Not enough use of Information Technology.
    Now the patient often knows more than the staff (in some areas) because they’ve got the time or the desperate need to know about their ‘condition’ and what is available.
    Make sure training is part of every week not “protected time” to be applied for.

  42. Richard Wallace says:

    The Department of Health spends a lot of time and money and rescources in putting together guidelines and standards for it never to reach the grass roots level.
    Make sure there is a proper pathway and someone is responsible for making sure the relevant information is properly targeted and signposted and gets read and acted on.

  43. Alice R says:

    As a medical student I have obviously examined the plans with great interest, as they dirsctly affect my future and training.
    The proposals here, and I’m not even sure how intentional it is, seem to have radically reformed medical education – and it seems like a bit of an after thought. There seems to be no clarity either within the document OR within the debate as to what any of the proposed changes will do, where the money will go, and how it will all be monitored and appraised. What does seem to be clear is that the government has decided they don’t like the current system, for some reason unknown to the rest of us given that the UK Medical Graduates are among the most respected in the world.
    Furthermore the disposal of deaneries and the almost self-appraisal of hospital education delivery cannot in ANY way be argued to improve medical education, and given that there is no way Scotland, Wales or NI will accept these changes into their own system, it locks medics into a single system, as well as patients.

  44. Alison Forrester says:

    I can only echo A Christopher

    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?

    and add please save the deaneries…

  45. There needs to be a greater emphasis on soft skills and leadership skills which will lead to a better managed and smoother running service. Much of the money and effort spent on training at the moment delivers very limited benefit to the service as a whole whereas better leadership and operational management would make a significant difference and help reduce costs too. Achieving this needs specific training and education.

  46. Christina Gray says:

    What support and training will there be for Pubic Health practitioners? How will this be funded and coordinated? We would like to see this clearly set out in both national guidance and in local arrangements. There is a danger that this area will be left unfunded and unmanaged, as regional structures disappear and local structures emerge. This is an issue for the wider public health workforce, currently employed in a range of health improvement / public health roles in the voluntary sector, the local authority and the NHS.

  47. I believe that it’s excellent that we train staff on important items such as safeguarding children, and soft skills and so on, it is equally important that we train staff on IT, the NHS currently spends a silly amount of money on getting newest equipment and IT services & software, yet not every feels that it is vital to make best use of equipment and/or software that have at their disposal. It amazes me that we live in the 21st century, yet some Consultants, GP’s, and other non-medical staffs, throughout the NHS, still choose to ignore technologies which makes life simpler.

    Mandatory IT training should be enforced. All staff across the NHS should be IT literate, or at least know the basics, if not know how to make the most out of the software/applications they have at there disposal. I have seen and heard so many examples of bad use of IT in the 5 months I have been working in the NHS.

    With better training comes greater efficiency, guess what that means when it comes to costs!

  48. Jos Wace says:

    There needs to be urgent detail formulated for continuing the work of the deaneries. It has to be be overseen by independent bodies with the interests of quality care at heart and not just medical schools, or commissioning groups who all have other axes to grind other than provision to the NHS of quality CCT holders and fledged GPs

  49. Dr Jacqueline Marshall says:

    The NHS reforms are a disaster for medical training both under and post graduate. I have worked in the NHS for over a quater of a century and been involved in education throughout.
    There has never been a worse time.
    I know that we all have to tighten or belts but cutting the time and money needed for solid medicaal eduaction will be a false economy and ultimately cost far more when things go wrong.

    • Rod Whiteley says:

      It is short sighted only to think in terms of the time and money spent. There are still too many examples of NHS staff who are over-trained in things that have little relevance to their job, but who remain inadequately trained in things that do matter.

      Time and again, failures in caring for patients are traced back to lack of relevant training. That’s why the question here is about having the right skills to meet patient needs.

  50. Pete Shulver says:

    Having worked in industry for many years I have seen that the best candidate is the one who has a good basic level of general education but also has the physical and mental skills, personality and attitude to learn the job. I am now working in the NHS and it is all to apparent that academic qualifications appear to be the sole criteria for the selection of candidates due mainly to the selection process being controlled by managers who have no real idea of what the actual job entails so they have to fall back on “national qualifications”.
    Since the death of apprenticeships, non practical academic qualifications are no guide to the ability or potential ability of anyone to fulfil what is in it basic a caring role in society which is fundamentally the heart of the NHS.
    More real skill and care is what is needed. Not academic ladder climbing!

  51. Dr Shazad Amin says:

    The plan to abolish Deaneries and expect Trusts to take over the role of education and training of junior doctors is naive and short-sighted. In difficult financial times with unprecedented cost savings to be made, Trusts will see the currently protected budgets as fair game, with a consequent diminution of the quality of training. The quality of training can only be realistically protected if there is an independent body overseeing this. In addition , I am sure the various Private Providers entering the market are also hardly going to have medical training at the top of their agendas.

  52. Gary Featherstone says:

    Its all about the training of staff it has been proven time and time again, the research is there for all to see. When are the government going to listen to the people that work on the front line of the NHS instead of listening to managers with no experience of healthcare and that are only interested in targets and their own interests. Personally I don’t think that their is a financial crisis in the NHS but the money can’t get to the patient because it has gone into the big hole spent on managers and there free lunches, flat screen TV’s to monitor us from afar whilst front line staff struggle in the sea of paperwork they have created.

  53. Anna Webb says:

    Training can be enhanced by using lived experience speakers in training, expecially in areas which have traditionally been the “poor relatives”, such as mental health, Autism, learning disabilities, carers. However this has to be funded. User led organisations need to be given money to train, supervise and pay their public speakers and canvass their peer group for their views. This is how patients can be at the heart of the NHS and help people to provide a better service which is more fit for purpose. Mistakes of yesterday are not repeated tomorrow and the people who take part move on in their own recovery. This is particularly effective in mental health and is a major way to change public opinion as part of the Time to Change initiative. Those areas who fund this work properly eventually have ULOs running some of the services and it has proved cost effective as well.

  54. Paul Gibbons says:

    I wasn’t aware that this was an issue.
    If there really is a spate of new private entrants into the field a health service training levy will be needed. This would be similar to the Construction Industry Training Board and its levy.
    If money gets tight the practice of attending national and international conferences could cease.

  55. Malcolm Bourne says:

    May I take this opportunity to say, why is training and education compulsary in, for example I.G, Equality & Diversity and so forth, but it is not compulsary to undergo training in the use of medical equipment used every day on patients.

  56. Rachel Atkinson Speech and Language Therapist says:

    Your healthcare bill is damaging education and training.

    1. The NHS paid for my SLT training. If you introduce private providers to compete with NHS providers how are you going to deal with the fact that NHS money will train professionals which will then go and work for private companies in order to make them profits? Are you going to eliminate NHS funding for training places? If you do you’ll limit the diversity of your workforce and reduce opportunities for those less well off.

    2. If you want to maximise proliferation of best practice a market economy in provision is the WORST possible thing you could do. Once you make providers compete it is in their interests not to decimate but to hoard information which would improve services in order to use it to beat their competitors. Thus if a particular way of managing a service effectively, a particular therapy technique or service is developed by a provider they will keep it to themselves. Is that in the best interests of patients across the country? Will that help deliver equality of services? Will that promote nationwide improvement in service delivery? Will it encourage publication in the scientific community, ensuring rigorous peer review? I don’t think so somehow.

  57. Bruce says:

    Education and training of doctors has taken a nosedive since the creation of “Modernising Medical Careers” and the notorious on-line job application scheme, exacerbated by the cynical “hospital at night” response to the EWTD (minimal levels of cover provided by largely inexperienced, untrained, inadequately supervised trainees).

    There is little or no continuity of care – many patients will never see the same junior again. The ward rounds consist of harassed consultants seeking information about patients clerked in by doctors who are no longer on shift, and the overworked nurses are hardly ever available either.

    Consultants have little or no input into the appointment of their trainees and the online application forms emphasise the wrong areas of experience, giving disproportionate weight to largely irrelevant attributes.

    The supervised training and patient contact times are a fraction of those in past years. A consultant can now be appointed with half or less the hands-0n experience of his/her previous generation. Training has become a salami factory, dumbed down to the lowest common denominator. If a trainee discovers he or she has no aptitude for a specialty, it is close to impossible to change specialties.

    Private providers will ‘cherry pick’ low-risk, high volume conditions, whilst the complex, risky or unpopular conditions will remain within the NHS system. Private providers have no interest in training, thus trainees will receive far less exposure to common conditions, whilst becoming familiar with complex problems they may never see in their own clinical practice.

  58. Michelle Brindley says:

    My comment is that the NHS is not just medicine! Dental Nurses are largely expected to fund their own diploma level training – which is a requirement for registration. The subsequently need to meet GDC specification of CPD hours – again largely self funded. Whilst I realise a lot of these are employed in the private sector, PLEASE do not forget those working within Community and Hospital Dental Services who must be one of the only groups of health care professionals who attend evening classes and fund their own entry level qualification! Some of this training is currently provided by and subsidised by the Deaneries – without whom there would be even less access to affordable training and CPD for the dental teams

  59. Claire says:

    Having recently undertaken a Foundation Degree, sponsored by my SHA and not supported by my employer, which I have to say of the 8 other cohorts on the course who also worked in PCT’s I was the only one who completed the course in my own time, at my own expence when it came to covering childcare and travel costs.

    I can honestly say the support I got from my PCT left a lot to be desired. Funding for the second year was written into training plans for the PCT by the SHA and my course fees were allocated to them. Imagine my dismay when the PCT refused to release the fees as they did not support me undertaking the course.

    Since completing the degree I have been told that although it highly relevant to my role, as they did not support me and did not want me to increase my skills and knowledge, they see no reason as to why they should intigrate these into my role, even if this would result in a better service.

    I have been openly told if you don’t like this then go elsewhere.

    How does that motivate and empower NHS?

    Also, all CPD now has to be undertaken in our own time, even manditory training has been reduced.

    How are we to become this new empowered NHS workforce if we are bing held back by the senior managers?

  60. Gillian Kerman - Wider Healthcare Team says:

    Why is everyone just focussing on the professionally qualified staff and not looking at the Wider healthcare team and their education and development needs. These are often the people working on the front-line who care and deal with the patients and their families on a day-to-day basis. Despite the consultations acknowledgement that a career framework for Band 1-4 remains underdeveloped and funding through the MPET(NMET) Levy has been significantly reduced. Here in Yorks and the Humber region we have created the Support Staff Learning and Development Fund using the MPET Levy. The current reality is that the funding regime for individuals moving through from level 2 to 3 has all but been removed by BIS. This is a significant problem considering that some of our Support Staff do not hold a level 2 qualification. Further clarity on how the new arrangements would support a development framework for the lower bands needs to be given, as the current proposals appear confused and contradictory. There should be equitable access to education for ALL staff and this should include all non registered staff. Although access to education and training is mentioned in the NHS Constitution, the Listening Forum will need to make the point to the Government that we need to ensure that there are mechanisms in place so that it is not just professional staffs training needs are funded from MPET and to help in our aim of developing a diverse workforce and a “fully qualified workforce – competent and fit for purpose” that ALL staff (including Bands 1 to 4) have equitable access to education, training and opportunities to progress in their chosen career.

  61. Gillian Kerman says:

    Steven Field’s interview in the Guardian (see stated that his report to David Cameron will say “Plans to overhaul medical education and training will be slowed down.” If Nick Clegg gets his wishes, then alternative arrangements will need to be put in place for the functions of the SHAs and PCTs – so all we are doing is the same work but in the new organisation called by a different name ie GP Commissioning Board or Provider Skills Network. There is of course a risk to this that neither of which have been thought through and costed. No-one has considered governance and risks to setting up Social Enterprises and NHS employees have concerns regarding the cost of such a model in terms of VAT and Corporation Tax implications, its ability to recruit and retain key staff/expertise/knowledge/skills, opening it up to European Tendering process/costs and the tight timeframe for putting such changes in place. If the public cannot get their head around the GP Commissioning proposals, then how can they understand changes proposed around education and training. It is suggested that Health Education England (HEE) will have responsibility nationally for education commissioning for some specialities ie Modernising Medical/Modernising Scientific Careers, but it is important that there is devolution of funding and decision making with lead education commissioning arrangements in the Provider Skills networks – and therefore wouldn’t it make sense if the PSN were just Regional Offices of HEE? Relationships and roles/responsibilities have yet to be agreed between HEE and PSNs. The Lib Dems manifesto stated that they wanted to get rid of SHAs – so where does this leave the views of the Lib dems in all of this??

  62. Dr Penelope Jarrett says:

    The proposed changes are riduculous. Education and training should NOT be left to local proviers, who cannot take an overview nor a long term view. It should be nationally organised (so trainees can move around the country), advised by academics, Royal Colleges and the GMC (to maintain standards in all parts of the country), and administered locally by impartial deaneries. All healthcare providers should be required to participate in training, and should be inspected and monitored in this role by the deaneries.

  63. Dr Alexa Mannings says:

    The deaneries fulfill a vital function, and breaking up a structure that has just been reorganised seems ludicrous. Local knowledge seems to be what the government want to build, so why destroy the adequate system that holds most of that knowledge? And the oversight and liasion that is required to manage the “micro” specialties e.g. all the paediatric sub-specialties will also be lost.

    If work does wholesale go out to the private sector, we as trainees will have to follow it to gain the necessary experience – are we really going to parachute into a hospital that has never before supplied any education, and gain the right support? Doubt it. There will be absolutely no educational structure in place in these hospitals, and no interest I should think in providing it. Seeking profit does not allow for expensive staff members taking work time out for education. And I have concerns about the safety of working in multiple sites for only short periods of time – our modular training pattern has 3 month blocks.

    We currently have gaps on most of our rotas. If trainees are going to be allocated to even more hospitals in the region (as they will be required to be if there is to be adequate daytime training opportunity, and for provision of appropriate levels of medical cover) where are these extra trainees going to come from? The system has been trying to match training numbers to job prospects, and migration has been restricted. It’s not going to be workable. A lot of training happens in anaesthetics out of hours, it is important that we work within our specialty to get exposure to those training opportunities, not trawling the wards doing generic post-operative prescribing and care. Will the boundaries of our out of hours work be respected and maintained in specialty?

    Will there be surety that the contribution of the new education providers will be of adequate standard for me to gain my CCT? Who from? Particularly in the start up period I imagine that ensuring educational quality assurance from brand new educational sites will be impossible, until several rounds of trainees have passed through the department. If that training is then found to be inadequate, many trainees will have to extend their CCT through no fault of their own. Alternatively of course, the educational burden will remain with the NHS hospitals….

  64. The proposed changes to training and education are ill thought through.
    If different providers will be providing diagnostic tests, operations and other therapy, how will a trainee be provided with a co-ordinated and comprehensive experience of all different areas of the patient care pathway?
    How will a trainee surgeon obtain a training in all different areas of surgery when different providers will be performing the routine cases, with the NHS at risk of being left with only the complicated acute cases?
    It is not clear to me at all why the goverment feels it is necessary or wise to disband the independent and well established Deanery system. I agree that our training is the envy of many other countries and there is no need to meddle.

  65. Recommendations:
    • The Government needs to allocate sufficient financial, training and support resources to ensure there is effective community engagement with the new structures.
    • The Department of Health must extend the planned timescale for establishing GP consortia and clarify what training will be available to GPs on commissioning violence against women services and gender awareness.
    • Healthcare professionals must receive guidance/training/support to understand health inequalities and how these relate to social care/needs.
    • Healthcare professionals and those responsible for commissioning should have comprehensive knowledge about the range and quality of services available in their area.
    • The government should provide information and support to the voluntary and community sector on bidding for tenders to provide NHS services.
    • NHS Commissioning Board guidance to commissioners on the procurement of services should include guidance on specialist services such as those for women and other equalities groups.

  66. Andrew Watson says:

    I am very concerned with the suggested changes. I found no reference to the fact that junior doctors as well as being trained deliver a lot of service. They look after patients as well as learn. The worry is that the failure of the white paper to recognise this will destabilise services. For instance in maternity care nearly all care out of “office hours” is delivered by doctors in training. Ideally we should move to this being trained doctors. If the training monies are withdrawn from maternity there will be gaps when maternity units will need to close temporarily or permanently. Really we should be reducing the number of trainees in the speciality and have an increase in consultants to work out of hours. If the deaneries and SHAs are closed down who would coordinate such large shifts of finance?

  67. Paul Sackin says:

    I am much concerned at the proposal to abolish deaneries. Individual Trusts may be able to provide education but they cannot have an overview and provide the structure and monitoring processes. This needs regional input. Deaneries play an essential role at all stages of general pracititioner training (an area in which I work). To fragment this would be very risky.

  68. Claire says:

    I am not sure if this comment is relevant but the goverment need to invest in the future of health care and provide more support for our future doctors, nurses, midwives and other MDT. Having a shake up of the training seems mad. Personnally working in the NHS for 10 years I feel we produce good staff that just need more investment not moving the responsibility of learning from one area to another not solving a funding issue just moving the problem.

  69. Christopher Linthwaite says:

    All persons providing health care paid for by the NHS must be trained in faculties which are licenced by the Government to undertake such training. The cost of which would be divided between current providers and private companies bidding to provide services funded by the NHS so as to level the playing field when it comes to competition and providing the calibre of personal that is currently provided by the NHS. Private Companies providing healthcare using Public money cannot be allowed to gain financial and a competitive edge by merely poaching staff paid for and trained using the public purse.

    Training should of course undertaken under the guidance and auspices of the relevant proffesional Organisations currently involved with the NHS.

  70. Gini says:

    Education and training is about investing in people, and valuing people. These reforms are based on an ethos of not valuing or investing in health professionals, the NHS as an institution, or patients. Education and training equips people with the ability to think for themselves, and to critically evaluate and appraise. I have been fortunate to have had a good and free education despite my economic background. I have also received excellent care when I have needed it. I want this for future generations. These reforms will not allow for this to happen.

  71. D Laheru says:

    The whole phrase of “Government” Listening Exercise felt like an oxymoron to me initially. Am glad things are on hold for the time being.

    If the pot of money is shrinking and money needs to be saved, then cutting Education and Training Quality, compromising future healthcare needs is short-sightedness. Best to try and save money in other redundant or overlap areas – or even an overhaul in the way we work to iron-out the inefficiencies.

    It takes away a lot from my training (and that’s even before any change has happened!) when I spend 70% of my day filling out forms and typing in passwords on a computer rather than seeing my patients!

    And giving the NHS Education/ Training area a rest from continual change and flux might actually help the Trainers and Trainees to settle in and learn something for once.

  72. D Reilly says:

    Cuts to budgets in London are having an impact on the number of band 8a and 8b and above psychology posts. These post holders traditionally have protected research and teaching and training time. The deleting of these posts and replacing with band 7 posts will limit the research that can be done to ensure psychological therapies are reaching those in need in the best possible way. This will also limit the amount of training that can be provided to psychological and non-psychological staff resulting in expensive private training having to be sought.

    With the proposed changes the loss of band 8a and 8b posts will continue as on paper these psychologists have less patient contact instead providing vaulable supervision to less qualified psychologists, carrying out research, provide staff training, providing consultation, and taking the lead on service development. Theirs is a complex role that will not be understood by non psychologically trained GPs and will not be comissioned. The knock on impact for access to therapies and work towards improving access to psychological support for marginalised groups will be considerable early intervention and early support will decrease and in the long term there will be a greater financial burden on severe and enduring mental health services.

  73. Dermot Ryan says:

    The dearth of knowledge and skills in the primary care environment is an obstacle to increasing the amount and quality of care delivered there and in the community.
    The Finnish experience of improving health care in various domains was predicated on building knowledge and skills by investment in training. Currently particularly with regard to LTC’s there is neither the capacity nor ability to provide an adequate system f ongoing review of the currrent work load, let alone increasing volume.
    All consortia need to identify monies for traiming and education. As a corollary list sizes need to be drastically reduced and consultation times increased to meet the currently unmet need.

  74. Jane Birkby says:

    ■Will the proposed changes to the education and training system support the aims of the modernisation process?

    Nursing training, and doctors training must always be practical hands on patient based and not university based, or a mix of both, to produce well rounded staff able to empathise with patients.
    This always worked best when hospitals had blocks of accomodation for medical staff on site (i.e. University Hospitals), and a matron to oversea the cleanliness and running of the wards.

    ■How can health professionals themselves take greater ownership of the education and training of their own professions, whilst meeting the needs of healthcare employers?

    The healthcare employers are the spanner in the works of the NHS, they create an unnecessary and expensive layer of bureaucracy, placing pressure on frontline staff.
    Let the doctors and nurses decide on the training.

    ■How can we ensure that the values of the NHS are placed at the heart of our education and training arrangements?

    Don’t privatise and give staff the means to have pride in what they do without some manager breathing down their necks all the time.
    Employ more nurses and doctors, and get rid of the bureacratic layers.

    ■How can we best combine local and national knowledge and expertise to improve staff training and education?

    Appoint healthcare staff at the sharp end to spread their knowledge at seminars.

  75. Justin Baker says:

    Without specifying what the “aims of the modernisation process” are presumed to be, the question of how proposed changes to the education and training system will support those aims is a bizarre question. However the way health professionals can take greater ownership of education and training is definitely NOT to use GP commissioning to re-direct State healthcare funding towards private providers who have no obligation whatsoever to invest in the training of NHS staff.

    The same response also answers the questions about how we can ensure the values of the NHS are placed at the heart of our education arrangements, and how we can BEST combine local and national knowledge to improve staff training – in neither case can these objectives be served by siphoning tax-payers’ money towards buying services from private healthcare providers who have no obligation to invest in training NHS staff.

  76. Kevin Orme says:

    I think that the current situation is deteriorating and will continue to do so. Some staff courses have to be booked in staff down time and “time owing” claimed back. Deanery cash is being reduced, preventing staff from adding modules pertinent to their practice unless they are willing to self fund. I don’t expect the NHS to pay for everything without expecting loyalty, commitment and hard work from it’s staff. But, with KSF downbanding of experienced staff, increment freeze proposals and other measures staff will not be willing to self fund as their seems little prospect for advancement or reward from the NHS. If this continues the private sector who offer training packages in T&C’s will cream off the most motivated NHS Nurses and AHP’s.

  77. Kevin Orme says:

    I think that the current situation is deteriorating and will continue to do so. Some staff courses have to be booked in staff down time and “time owing” claimed back. Deanery cash is being reduced, preventing staff from adding modules pertinent to their practice unless they are willing to self fund. I don’t expect the NHS to pay for everything without expecting loyalty, commitment and hard work from it’s staff. But, with AFC downbanding of experienced staff, increment freeze proposals and other measures staff will not be willing to self fund as their seems little prospect for advancement or reward from the NHS. If this continues the private sector who offer training packages in T&C’s will cream off the most motivated NHS Nurses and AHP’s.

  78. James Goodhew says:

    I can only vouch here for training of doctors, however I note the nurses’ comments above second this veiw!!

    Doctors spend 5 years at med school learning how to understand another doctor when they speak to them. They then spend 2 years (F1 and F2) learning to practise as doctors in a clinical setting. THIS IS THE WRONG WAY AROUND.

    ‘nuf said.

  79. Sally says:

    Chronology of the last ten years of education and training for biomedical scientists in my area – covering about a half of an SHA

    2001 onwards – new undergraduate programme developed and introduced in partnership with local university, eight large NHS hospitals and some enlightend SHA folk who sponsored placements. Course approvals by professional body and HPC. Excellent, fit for purpose graduates recruited into the NHS to replace retiring leavers.

    About 2008 Modernising Scientific Careers seeks to shorten courses, impose national prescriptive process, deregulate many of the regulated functions undertaken by biomedical scientists and introduce a new lower grading structure with new titles, though at first said to be to improve the service as soon as the economic crisis is spotted said to be financial imperative to support QIPP

    2010 – New Government takes over, financial savings now number one priority – therefore modernising scientific careers essential together with planning to train far fewer new staff.

    Beyond 2011 – Easy to predict insufficient new staff to replace leavers, complete ignorance of what biomedical scientists do by DH leads to failure of pathology services to meet needs of patients but by reforming the NHS and ensuring individual hard pressed hospitals are solely responsible and privatising pathology services the effects of poor meddling policies will be increasingly seen as a problem nobody envisaged and through reflecting on a useful learning experience in 2014 or 2015 a new initiative will be developed for which the political parties will compete to show which will introduce the best improvements.

    In summary – we had professionally and locally led egagement in 2001, professional roles in the NHS need regulation to protect the public and drive high standards in the interests of patients, higher education and local hospital partnerships flourish given half a chance, evolutionary change is much more effective than revolutionary change and the costs of top down meddlesome change by remote experts should be the first efficiency saving.

  80. Dr Yvonne Sougnez says:

    I suggest that a healthy dose of Education and Training is needed to enable the design a genuine listening exercise. An effective listening exercise does not trawl for support for limited and heavily biased options. It begins BEFORE policy is made. There is no mandate for changes of this magnitude. Are you surprised that so many of the vigilant who have scrutinised these proposals suspect the worst motives? (There was no other place for me to post this comment which is in itself an indication that the listening exercise is designed to exclude these observations.)

  81. Kevin Orme says:

    Hi James,

    thanks for the comment.

    I have always been impressed how quickly F1′s adapt to clinical practice in their first few months when you consider how little clinical exposure student doctors get in comparason to student nurses, radiographers, physios, paramedics…et al.

    I have often wondered how daunting it must be to be a med student on a friday night and a fully fledged F1 Doctor on a monday morning….

  82. Janet Dickinson says:

    When you’re sick and in a hospital bed you don’t ask to see the certificates the nurse and doctor looking after you have. You assume they have been trained properly because otherwise they wouldn’t be there. Make practical training the most important part of it, not sitting in a lecture hall watching a Powerpoint presentation.

    Most replies from government use those awful buzzwords so beloved of people who have nothing to say but want to sound as if they have. “

  83. doug forbes says:

    Will Commissioning Genocide help the new Health Reforms?

    The new health reforms are being built around the concept of commissioning which is fundamentally about ‘What to acquire’. With the previous Parliamentary Health Committee severely criticising standards of commissioning, the NHS has now embarked upon a set of reforms which put ‘clinical commissioning’ at its heart. Why not have qualified clinicians taking expert decisions about ‘what to acquire’? They certainly understand the technical and human requirements but are they as well versed in the business and legal necessities? Has this new term of ‘clinical commissioner’ been defined and does that mean that the whole role from user consultation to acquisition, delivery and satisfaction is to be directly undertaken by a clinician?

    The loose definition of commissioning has tended to focus upon procurement. This has allowed the debate to be turned into one of ‘Make or Buy’ with the inevitable spectres of privatisation and divisiveness being raised. Related to the key skill of ‘What to acquire’ is the question of ‘how to acquire?’ There are a wide range of ways of how to acquire from competitions to grant aid and forming partnerships, employee owned organisations and mutuals. No matter what route is chosen, it is public money whose spending is subject to value for money provisions.

    Some years ago, after assisting DCSF with their Five Year Vision of Commissioning, we identified that there were massive workforce development requirements in order to upskill the new entrants. Our commissioning analysis of commissioning at that stage identified a need for increased professionalism helped by the formation of a professional institute. Key educationalists and social workers were being taken from the front line and expected to handle the complexities of commercial arrangements with little training, guidance, mentoring, reference material and professional standards. At least accountants have Standard Statements of Accounting Practice, regulation and a standards board. Where is the equivalent for commissioners?

    The Institute of Commissioning Professionals was established in 2007 after a market survey indicated that over 93% of commissioners felt they needed a professional body to improve standards. A member survey undertaken in 2008 revealed that 91% thought that they had less than 3 years to deliver the vision. During that period, the IoCP has established an accredited membership exam, is pursuing voluntary registration of commissioning professionals and developed the concept of Commissioning Excellence.

    It was apparent during the period that as one University Director put it, the PCTs have ‘Taylorised’ their commissioning activity with the tasks broken down into specialised components where staff were unable to see the bigger picture. This led to criticism from workforce development staff that commissioners were often unable to take a strategic view.
    It also meant that commissioners skills did not fully meet those defined in the National Occupational Standards. We would expect the requirement in the GPCC’s to be for broader skills and that their commissioners should attain the National Occupational Standards.

    In the new world, commissioners require to take a strategic view and we applaud the efforts being made by NICE and SCIE to provide an evidence base for commissioners. The focus is now to learn from the experience of the past on implementation and how to embed this organisationally.

    In the recent clustering of PCTs, where in some areas of London, three PCTs have been combined into one with a reported loss of 60% of staff has destroyed capacity which has been painstakingly built up through the ‘World Class Commissioning’ era. It doesn’t look as if there is any movement to build upon the ‘Taylorised’ skills of those remaining. In addition, the Council budget reductions have also led to the elimination of commissioning roles in key councils. When there are calls for Councils to provide support to the GPCCs, again we fail to see where this will come from. Given the large numbers of posts which have been eliminated, we have termed the cull ‘Commissioning Genocide’.

    Whilst green shoots will appear, the position on ‘clinical commissioners’ is just a rerun of 1997. Clinicians will be taken off the job and without guidance, will go through the same experience of other commissioners over the past few years. The scale and pace of reform again lacks a clear foundation of commissioning professionalism. This time, it is complicated by the need for efficiency savings and the inevitable political fallout.

    We have been informed that encouraging commissioning professionalism is low down the level of priorities. How can an effective system be built without embedding a higher level of professionalism into organisations? The Health and Social Care Bill will require GPCC’s to gain authorisation and to submit its Commissioning Plan. How many GPs have produced a Commissioning Plan? The clear focus is on authorisation but where are the experienced clinicians who have produced a Commissioning Plan?

    Its time for clear leadership in this area and without it, the reforms will collapse as did World Class Commissioning. If commissioning skills are not embedded into the GPCCs, then the reforms will lack foundation and collapse. Commissioning genocide will only help if it is used to learn the lessons of the past and develop commissioning like other mainstream professions. This is a complex world where the detail does need to be fully thought through or else scarce resources will be wasted rather than being better used saving lives.

    Doug Forbes is Director of the Institute of Commissioning Professionals, a not for profit member owned organisation dedicated to improving commissioning standards.

  84. Rajvinder says:

    improve the quality of knowledge that Educationa dn Training staff have, to enable them to find the right development tools and qualification for their staff. then ensure they have the funding to pay for it!

  85. Robert Reynolds says:

    So much good sense from so many respondents. The objective is widely shared of ‘a good hospital, reasonably close, in a national service sharing best practice’. Even to think of ‘the service we all wish’ is to think of democratic expression. We may thank the Coalition proposal for raising the fundamental choice to be made between democracy and variants of ‘human husbandry’.

    As a retired doctor, also a patient and a relative, I welcomed the promise of the Health and Social Care Bill 2011, at first sight the ‘liberation’ of all to ensure ‘equity’ and ‘excellence’, within a reformed system of Health and Social Care, preserving the 1948 NHS principle of ‘treatment free at the point of need’.

    Unfortunately, definition was lacking as to the meaning of principal terms:

    1. The ‘liberation’ intended is for competition, in pursuit of profit, leaving quality to be defended by ‘regulation’ rather than advanced by secure conscience and free communication.

    2. The promised ‘equity’ in care will continue to be ‘as far as might be deserved’, inequality of access left to be dictated by inequality of political power or insurance cover, poverty left as deserved and to be only palliated by state or private charity.

    3. The hoped-for ‘excellence’, serving the top end of a market with unequal access, might easily be both exclusive and precarious in its isolation, and its impact on national statistics might be overwhelmed by a long tail of poorer performance, emulating the United States in value-for-money failure.

    Many have drawn attention to the downstream semantic deficiencies of the Bill and of the Listening exercise. We are invited to comment on four groups of questions, in areas sensibly to be addressed only alongside each other:

    1. With respect to the leading question, ‘how can we best ensure that competition and patient choice drives NHS improvement’, we should rather be asking ‘what steps must be taken to liberate inventiveness and care and funding as appropriate to democratic ambition?’
    At present we can only guess at the dimensions of ‘patient choice’ that in a democratic society might be thought ‘worth the bureaucracy’: given equality ‘in the market’ we might wish to choose our surgeon, priority in non-urgent procedures, the latest of room facilities, etc.
    In a democracy the essentials of health care would not be delivered in ‘a levelled playing field’ for the material elevation of doctors or managers or share-holders.
    Even if, in a democratic society, global and sectional healthcare budgets were adequate, competition would play a part in the allocation of funds for individual training, for particular research projects, for service developments, for new sites, etc.
    Healthy competition would be on merit, for society, not tainted by fear or greed possessing concerned individuals.
    We do not have to choose between systems half-understood in America or Europe, or in recent party propositions: we can choose democratic liberation.

    2. With respect to the vital question ‘how can we make the NHS properly accountable to the public, and make sure that patient involvement is at the heart of its decision making’, we might trust to luck (!), to political salesmanship (and luck!), to simple humanity (our care for the unfortunate, and luck!), to humanity expressed through inherited belief systems (injunctions to care, and luck!), or to the social contract offered by democracy.
    A democratic society might make mistakes, but it will tend to make its own ‘luck’, to afford what is wanted and what is deserved, by the agreement and contribution of all.
    If we give up income inequality (to give and not to count the cost), and set a savings maximum at a reasonable level (my cup runneth over), we will free ourselves from fear and greed, enabling trust and liberating conscience.
    We need openness rather than ‘transparency’ (having to watch out and ‘seeing through’ each other’s dastardly schemes), and rational trust rather than ‘accountability’ (having to defend or hide the hardly defensible).
    GP-led Commissioning, set-up out-with democracy, cannot emulate democracy: no mote than could PCTs working to ‘equality agendas’ in recent years.
    Including the voices of other health professionals, patient representatives and politicians, and replicating much of past structural complexity, will quid soon be found essential in preserving or in re-creating the creaky NHS of today.
    The current proposal appears set up to allow a shake-down to a system of local private NHS-franchise-holders, sized for viability (comparable to PCTs), and like PCTs offering competition or co-operation according to population geography.
    Adopted as proposed, much bathwater and a few babies will no doubt be thrown out, much more of financial bureaucracy will no doubt be added, and the transition costs (financial and human) might alongside other looming problems within months or a very few years precipitate final demand for democracy.

    3. With respect to the linked questions, ‘ how can we ensure that advice and leadership from NHS staff themselves on improving services and tackling patient needs are at the heart of the health service’, and ‘what more could we do to ensure that commissioners collaborate to fit around the lives of patients and carers, and the particular circumstances of certain conditions’, let there be freedom of movement of people towards worthwhile work, and freedom of voice to attract funding towards worthwhile work, no personal financial advantages and fears to corrupt, just the joy of the worthwhile and the ever better.
    In all of the scandals that over decades have continued to emerge, in ‘our NHS’ as elsewhere, ‘someone knew’ or had concerns.
    Our great need is for the liberation of all, making all representative of all. Only income equality can deliver the security required for universal freedom of conscience.
    The logic has to be faced – every labourer treated as worthy of hire – if we are to enjoy the fruits of democracy, an end to the rush to use up the Earth, a future of not hundreds but millions or billions of years.

    4. With respect to the question ‘how can we make sure that NHS staff in the future have the right skills to meet changing patient needs’, the need is to respond to demand, and if possible anticipate both increase and decrease in demand, erring on the side of over-provision, trusting in the good sense of trainers and trainees, all aiming for ‘careers of service’ rather than ‘careers of shelter or financial advantage’.
    There is scope for far more cross-fertilisation of ideas and practices, with earlier recognition of need to adapt, or focus more narrowly, or move on, unimpeded by personal and family financial considerations.
    Strategic planning will always be difficult, more so with commercial secrecy. Past arrangements were poor, the current I am not involved with, the proposed will have to be proved in a context of chaos, I would guess leading to greater variation in quality, increased emigration, and even greater reliance on imported labour with attendant difficulties of integration here and of loss from countries of origin.

    Until we have genuine democratic government – all free to represent all – we can only guess what systems of care and investment a democratic society would choose. Until we have such a democratic context, it must be the responsibility of pro-democratic governments both to lead towards democracy and to frame legislation as far as possible as if for a democratic society.

    We live in a society that has worked and fought for democracy. If a democratic future is wished, then each generation must educate the next to that end. In the spirit of Benjamin Disraeli, truly to ‘educate our masters’ we must show willingness to educate ourselves. As a start we need to have a shared language, recognising ambiguities and clarifying central intents in the use of words, aiming for sharable understanding based on a logical sequence of value choices. I would commend the prime choices of faith in the worth of caring, and trust in the wisdom of genuine democracy, not to ‘officiously strive’ but to ‘give care to others’ as we would wish for ourselves.

    The Coalition has to deal with the world of today, but we all today could affirm our choice for a democratic future, taking account of life’s trials and seeking to reform the NHS as if for all, for patients and relatives and staff and society as a whole.

  86. Karen says:

    We have to ensure that patients are never treated like ‘customers’. The caring personal touch of the service is as necessary as medical training. The people that use this service are ill, often very scared and incredibly vulnerable. They need nurturing and caring for, not putting on a conveyor belt and shunting through the system as fast as possible.
    Staff medical training should be geared toward the job they are intended to perform, and should be as comprehensive as possible. This takes funding, and obviously the government does not want to pay for that. The problem that this government has is that we do want them to pay for it.
    We want to keep our NHS and we want it to improve and grow to accomodate all the needs of the people it was founded to serve. Funding is available, we just need the government to start putting their own country first. They work for us, and they should put our needs ahead of everyone else’s, that’s their job!

  87. Thomas STocker says:

    Train train train, establish a training program that follows Nigel Crisp’s vision of inter-state training programs and healthcare worker exchanges – the DoH working hand in hand with DFID, which was until recently a leader in healthcare in international development, and I think should be re-focused on this beneficial aim, and away from fueling conflict zones. (which will also help reduce our disease burden from contageous diseases, increase global GDP, etc.)

    GPs are under-utilised, much of their job is listening to patients. Councillors and health-workers can be trained quick and cheap that can identify cases that need to be seen by a doctor and people that need to be listened to and given a sick note or some anti-biotics etc. It is working in Iran, America, South Africa and Rwanda – why can’t it work in the NHS? Would save a fortune!

    Also, training on process engineering from people outside the NHS like empoyees from NASA, engineering corporations, BP etc. (done at cheap rates where possible and with a close eye on corruption) would be good – looking at phlebotomy processes where patients recordings get lost, looking at processes with an eye on efficiency and safety rather – for example trying to reduce the number of times important informational items change hands (each time there’s a risk of loss), processes that are failing at an institutional level and need more checks (for example bed sores in older patients, as nurses no longer turn them in their beds and no one has really taken clear responsibility for this).

    I also think that Cuba has a healthcare system that we could learn from in terms of process, procurement and service management, also ‘joined up government’ and how other departments can learn from the health department and visa versa.

    Just look with fresh eyes at the gaping sores in teh NHS that need to be patched up, keep NICE, keep the new learning process of what people value in health, keep listening, work harder, train appropriately rather than historically – it’s all common sense stuff and the NHS staff have been trying it for a long time, don’t destroy the old knowledge but build on it instead. What are the PCTs telling you?

  88. Carla John says:

    Education and training is key to NHS development. We need patient care to follow Best Practice.

    Current proposals are hinting that the NHS may no longer fund any of the medical/physiotherapy/(etc) tuition fees; and whilst I understand that the NHS needs to save costs, they could get around this by contracting: i.e. Work 15 years in the NHS and students will be fully funded, 10 years and they are partially funded etc. This way the NHS keeps those they spent the money training, maintaining permanent staff and reducing outside agency/overseas costs.

    Additionally I hear discussion on potential devolution of Medical deanery schools – moving teaching to a local hospital based level which may put future doctors and therefore patients at risk. If staff are trained with no national set standard then there is increased scope for failure.

  89. David R Reed says:

    There is little evidence that the training of medical specialists in the UK is seriously inadequate, so fiddling with the existing system seems pointless. If any changes are needed it is in ensuring that they remain up to date in their skills, through frequent — and compulsory — retraining/updating courses.
    And, while patients are emphatically NOT customers, they do need to be treated with courtesy and understanding by all parts of the medical establishment. To ensure that this happens, external monitoring is needed.
    This monitoring could examine all aspects of the process, from improving the basic people skills in talking to patients by nurses, GPs and other specialists, right through to ensuring all those involved have up to date skills.
    NICE is the obvious body to do this, providing input to the PCTs which should be made responsible for the monitoring processes needed.
    The important point is that someone needs to be monitoring the GPs, the primary contact between patients and the NHS, as this is where most of the problems arise.

  90. David R Reed says:

    Leave the NHS alone and forget about your competition-based reforms, focus instead on improving excellence thoughout the whole NHS by independent monitoring and enforcement by combining the expertise and connections already in existence such as NICE and the PCTs.

    GPs CANNOT drive the changes needed, they are the ones who need changing the most! What we need are specialist with the skills needed to find best practice and then to ensure that this is used throughout the whole of the system.

    You cannot plan, develop or manage from the bottom up and uniformity of provision requires external monitoring and enforcement.

    Use the skills, people and resources we already have, GP consortia will be useless, remote and unworkable.

  91. Dr Hilary Kinsler says:

    Education and training are vital in the NHS. To save this from being ruined we should reject this bill completely. It will privatise the NHS mainly because the private healthcare firms are bribing Tory MPs with large sums of money so that they can make a profit for their shareholders. Education and training will not be a priority for them and standards will decline. This is a greater scandal than the expenses.

  92. Dr Hilary Kinsler says:

    Education and training will be a very low priority for a private healthcare service as proposed in this bill. They are essential for a high quality NHS.

  93. Void Excercise says:

    This listening exercise has to be stopped and corrected.
    I am deeply outraged that this listening exercise has been designed and implemented in the way it is.

    - There is not enough publicity. No one I know (family or friends) know that there is a listening exercise, let alone how to get involved

    - The interface has been just designed so that new participants cannot read what others have said. Am I supposed to make my point without reading the 529 other ideas that others are discussing below me?

    - 4 different sections make the navigation more difficult, and sythetizing the information impossible. This is a good way of preventing anyone from being in the position of making their point

    - There is no summary of what is being discussed which can be easily reached from this page. A document stating clearly what changes we are exactly discussing should be visible at all times.

    - There is no information on how these random comments by users are going to be processed, valued or used. There is no statement on what guarantees that they are going to be even read by someone

    - Any ethical and true listening exercise should start by listening to patients and citizens, who are the ones sustaining whatever system we come up with, and the ones suffering the consequences of any bad choice in this respect. The only section of society who seem to be giving their view here are mostly doctors, nurses and other institution workers who are aware of this sham.

    Shame on this listening exercise, Shame on Mr Andrew Lansley. Shame on our government. Shame on this authoritarian and corporation-driven proposals.
    We are citizens. We are patients. We are tax-payers. We are consumers. We have the right to be listened to, and above all, we have the right to be respected. Stop insulting us. Stop lying to us.

  94. At present, the NHS is THE practical medical training organisation. Apparently the government thinks it entirely satisfactory that billions of public money is put into training the medical profession, just for it to be used for profit by the private sector. Puny ‘remedies’ like maybe putting a levy on private healthcare providers is nopwhere near enough. The private healthcare sector can train its own personnel, or bring in people whose training, which must reach NHS standards, has been provided by some other country or organisation.
    Such a proposition is, of course, untenable, and simply shows the crucial importance of a total, publicly funded and coherent health care SYSTEM.

  95. Damian Roland - Medical Trainee says:

    In order to change the way cardiac services for children are run in the UK a high level executive was created, the evidence digested and potential solutions/proposals put forward for consultation.

    Obviously this is a larger exercise but what we have are proposals that don’t appear to have been checked at the outset to test the reaction they have inevitably caused. Nothing wrong with wanting major change but if you are unable to react to serious concerns (abolition of deaneries, concerns over leverage etc) in education and training then gossip spreads and people become dis-enfranchised.

    In the future it would be useful to feasibility test options and reduce the consultation time (or at write in an opportunity to respons)

    As for the now it is vital that unintended consequences (all described in the comments above), missed benefits (there are some good initiatives being drowned out by noise) and pace of change (its all too much, too quickly) are clearly understood and fed-back by the consultation panel.

  96. mandie says:

    Education and Training of all staff within the Health service is essential and from a patient / carer perspective is reasonably good. However I have very serious concerns about the ability of staff to put their training into practice. When in hospital I have had a chance to discuss with staff how they feel and they often say I love my job but I just wish I could do what I trained to do. I have been in hospital many times at the change of junior doctors and see these new ones coming in with very little understanding of how it works in practice in the hospital. It can be very frightening for a patient to see the inexperience first hand. They do learn very quickly, but I hate being a guinnie pig.
    We have been asked to be involved on the job training and often the staff will say that was great better than lectures. Introduce more mandatory training including actual patients and Carers to ensure that staff can see it from their perspective.
    I am totally against the privatisation of our NHS , it need modifying not destroying.
    Leave our NHS alone, we did not give you a mandate to do this.

  97. Dr Simon Fenner says:

    As a TPD, I strongly suggest that the proposed abolition of (Post Graduate) Deaneries & the devolvement of postgraduate medical & dental education/ training to local providers and/ or consortia will at best lead to fragmentation & derailment of the current approach to provide national recruitment & standards in training which even trainees seem to think is a better, more fair system than the one that it replaced. The Deanery system that we currently have works pretty well & is getting better (this is called evolution) and at it’s worst, its abolition (revolution) will almost certainly set things back a decade which will be the time required to reinvent what we are about to scrap!
    One gets the impression that the consequences of scapping SHA’s whose responsibilities include Postgraduate M & D deaneries were not thought through at all from and education/ training point of view. The Government should just eat humble pie & admit this part of the NHS reform proposals at least was ill judged & should be abandoned.

  98. We wish to register our concern that the future funding for the NIHR/CNO Clinical Academic Training Programme for nurses, midwives and allied health professionals is under threat. The launch of the 2011 round of doctoral fellowships has already been delayed and the future of the scheme remains uncertain. This programme is a route for health professionals to develop their research skills alongside clinical practice. Having researchers embedded in clinical practice is essential to ensure that research answers the questions which are directly relevant to the needs of the NHS. Reducing the opportunities for dedicated research professionals to undertake patient-oriented research which will have a direct impact on patient care and outcomes is worrying, especially at a time where competition for research funding is becoming ever more competitive.

  99. Peta Kerrigan says:

    It is very important to me as a nurse, that any training I undertake is regognised nationally and is transferable from hospital to hospital. It is also important that professionals are given some time to train and update themselves properly, and this is seen as a key element of giving good safe care to patients.
    Training and education should be available to all no matter of their academic background. If you are in a profession, the most important thing is, that you carry out your work to the best of your ability backed by evidence based knowledge. This will help enhance the patient experience.

  100. Jodie says:

    Do we still know what the values of the NHS are? Many OT graduates are finishing their training and becoming quickly disillusioned with the service that is being demanded of them. Client-centred care certainly comes further down the list than reducing length of stay or hitting financial targets.

    Our professional skills sets are being challenged by the notion that one therapist can do all, whilst there are some areas that can support an increase in generic working it is unlikely that the current quality of education and training will be sustained in pracitce if post move to a more generic approach.

    There is some excellent provision for post graduated courses however these need to have a component funded if we are to expect our staff, especially non-professional assistant staff whose skills are reflected not their pay, to attend these. There also needs to be sufficient staff within a team to enable someone to be released from their workplace to attend!

    The mentorship schemes that are developing are positive and will promote greater ownership of individual responsibility for continued professional development. This could also be stressed at an undergraduate level as new graduates are coming out with an increasing expectation of being ‘spoon fed’ training. There is a difference between establishing specific clinical competence and taking away ownership for self learning.

  101. Geoff Collard says:

    Will the proposed ‘reforms’ of the NHS mean that private companies will have to contribute to the cost of training doctors and nurses? Of course not. Yet another way in which this privatisation under the Health and Social Care Bill will be giving advantage and NHS money to private individuals and companies.

    On a general note, nurses should not have to be graduates. Academic ability does not make a good nurse. Training in basic health care such as feeding, washing, bathing and toileting of patients has been progressively neglected which is why there has been such a huge rise in MRSA and other hospital acquired infections. And which is also why I was not at all surprised at the shocking Health Care Commission findings yesterday that doctors were having to prescribe water so that patients got enough to drink. This is largely due to privatisation of ‘hotel services’ within the NHS. When nurses were responsible for feeding patients, it rarely happened. Ward cooks and cleaners were part of the ward team and learned first hand from nurses the importance of hygiene and nutrition. They felt valued as part of the ward team and as a consequence felt more of a responsibility to the patients. Ward cleaning was done under the direction of the ward sister, and cleanliness standards as a result were far higher than they are today. The consequences of privatisation speak for themselves. So called health economists of course have no understanding of this, which is why they always get the outcomes wrong when they are only looking at balance sheets. How much have hospital acquired infections cost the NHS since these privatisations? These likely consequences of course are not factored in when it comes to decisions on privatisation of NHS services.

    Nurses need to be given back the responsibility for feeding patients and cleaning wards and the privatisation reversed, and basic training needs to reflect this.

  102. Richard Worth says:

    Beware of meddling with Education and Training at the same time as so many other changes to the NHS! Government must never forget the disaster of the medical training scheme (MTAS) only a few years ago. Professionals warned over and over again that this was ill conceived but to no avail. It was only at the eleventh hour that it was accepted that there were major problems and emergency measures were put in place to avert the hospital system collapsing. However, that generation of doctors will bear the scars of the fiasco for the rest of their careers!

    It is a great worry that it is proposed that so much manpower planning is to be devolved to local level. This is a hugely complex area and impossible to get absolutely correct. It is vital that regional as well as national oversight and expertise is maintained. The lead time is far too long to take risks in this area.

    And finally on the workforce issue, remember that effective clinical teams are only built up over many years – yet they can be destroyed overnight by incompetent decision makers who have little understanding of the issues and the consequences.

  103. Susan Whitehead says:

    A levy should be charged (on a sliding scale relevant to the number of years’ training) for all NHS professionals i.e. trained by the NHS and subsequently recruited by the private sector.

  104. Gareth Stone says:

    All interested business stakeholders should contribute to the costs of training. Training should be such as to allow transferability of staff between locations.

    The NHS should focus on providing quality healthcare, not on competition. The role of the regulator, “Monitor”, should reflect this and promote collaboration.

    Any changes to the NHS of the scale currently proposed should be trialled in small areas for several years first

  105. Emma says:

    If additional providers are to be introduced how will you ensure that training they provide to their staff is of the same standard as NHS organisations? NHS organisations invest a great deal of senior clinician time to training staff. How will other organisations do this if they are concentrating on making profits?

  106. Orris Orrison says:

    I am heartily fed up with having to deal with people in foriegn call centres, who we are told, can speak our language, only to find that not only can they not understand my English idiom, accumulated over 62 years, but I have the greatest difficulty in understanding them. It is therefore intolerable that people from abroad are made responsible for our health care when they cannot understand me and I cannot understand them. For me to get the best possible care from the NHS it needs to ensure that there is a minimum level of English, written and orally, for those wishing to work in the service. This needs to be assessed by someone with my sort of level of experience speaking, reading and hearing English, before they are allowed to practise, however brilliant they may be in a given field in their own country.
    NHS staff generally need to be regualrly assessed on their humanity in the care of their patients and the way they are addressed. The present over familiarity we are faced with from staff, addressing us by our first names without asking permission first, needs to be dealt with.
    The sometimes callous attitude of some staff to those “difficult” patients needs to be addressed too. The over reaction of some staff to what is often misinterpreted as “abuse” also should be addressed. Because a patient takes exception to what is happening or being said by a member of staff need more consideration than simply screaming “abuse”.

  107. Dr Heather Williams says:

    University education is only good for theoretical understanding, it needs to be accompanied by local, hands-on training in the specific techniques needed to do the job well in practice.
    But this kind of training is expensive. If you push through these reforms, and the associated expense, in addition to the current cuts, then the quality of practical training will actually diminish. Wards and clinics are already losing frontline staff in the cuts, and understaffed departments are not the places where people can be trained effectively as no-one has the time (quite literally) to supervise trainees and explain how to do things the best way and why. If you want to invest in education and training you need to stop this piece of legislation in it’s tracks and invest in that training instead.

  108. Lindsey says:

    The majority of training within the NHS seems to concentrate on permanent nursing posts and how they can be provided with the bare bones updates at the cheapest price. However, the NHS involves a diverse workforce. The training ought to reflect the needs of the entire workforce, including helicopter pilots!

  109. FJR says:

    extremely worried that fragmenting training process will just lead to confused training with poor outcomes. as a trainer it is complicated to keep up with all the changes to e-portfolio & manage a crashing system. who would sort all of this out? can see disparate training depending on different providers. at least within the NHS we all pull in the same direction. seems odd to risk mayhem -cf MTAS fiasco. too much change too fast. whatever happended to trying things out small scale first?

  110. John Irwin says:

    The one thing I am absoluely sure about is that I do not want useless MPs deciding on medical training. If this so-called listening exercise is anything to go by they should not be in charge of anything more than boiling water for those who DO know what is required for public health.

  111. DR Cathy Wernham says:

    AS a GP trainer I am very concerned by the proposed fragmentation of training, with differnt deaneries becoming much more autonomous. It is vital that there is a consistent standard of training nationally to provide a national health service.

  112. Andrea says:

    One simple concept about medical training is that it starts with straightforward concepts and procedures and gradually progresses to more complex scenarios, within a supportive environment in a balanced mixture of supervised and unsupervised practice.
    This is only achieved in a place (Hospital and / or GP practice) where the full range of procedures and clinical cases (straightforward and not) are present.
    The proposed Bill and opening of healthcare provision to “any willing provider” will remove from NHS Trust the “bread and butter” of medicine, which is also the “bread and butter” of training.
    Where does a trauma surgeon start from? Not operating on major traumas I believe. An Obstetrician needs to perform a lot of straightforward elective Caesarean sections in the day time, before managing a difficult emergency. And so on.
    I do not believe that alternative providers will ever be competitive at managing high risk cases and will try their best to remove from the present service easy, low-risk and profitable cases. Such providers will not have (slow operating) trainees in order to maintain their efficiency and in turn they will destroy the basis for medical training.

  113. Mark Bannister says:

    The fact you are asking any of these questions suggests that you know too little about the subject matter to be attempting a top-down overhaul of one of the best healthcare systems in the world.

    Of course, many of us know that your mind is already made up; the “listening exercise” is merely a fob for the public and you will open the NHS for private companies to move in and make a profit at taxpayers expense.

  114. Tony Hamilton says:

    Education and Training.
    The biggest failing in the health provision (and the NHS) today is that we have made it almost an entirely technical process. We have lost sight of the importance of CARING. Education and training are fine, but if medical personnel do not empathise and care for patients their delivery, however technically excellent may fail. Human beings are more than flesh and blood machines. We should select people who genuine care for their fellow people and this should be as important a selection criteria as brain power.
    Nurses who pass their exams, but do not help their patients who need it to eat are actually a disaster. Doctors who ignore relatives knowledge and worries are not doing the job required of them. These characteristics are not simply a matter of training but of selecting the right personality types.

  115. Dr Rebecca McLaren, Consultant Child Psychiatrist says:

    10. Will the proposed changes to the education and training system support the aims of the modernisation process? These reforms are a disaster for an educaton system that is only just recovering from the fiasco of Modernising Medical Careers. Getting rid of deaneries is extremely short sighted and the only reason we can see is to allow in commercial for profit organisations. A real worry is that as all hospital are forced to become Foundation Trusts a coordinated training programme for juniors who wish to move around various establishments will be lost The fragmentation that will devastate patient care will do the same to staff training.
    11. How can health professionals themselves take greater ownership of the education and training of their own professions, whilst meeting the needs of healthcare employers? We could have the courage to “interpret” the European Working Directive as some other European countries have done rather than slavishly following the directive. Recent research both in the US and UK have shown that although restricting working hours has not harmed patients neither has it impove care. The view of the staff on the ground and especially the Royal College of Surgeons is that it is significantly affecting training.
    12. How can we ensure that the values of the NHS are placed at the heart of our education and training arrangements? We can ensure staff do not become “marooned” in an environment they perceive as driven mainly by profit. Recent research of front-line staff who had transferred to the private sector found that many felt marrooned and longed to return to the NHS.
    13. How can we best combine local and national knowledge and expertise to improve staff training and education? Don’t pursue these reforms. Develop on what is already there and allow the deaneries and the Royal Colleges to work with their members to develop bottom up curriculae.

  116. Chris Etherington says:

    As a qualified Nurse of many years, I am extremely worried by the broadness and speed of implementation the proposals within the Health and Social Care Bill.

    The terminology and proposed changes are very easily used by Private Sector Commissioners to “cherry pick” the areas of health care they will deliver. The lessons learnt regarding the Banking Sectors response to the financial crisis and the payment of bonuses should serve us well as a reminder of how much public interest is carried through to delivery. Money and profit is the master for shareholders.

    Are the training needs of our NHS are going to be reviewed with our patients interests as a priority?

    Will the review ensure we have the right staff, in the right place with the appropriate skills and competencies?

    How will these be measured and who will be accountable for sustaining the level of Workforce Development and Academic Excellence that has been previously taken for granted? The removal of the SHA’s is well underway.

    Vulnerable Groups:
    The specialist skills needed when caring for children, learning disabled and elderly patients are at present required for posts in our NHS. The cost/benefit model of business will not be aware of such needs unless issues like this are written into the Commissioning agreements in a watertight legal proof manner. Do we have the knowledge, skills and experience to Commission safely. Our Privatisation of cleaning in the NHS left us with many long term issues to be addressed!
    The ratio of trained staff will no doubt be further diluted and the roles of assistants will be enhanced. The NMC should be involved with the Consortia to explore what is an appropriate model and minimal level for safe practice.

    Funding Streams:
    The Private Sector is now a major employer of health staff, so it seems appropriate that as previously suggested there is a significant financial contribution made to all training from work Commissioned. This could be weighted to reflect the “easy profits” that are usually the first areas of work to be Commissioned privately.

    The provision of a Public Health education contribution could also be included in this way. How do GP’s contribute to funding of Practice Nurses at present? It may be worth exploring what models of staff education and development are being offered in the present model.

  117. M CARTER says:

    firstly Nurses should not be trained and educated in isolation from hands on experience in Hospitals, too much trainging for too long takes part away from Patients and the reality of nursing that some Nurses may get to qualification when after starting nursing proper they leave nursing as a professioning, after finding it is not for them. The training of nurses should be a mixed experience, technical, and hands on, it is vital, plus nurses must keep learning. Introduce Matrons again, as so many call for, to keep discipline, encourage ownership of the care given to the Patient, if Nurses actually were allowed to keep to the principles of nursing, which is providing care, patients would not be going without food, etc etc. Cleaning of hospitals must be kept in house, there should be pride in all. The threatened changes are demoralising, and this is not good for anyone, not the patient, not the staff etc.
    Trainee Doctors and Surgeons should be incentivised to work within the NHS, by providing cheaper tuition fees, perhaps it would be ideal if there were no charge at all, if any one pays back the costs of their education it has to be our surgeons, doctors and nurses. If a Doctor is to serve within the NHS contract them to do so, in exchange for free tuition, or reduced rate tuition, do the same with dentists while your at it, the public would love it… dentistry, or at least affordable and available nhs dentistry.
    Do not, not make any cuts to our Scientific staff, they are part of what makes the NHS great, and it is great, it is envied throughout the world, including by Barack O’bama, who wished to emulate our wonderful NHS for his own people, but has been defeated seemingly by scaremongers and interested parties, who would destroy our NHS too, if they could.
    Our Science staff enable us to have top notch diagnosis, which may be expensive, but saves money when the illness is caught early enough.

  118. K Vines says:

    At the moment, we have tertiary level education for nurses and doctors before they enter their professions and it’s difficult to see how this could be improved. University education is the most advanced that we have, and it’s led by people who are regarded by their peers as the most expert there are. As medical advances are made by the experts, they can implement advances in training. It’s a natural progression and I can’t see any need to muck about with it. Anyone who thinks otherwise doesn’t have the best interests of the NHS at heart.

  119. Dave Waite says:

    There are 32 fully trained professionals, skilled in ‘re-ablement’ working in Scunthorpe. They have the skills, qualifications and many years of experience, to get elderly patients out of hospital beds and eventually back into their own homes.
    A reduction in the council budget of 8% means they are all being sacked by the end of the year.

  120. Joel Arnstein says:

    Good education and training of health service staff requires co-operation between and the participation of colleges, universities, hospitals and other health service providers. Such participation incurs costs. Competition will discourage participation and co-operation: if your competitors spend on education and training and you can avoid such costs or spend less, you gain a competitive advantage. This has long been a problem in British manufacturing and it would be foolish to import it into the health service. So avoiding the increase of competition in the health sevices would avoid damage to education and training in health care.

  121. Kate Inglis says:

    Education and Training. Seriously “What Training”
    A set amount of time at university and then straight onto the wards as qualified staff. Lots of Theory, but no practical skills. WHY?
    Many of the newly qualifies nurses barely know a Bedpan from a Bowel.
    Their workplace experience has very likely been working in a Charity shop, this is a fact. How does this prepare them for working efficiently and effectively on a ward? Feelings and empathy with the needs of the patients is a prime need,but even more so is the need to see the signs and symptoms a patient may be displaying or describing. Because todays new nurses have not had the opportunity to start at the bottom on the wards and be guided by senior/qualified staff. As with most careers, they need to experience hands on while still learning with ongoing supporting and guidance. Theory alone does not give one the skills required to carry out any job proficiently – why not give nurses a real chance to be a most effective tool on our wards. Give them REAL nurse training on the job..

  122. Sue says:

    I think the government should be listening to the views of health professionals on this. They have no mandate for their proposals, and these changes should be abandoned forthwith.

  123. Dr Charles Elliot says:

    We have already seen what happens when healthcare and ancillary services are outsourced; commercial providers need to make a profit so they have to cut the quality of service, staff and levels of staff pay thus resulting in more poorly qualified staff and an inferior service. There is no incentive for them to invest in expensive training and education because it won’t provide a significant return on their investment. There is a fundamental mismatch between the aims of commercial companies and the aims of a good health service. Shareholder profit one the one hand and the best possible patient care on the other. Ultimately these two pull in opposite directions.

  124. Richard says:

    “How can we ensure that the values of the NHS are placed at the heart of our education and training arrangements?”

    Surely one of the key values of the NHS is the duty of the government to provide comprehensive healthcare. Why then is this being removed by the current bill?

  125. J Salisbury says:

    Personal/professional mentorship is an excellent way of nurturing junior staff. A number of professions also now have a preceptorship programme for now graduates. However, there has to be the time, funding and resources for higher grades to go on training courses to maintain current best practice and skills. This enables them to maintain standards within a department and nurture others.

    I am a member of frontline NHS staff. Half of my post (job-share) has been axed to save money, and we are waiting to hear which other posts will disappear or be down-graded. Having departments running on the lowest possible level of staffing at the lowest possible grades does not promote exemplary care. And on a practical note, it leaves no time or money to train those who remain there anyway. Many of us use our own time, resources and the kindness of the occasional charitable bursary to acquire the skill level we feel the NHS deserves.

  126. W M Wong says:

    1. Will the proposed changes to the education and training system support the aims of the modernisation process?

    No. Deaneries should not be abolished. Post graduate medical and dental education has to be co-ordinated across multiple education providers so that the trainees get wide exposure to all aspects of their chosen specialty. No single local Hospital no matter how eminent can produce a fully trained consultant, and it is unlikely that any single hospital will take on the role of co-ordinating training of several hundred trainees in 30 specialties over 5 to 10 years.

    2. How can health professionals themselves take greater ownership of the education and training of their own professions, whilst meeting the needs of healthcare employers?

    The Royal Colleges have always been standard setters for postgraduate medical education. They have run ‘Training the Trainers’ courses for many years and been active in research programmes around adult learning, teaching and assessment methods etc. Foundation Trusts should be obliged to have Royal College and Deanery representation on consultant appointment committees. This sets a baseline expectation that all consultants will have some teaching commitment. Royal Colleges could make training in educational skills a mandatory part of subsequent continuing professional development.

    Healthcare professionals will always take into account the needs of their employers – they have no interest in bankrupting them! But employers must be committed to the continuing education of their staff – to pay for course and travel expenses is likely to be a relatively cheap way of improving staff loyalty and retention, as well as improving knowledge and skills. Clearly healthcare professionals cannot go on any course they feel like. This is where good appraisal and job planning come in, so that the employer and professional can agree on what continuing education is needed and how it should be provided.

    3. How can we ensure that the values of the NHS are placed at the heart of our education and training arrangements?

    The same way those values are placed at the heart of all other NHS activity – the people at the top have to live and breathe them. This has to start with the Secretary of State for Health and the Department of Health. They have to make sure policy is concordant with those values, they must actively remove obstacles to practising those values, and they must refrain from any suggestions that other values may be put above them.

    Just in case anyone has forgotten, those core values are that the NHS exists to provide health care that is:
    comprehensive, ie all medical conditions,
    universal, ie everybody,
    equitable, ie fair,
    and essentially free at point of use.

    In addition, the service provided should be reliable, effective, safe and delivered in a caring way.

    4. How can we best combine local and national knowledge and expertise to improve staff training and education?

    For postgraduate medical training, there already exist local, regional and national training centres and networks. Deaneries and Royal Colleges inspect training providers and provide feedback. Trainees are surveyed annually by PMETB (now subsumed into GMC) as to quality of training. In addition trainees give feedback at their own annual assessments. Trainers are already expected to learn and maintain teaching, supervision and assessment skills, and teaching sessions usually have some feedback form for the learners to rate the teacher. I think that the current arrangements should be left to mature for a few years, given the many changes that have happened in medical education over the recent past.

  127. Hellen Kirby says:

    I have seen health professional training and have taken part in training for health proffessionals. I am an actor and run a theatre company that creates bespoke training solutions for health services as well as schools and other organisations. I believe that using a creative medium such as theatre is the future of training. It engages and involves people while not getting personal. It’s all about the situations they see in front of them. We use a technique called forum that involves the audience and we have always had 100% feedback. Using theatre to mirror real life and then debating around it trains people in a way that they don’t forget and put patients at the heart of it. America uses this technique of training in most workplace settings and so sould we.

  128. Michael Meinen, GP says:

    By fragmenting the health service, education and training will suffer. The drive for greater privatisation will make things worse. In a state-owned health service, education and training is an investment in the future of the service; in a privatised world, it is a cost factor that eats into the profits and therefore has to be minimised. Better still, the costs have to be put onto the workforce, so they really take ownership. It is only forgotten that the majority of the health service staff are not GPs or consultants, but of the less well paid varieties. Ringfencing of training money has already gone, with predictable consequences.
    Again, what is the evidence that the proposed changed improve anything?

  129. elizabeth field says:

    I am concerned about the impact of cuts on training and education. More and more it is the case that experienced staff are expected to take time out from their clinical work, without backfill, in order to provide teaching to more junior staff. The message is a mixed one – training is important (essential) but cannot be funded and must be, in effect, provided and undertaken in what amounts to the clinicians own time. Dedicated staff can take on only so much before risking becoming demoralised or ‘burnt out’. The alternative outcome is a reduction in skill levels.

  130. Dr A Iqbal says:

    Education and training are not only a cornerstone but the foundation for the future NHS. The multitude of staff( Drs, nurses , physios , OT, etc ) that work for the NHS and were trained by the NHS are now under threat in 2 ways- A. service delivery to patients and B. education and training due to competition form private sector which has no interest in developing staff(In most cases private sector staff are NHS Educated & trained !!) . Due to long term under funding the NHS relies on Goodwill with staff frequently supporting & mentoring junior colleagues. This is something the private sector is unlikely to provide.

  131. Louise Irvine says:

    The proposals on education and training of doctors are very badly thought out and will seriously damage the quality of training. The proposal to abolish Deaneries and with them national standards, accountability and oversight of training is dangerous. The idea that health care providers should organise training is very risky as they are likely to put service needs before educational needs.

  132. Dr S Anderson says:

    Will the proposed changes to the education and training system support the aims of the modernisation process?

    No. Deaneries should not be abolished. Post graduate medical and dental education has to be co-ordinated across multiple education providers so that the trainees get wide exposure to all aspects of their chosen specialty. No single local Hospital no matter how eminent can produce a fully trained consultant, and it is unlikely that any single hospital will take on the role of co-ordinating training of several hundred trainees in 30 specialties over 5 to 10 years.

    How can health professionals themselves take greater ownership of the education and training of their own professions, whilst meeting the needs of healthcare employers?

    The Royal Colleges have always been standard setters for postgraduate medical education. Foundation Trusts should be obliged to have Royal College and Deanery representation on consultant appointment committees. This sets a baseline expectation that all consultants will have some teaching commitment. Royal Colleges could make training in educational skills a mandatory part of subsequent continuing professional development.

    3. How can we ensure that the values of the NHS are placed at the heart of our education and training arrangements?

    The Secretary of State for Health needs to believe in the core values of the NHS – ie.e that the NHS exists to provide health care that is comprehensive, universal, equitable and essentially free at the point of delivery.

    One gets the impression that the consequences of scrapping SHA’s whose responsibilities include Postgraduate M & D deaneries were not thought through at all from an education/ training point of view. The Government should just eat humble pie & admit this part of the NHS reform proposals was ill judged & should be abandoned.

    Postgraduate M & D deaneries definitely need to exist in some form and should not be abolished.

  133. John Puntis says:

    The fragmentation of the NHS through the privatisation (see British Medical Journal, 21st May 2011, p1112) and competition at the heart of the proposed reforms fundamentally threatens the coordinated training vital to providing the future workforce.

    It is highly unlikely that locally organized training will enable the medical workforce needs of England to be met in the future. The Royal Colleges for years oversaw an excellent training programme which is recognized throughout the world. The Deanery system which has evolved over the last decade has achieved good results. Introducing a purchaser/provider split into training was unnecessary but abolishing the whole system is wrong.

    Medical training has attempted to become evidence based; it is time that management policies and proposals for restructuring (as in this bill) should also become evidence based. There is very little sign of this at present.

  134. Tim Cribb says:

    Doctors and all levels above should be educated at degree level because they need intellectual discipline and holistic perspectives that a university provides, with specific medical skills to follow after that foundation. The levels below doctors need purely technical qualifications, which are best acquired at the appropriate specialist institutions, not at universities. Once qualified, people at all levels should be subject to periodic inspection and all should have access to in-service training and refresher courses.

  135. Angela Dunn says:

    * Will the proposed changes to the education and training system support the aims of the modernisation process?

    Not from what I have read above it wont.

    * How can health professionals themselves take greater ownership of the education and training of their own professions, whilst meeting the needs of healthcare employers?
    They need support to do this surely. If your cutting training budgets then this seems rediculous to me!
    * How can we ensure that the values of the NHS are placed at the heart of our education and training arrangements? By not meddling with it in the first place seems like a good place to start!

    * How can we best combine local and national knowledge and expertise to improve staff training and education?
    Erm standised training instead of leaving it up to local standards.

    At the end of the day as a patient I will not be asking what qualifications the staff have. All I care about is if the staff know what they are doing, if they can use the machines and instruments properly, if they can make an injection painless, if they know the right medication to give me in the right amount, fix the broken bones, get the IV line and catheter in properly, cure the illness and give me a decent quality of care whilst they do so. Oh and if they can answer my questions about my illness along the way that would be brilliant to. And can relate to a wide range of people from babies to oaps, to disabled and mentally ill to those whom are as fit as a fiddle. Or at least have the ability to access the information or for someone to show them how to do so properly.

    As a patient it is not reassuring if this can not happen. The training needs to ensure this and if the proposals mean that this does not happen, as my impression of them suggests then they should not be implemented!

    And the only way they can do ALL that is through practical experience with real life people and not being stuck in a classroom. But the people training them naturally need the support to be able to do this be it via payment, training, the ability to do this during working hours or useful teaching resources. It seems crazy to cut a training budget-JUST NO!

  136. Celia says:

    any training must include these as well as all the elements descibed in previous comments. we provide a non-clinical community based HIV testing service and it is the human elements and the fact that we are connected to clinical and non-clinical services that make our service excellent. we train our volunteers to think about the person – not the diagnosis.
    o core elements for all GP / clinical delivery staff to cover confidentiality and respect and signposting.
    o Inform what local services are available
    o Cultural aspects – one approach does not work and drives people away.

  137. B. Smith says:

    I believe in this case, the NHS should look to other countries for solutions. One example would be the United States where health professionals are licensed based on their education such as Registered Nurse and Psychologist. Other supporting roles such as the Patient Care Technician, similar to the C & D grade nurses in the UK, perform more basic care in order to allow the nurse to focus on the more technical aspects of their role. Under such a plan the service can be cost effective because a Bachelors level nurse is not spending a lot of time bathing patients and that duty is being under taken by a cheaper helper.

    In addition, I feel, in order to improve patient care more roles need to be licensed / regulated under HPC and I believe before someone can enter in their chosen field they should undergo competency based testing to ensure they have the needed skills, undergo a criminal background check and a hair analysis drug test. Competency based testing would take into account issues that may arise under Equality Act 2010 and those applicants that can demonstrate an issue under Equality Act 2010 can get modifications to the test. Nonetheless the competency part of the test would be two parts, a written part and a skills demonstration. The other two parts, drug test and criminal background check, would be done to protect the public and employers from potential risks. Only those who passed all three parts would then be allowed to practice.

    Regarding who should pay for this, it is my feeling the stipends currently offered should continue along with the free tuition. However if someone leaves their studies before completing their education then they should be required to pay back any money paid for their education and living expenses. In addition I feel, anyone who undergoes training to become a nurse for example should have a minimum A-level grades and courses. The ones I would recommend with grades would be Biology, Chemistry or Physics, English with a grade profile of ABB.

    Finally I do not believe the health service should be open to immigration rules and anyone from outside of the EU should have at least a masters degree, doctors must demonstrate fluency in English, and those outside of the EU should not compete for spots in medical training from those who graduate from an English medical school.

  138. Adele Docker says:

    I heard a comment on the radio by someone ‘high-up’ pompously declaring that waiting times have been greatly improved over the past few years. As a patient, all I can say is I’d rather wait than be rushed through a a 10-minute doctor’s appointment slot in which the doctor has pen poised over prescription pad as soon as you enter, ready to throw down the usual panaceas: anti-depressants, pain-killers, sleeping-pill, and/or statins…with no questions asked as to other symptoms, no checking patient’s record to see if any of these is compatible with long-term medication as well as family medical history – there’s no time! Also the danger of being seen by ‘nurse practitioner’ who, as in my case, completely mis-diagnosed shingles as a kidney infection (which has caused obvious ongoing problems several months later). The ‘false economy’ of these ‘flighty’ appointments will be shown as patients’ more serious undiagnosed illnesses lead to serious hospital care further down the line.

  139. Michael Simpkin says:

    It seems unlikely that the proposals (just like the whole Bill) will do anything to enhance the holistic approach which the best staff have – i.e. treating patients as far as possible as people rather than processes, whether they are in theatre or on a geriatric ward. To this extent I would support comments above which call for more on the job and practical training not just academic skill. The call to have healthcare training employer led and patient focused seems to me to be a contradiction in terms because patient will be redefined as consumer. My experience of anything like local skills networks is that that they often either produce training which is unwanted or do excellent programmes which end up over budget (partly because they have too narrow a market) and are scrapped.

  140. Zoe Titchener says:

    I am not qualified to comment on how best to educate healthcare workers but there seems to be a well-informed response from within the profession on this thread and I would recommend the government listens to these.

    Education and training surely require funding and a stable environment in which to learn. I am concerned that the proposed changes will fragment the NHS and reduce the opportunity for quality training if different sections are hived off. I am concerned that the introduction of additional private companies as allowed under the bill could lead to the NHS effectively subsidising training, with staff being tempted away from the NHS to companies which can of course run services more cheaply without any requirement to train. This must not be allowed to happen.

  141. Claire says:

    The importance of the Deaneries in ensuring continuity of standards for doctors in training at this time of transition should not be underestimated. It is important to keep this link between Royal Colleges and service providers for quality assurance purposes.

  142. Martin Stanley says:

    Education and training is very difficult.
    Over the years the governments have said we need more Drs and Nurses and pressed the Royal Colleges to increase their programmes, then the government say we need to save money so all the new Drs and Nurses cant get jobs and existing ones are made unemployed.
    The government need a realistic strategy on what the form and function of the NHS is for the next couple of decades and stick to it. This will allow the training strategy to be put into place to ensure we have the best quality staff to deliver the services and have a CPD programme behind it to maintain and improve all staff over time.

  143. Genevieve Smyth says:

    I am concerned that the current proposed changes to education and training will fragment education and destabilise universities. Nothing in the proposals ensures Continuing Professional Development or student placements. Reponsibility for all levels of training needs to be built into commissioining decisions and provider contracts. The proposed local workforce planning will marginalise smaller professional groups such as occupational therapists. We do need a set of common values for education and training but this should not equate to purely medical values. Occupational therapists work from a bio-pyschosocial perspective and work across education, justice, health and social care. A common value base that is appropriate to all these areas is required.

  144. Neville Farmer says:

    The cross-fertilisation of training, healthcare and research and development is one of the most brilliant side-effects of a unified NHS. Clinicians can learn everything from multiple procedures to choice of specialisation and can continue to do so throughout their careers without being forced down the blind alleys offered in the private sector. In return, trainees offer a vital low-cost, high energy resource to balance the ebb and flow of needs in the hospital environment. This is not something that can be categorised and quantified in pure economic terms.
    Further, the broad base of this general training feeds in to research and development, interacting with universities to give us a focus on cures and treatments that is not substantially skewed by profit motive. Through this, the NHS and healthcare around the world benefits from remedies that might not appeal to the shareholders of large corporations but that will help economies by saving lives and keeping people productive.
    The proposed bill doesn’t even mention training, which shows just how ill-considered it is.

  145. Linda Waters says:

    There will be no “values of the NHS” to educate or train people to unless we have a NATIONAL health SERVICE. Unless the duty of care to every citizen remains we will only be left with health, no SERVICE and it will not be NATIONAL.

    The duty of care must be kept or all other discussion is pointless.
    Other discussion is a smokescreen to cover the removal of the duty of care. This must not happen.

  146. Su Davis says:

    Health care professionals need:
    An evidence based academic platform on which to base their practical skills
    The time and opportunity to develop clinical skills under the supervision of qualified professionals
    The time and opportunity to develop interpersonal and communication skills in order to be able to provide the best care
    Training needs to focus on the needs of the patients not the needs of the paperwork and students need the support from placements to develop as professionals not just act as another pair of hands in the busy workplace
    Education should stay in the hands of the education establishments not be given to organisations who are already spending far too much time and energy responding to the changes in structure.

  147. Lynn Fearon says:

    My particular concern is for the education of practice nurses, the greater majority of whom are directly employed by GPs at present. It has become a diverse role.Most of the clinical skills required for practice nursing are not covered in basic nurse training, eg all child. adult and travel immunisations, cervical smear taking, chronic disease management etc. Yet there is nationally no recognised training course for practice nursing. The Lead practice nurses in the South West, under the guidance of an experienced practice nurse lecturer, developed a quality Practice Nurse Foundation Course through the University, which over ten years was extremely well evaluated and has begun to be rolled out to other PCTs in the south of England. It was part funded by GPs, and in the South West part by the SHA. The SHA funding has been withdrawn this year.

    Quality education, training and regular updating equals quality service. Sadly not all GPs recognise the value of sending their nurses on courses (and in some areas the training required may not even be available). Yet practice nurses have largely been responsible for delivering the targets for the Quality and Outcomes Framework.
    Clincial Governance through the PCT up to a point ensured those practice nurses who were delivering chronic disease management, diabetes, asthma etc.and other tasks, were trained to do so. This governance needs to continue in some form. There are many highly trained practice nurses but others who sadly, and often through no fault of their own, are not.

    I believe the retiscence of many nurses to GPs holding the budget is due to the anxiety over training needs. But, having worked in general practice for 22 years I, and many others, also appreciate the difficult job skilled GPs undertake. It is hard enough for them to take time out for updating themselves but anything else which detracts from their essential role in diagnosing disease is to be feared.

  148. web editor says:

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