Future Direction of Education for the NHS in London

1. Future Direction of Education for the NHS in London Dr Anne Rainsberry, NHS London 30th April 2008, London Deanery Conference

2. NHSL’s Goal: To Become a World Class Leader in Healthcare Education and Research • Healthcare for London will require changes in the workforce • Education is a key enabler for delivering change by shaping the numbers and skills of London’s future healthcare workforce. • Education will play a critical role through: • Undergraduate education • Up-skilling through CPD, (70% of current workforce will be employed in 2016) • Diffusion of innovation and best practice • Driving system change • The workforce will be accountable for: • transforming services • raising healthcare standards in London

3. A Medical Workforce Strategy NHSL is in the process of developing a medical workforce strategy in order to: • Develop a set of priority actions for the SHA for the next 10 years Through: • A mixture of quantitative and qualitative issue analysis • Building on previous work • Identifying where the SHA is central to the outcome • Identifying the role of partner NHS organisations

4. Education as an enabler • Education is the key enabler in • Developing skills and standards • Exposing trainees to changing service settings • Defining standards for professional practice • Embedding change skills in individuals • Clinical Education is as much the business of service providers as it is the business of the higher education sector

5. 2007 Education Diagnostics • In 2007 NHSL undertook two significant pieces of work in reviewing the education system for all clinical staff groups: • Qualitative analysis within an analytical framework involving stakeholders in order to identify key issues • An international healthcare education benchmarking survey - Test and support issues identified through the education strategy work - Develop insights into education provision for doctors and nurses in the UK and elsewhere

6. We assessed NHS London’s Education System along 3 Dimensions • Is Education providing a workforce aligned to service needs? • Are education and training delivered to a high standard? • Is the system aligned to support education goals? • Robust application and selection process of trainees/students • Skills and competencies for high quality service (e.g., communications, clinical and research skills) • Clearly defined goals of education system • Clearly defined roles and responsibilities of stakeholders • Effective assessment of trainees/students • Right quantity of staff by role/skillset to meet demand • Incentives to educate • Design of courses and curricula to meet evidence-based needs • Effective planning and commissioning of education • Mindsets and behaviours conducive to high quality care (e.g., teamwork, evidence-based approach) • Clinical leadership for education • High quality of teaching and supervision • Information available for tracking performance • Appropriate duration and intensity of training G. Physical infrastructure • Value for money H. Training support personnel

7. International Education Benchmarking Survey

8. Online market survey to assess medical and nursing education internationally Countries analysed Cornerstones of the survey • Scope of the survey • 4 online questionnaires per country: • Supervising doctors; supervising nurses; Trainee doctors (residents); and Trainee nurses (recent nurse graduates) • Survey participants • Supervising doctors • Supervising nurses • Trainee doctors • Trainee nurses • Survey period • October - November 2007 • Results • Intra-country analysis of the quality of education and training • Intra-country understanding of the importance of, and performance against key medical and nursing competencies • Inter-country comparison of findings Source: McKinsey

9. Summary of Findings as Applied to Medical Education • Overall, UK consultants rank UK medical trainees satisfactorily relative to international peers despite • The quality of teaching itself in the UK is rated highly • The UK system is very supervisor-centric • In comparison with other countries, the UK rates management skills as a relatively low priority • Other countries appear to have focus beyond the values of supervisors • France develops collaboration with other professionals • US develops research and teaching skills • Morale is severely low among UK trainees, (2007)

10. Findings continued • Trainees have significantly low satisfaction levels with • The training and learning environment • Support from other professionals and management • UK trainees report the highest likelihood of leaving the profession and are highly insecure in achieving a job in their chosen specialty or geography, (2007) • UK trainees rate work-life balance very poorly, despite having the lowest working hours in the geographies surveyed (trainee opinion on this issue is directionally different from supervisor opinion) • No country performs particularly highly on CPD; in the UK it is seen to be important for career progression but is not seen to be very beneficial for doctors or for patient care

11. Education Commissioning RegimeFour Stage Commissioning Cycle • London Medical Education Plan • Responding to Medical Workforce Strategy • London’s role as educator for rest of NHS • Review of education content • Choice of providers • Learning & Development • Agreement with NHS • Clear standards for • Clinical Education • Review of funding with • DH • Earned autonomy • Structured interventions & support • Investment rewarding excellence • Baseline Assessment • Standard QA for ‘non-medical’ • Integrate with QA of Medical Education • Assess NHS organisations as clinical education providers

12. Implications for Education Providers, Trusts and PCTs • Organisational roles will be explicit • Organisations internally need to create strategic workforce capabilities • PCT / Trust strategic and operating plans will include workforce plans • MPET levy will pay for educational activity only and VFM will be required • Education will be high quality, relevant and will be required to meet specific standards • All organisations, (NHS and HEI) will be performance managed relative to levels of SHA MPET investment and held to account for their delivery