Select committee inquiry
Education, training and workforce planning
Closed
What the inquiry looked at
“The Committee examined the Government’s plans regarding healthcare education, training and workforce planning.”
The committee's words, from the inquiry page on parliament.uk ↗.
What the government said
1st Report - Education, training and workforce planning - Volume III (Additional (unprinted) written evidence)
No government response is linked to this report.
1st Report - Education, training and workforce planning - Volume II (Oral and written evidence)
No government response is linked to this report.
1st Report - Education, training and workforce planning - Volume I
The government responded on 6 September 2012.
Read the government's response ↗ Read the report ↗ Report an error
How the inquiry ran
Each dot is a dated item listed on this page, from the inquiry's opening on 8 November 2011 to 6 September 2012.
- Report 3 reports
- Government response 6 Sep 2012
What it recommended 6 recommendations · 36 conclusions
1Effective workforce planning in the NHS depends on the availability of up-to-date, high-quality data and...
Concluded (the committee's words)
Effective workforce planning in the NHS depends on the availability of up-to-date, high-quality data and intelligence, yet only in recent years have steps been taken to ensure that this is fully and comprehensively available. We welcome the remit that has been given to the Centre for Workforce Intelligence; we also commend its ambition to tackle deficiencies in workforce data and to establish a core national minimum data set.
2It is clearly not sufficient for the Centre simply to collate and interpret data.
Concluded (the committee's words)
It is clearly not sufficient for the Centre simply to collate and interpret data. It should also challenge data from individual health economies against current clinical standards to ensure their workforce plans make adequate provision for the best skill mix.
3We appreciate that the Centre is still a relatively new body and that its establishment...
Concluded (the committee's words)
We appreciate that the Centre is still a relatively new body and that its establishment pre-dates the full implementation of the new workforce planning system. However, we are concerned at some of what we have heard regarding its capacity and capability, in particular its capacity to test workforce plans against the requirement to match the best clinical standards. We are also concerned at the apparent lack of clarity about how it will fit into the new workforce planning system. The Department needs urgently to explain how it is ensuring that the Centre is adequately resourced to fulfil its remit, as well as to clarify the Centre’s role in the new system, particularly its working relationships with Health Education England and the Local Education and Training Boards. It must also set out how the Centre will be effectively performance-managed in the new system and held to account.
4The Centre is substantially dependent for its success on data that are provided by employers.
Recommended (the committee's words)
The Centre is substantially dependent for its success on data that are provided by employers. In future those employers will be autonomous organizations and Local Education and Training Boards will be responsible for gathering data from them. The Government must ensure that there are clear contractual obligations on all providers of NHS-funded services to provide full, timely and accurate workforce data; these obligations must be backed up by clear, strong and enforceable penalties. At the same time, there must be a clear complementary requirement on the local Boards in respect of gathering and passing on data—with a definite remit for Health Education England rigorously to performance manage the Boards in this respect.
5Innovation in skill mix and clinical roles is crucial to achieving a more efficient and...
Concluded (the committee's words)
Innovation in skill mix and clinical roles is crucial to achieving a more efficient and flexible workforce. However, it is important for policy to be grounded on solid evidence—both to overcome restrictive practices in support of sectional vested interests and to prevent inappropriate de-skilling in pursuit of mere cost-cutting.
6Effective workforce planning requires effective training and professional development.
Concluded (the committee's words)
Effective workforce planning requires effective training and professional development. Given the increasingly important role of healthcare assistants, it is essential that the Department of Health develop proper guidelines for the training requirements of this group of staff; and commissioners should take these requirements into account when commissioning care from healthcare providers.
7We note that the Government has announced arrangements for the voluntary registration of healthcare assistants.
Recommended (the committee's words)
We note that the Government has announced arrangements for the voluntary registration of healthcare assistants. However, in the absence of a professional regulator, we urge the Government to keep under review the requirements of this key element of the workforce for training and professional development. In the longer run, we reiterate our view that independent professional regulation of this group of staff provides the best assurance to patients.
8Four years ago Professor Tooke set down a clear agenda on the future of the...
Concluded (the committee's words)
Four years ago Professor Tooke set down a clear agenda on the future of the medical workforce which was widely accepted. An acid test of the effectiveness of the new education and training arrangements will be their ability to deliver the more flexible medical training programmes which were described by Professor Tooke and endorsed by the NHS Future Forum.
9While we recognise that introduction of the European Working Time Directive has had a significant...
Concluded (the committee's words)
While we recognise that introduction of the European Working Time Directive has had a significant impact on working and training practices, we do not feel any rose- tinted nostalgia for a system which used to rely on over-tired and under-trained junior doctors. We have received a broad basis of evidence which shows how it is possible to reconcile reasonable hours for junior doctors with high quality training and, most importantly, high standards of care for patients.
10A clear mandate must be set for the new system to take account in workforce...
Concluded (the committee's words)
A clear mandate must be set for the new system to take account in workforce planning of the full range of evidence-based treatments—subject to the evaluations carried out by the National Institute for Health and Clinical Excellence.
11The NHS has historically welcomed large numbers of staff from overseas, including healthcare professionals who...
Concluded (the committee's words)
The NHS has historically welcomed large numbers of staff from overseas, including healthcare professionals who have been educated and trained in other countries. Their contribution to the success of the NHS has been rightly acknowledged and celebrated.
12We believe that the openness of the UK to clinical staff trained overseas, and the...
Concluded (the committee's words)
We believe that the openness of the UK to clinical staff trained overseas, and the ability of UK-trained staff to work overseas, is a continuing source of strength to UK healthcare, and that this openness should continue to be reflected in workforce planning.
13However, we also welcome the Government’s view that planning of the UK health and care...
Concluded (the committee's words)
However, we also welcome the Government’s view that planning of the UK health and care workforce should not be dependent on significant future flows of trained staff from overseas, both in order to improve “security of supply” and in order to avoid “poaching” skilled staff from developing countries. This approach should apply to public and private healthcare employers.
14We accept that locum and agency staff provide a necessary element of flexibility in NHS...
Concluded (the committee's words)
We accept that locum and agency staff provide a necessary element of flexibility in NHS staffing arrangements. We do not believe, however, that they provide an optimum solution, either in terms of quality of care or value for money. We, therefore, urge the Government to proceed quickly with improved arrangements for workforce planning, which should reduce the importance to the NHS of locum and agency staff.
15We welcome the inclusion in the Health and Social Care Act 2012 of an explicit...
Concluded (the committee's words)
We welcome the inclusion in the Health and Social Care Act 2012 of an explicit duty on the Secretary of State to secure an effective system of education and training. However we are concerned that there continues to be insufficient clarity about how the Secretary of State intends to discharge this duty. In particular, we seek reassurance that the Secretary of State shares our view that the effectiveness of the new system will be fatally undermined if it is not built upon a more accountable and transparent system of workforce planning.
16We also welcome the fact that the Secretary of State will have a clear responsibility...
Concluded (the committee's words)
We also welcome the fact that the Secretary of State will have a clear responsibility for holding to account Health Education England. The Department must, though, spell out how exactly this will be done—including the part that the planned Education Outcomes Framework will play.
17We welcome the plan to set up Health Education England as an executive body with...
Concluded (the committee's words)
We welcome the plan to set up Health Education England as an executive body with overall responsibility for education, training and workforce planning, drawing input from all healthcare professions and other stakeholders. The creation of such a body is long overdue and has the potential to be a significant step forward.
18However, we are concerned, given the centrality of this body to the Government’s plans, that...
Concluded (the committee's words)
However, we are concerned, given the centrality of this body to the Government’s plans, that the Government has been slow in developing a coherent plan for the new organization. It is being set up in shadow form in July 2012 and will be fully operational in April 2013. There is an urgent requirement for the Government to publish a clear and detailed execution timetable.
19In the absence of this timetable there continues to be a lack of clarity about...
Recommended (the committee's words)
In the absence of this timetable there continues to be a lack of clarity about the role, responsibilities, powers and structure of Health Education England. Fears have been expressed to us that Health Education England, growing out of Medical Education England, could be predominantly focused on the medical workforce, despite its multi-professional remit. The Government must show that it is addressing and allaying these fears.
20Greater clarity is particularly needed about how Health Education England plans to ensure that it...
Concluded (the committee's words)
Greater clarity is particularly needed about how Health Education England plans to ensure that it develops a dynamic view of the changing education requirements of the whole health and care sector.
21Greater clarity is also needed regarding the role of Health Education England in relation to...
Concluded (the committee's words)
Greater clarity is also needed regarding the role of Health Education England in relation to the professional regulators and to its counterpart organisations in other UK countries.
22The Government has acknowledged the need to take account of the UK-wide dimension of education,...
Concluded (the committee's words)
The Government has acknowledged the need to take account of the UK-wide dimension of education, training and workforce-planning policy. However, in that context we are concerned that there must be adequate emphasis on workforce planning in particular.
23We welcome the Government’s plan to create Local Education and Training Boards as provider-led bodies...
Concluded (the committee's words)
We welcome the Government’s plan to create Local Education and Training Boards as provider-led bodies to take responsibility for education, training and workforce planning below the national level. We are concerned, however, at the Government’s protracted failure to produce concrete plans in respect of the Boards, which poses a significant risk to their successful establishment.
24Between July 2010 and January 2012 the Boards were conceived of as loosely defined non-statutory...
Concluded (the committee's words)
Between July 2010 and January 2012 the Boards were conceived of as loosely defined non-statutory “legal entities”, to be developed at local level. The Government has now concluded that they should be “outposts” of Health Education England. There is, however, still little central guidance about the requirements for authorization, despite the recommendation of the NHS Future Forum that there should be “common terms of reference and a single model […] to promote consistency across the country”.
25It is unsatisfactory that so much about the Boards still remains vague and indeterminate.
Concluded (the committee's words)
It is unsatisfactory that so much about the Boards still remains vague and indeterminate. Crucially, the precise extent of their autonomy, and the means by which they will be authorised and held accountable, are still worryingly opaque. This must be spelled out as a matter of urgency.
26We welcome the Government’s guidance that Local Education and Training Boards should be comprehensive bodies,...
Recommended (the committee's words)
We welcome the Government’s guidance that Local Education and Training Boards should be comprehensive bodies, not restricted to healthcare providers. However, concerns remain among higher-education institutions that their viewpoint will not be adequately heard. The Government should provide a definitive list of stakeholders which should be represented, as well as providing greater clarity on other aspects of governance—not least how potential conflicts of interest are to be addressed.
27We are also concerned that the geographical basis of Local Education and Training Boards remains...
Concluded (the committee's words)
We are also concerned that the geographical basis of Local Education and Training Boards remains obscure. Evidence submitted to us that there will be “10 to 15” (or alternatively “12 to 16”) calls into question their ability to reflect local conditions. There is a definite need for structures at the level of local health economies and the Department must make clear how these are to be facilitated.
28The integration of the postgraduate deaneries into the new system will be crucial to its...
Concluded (the committee's words)
The integration of the postgraduate deaneries into the new system will be crucial to its success. We regret the fact that the Government allowed uncertainty about the future position of the deaneries to persist for so long. Although there is now greater clarity of intention, the period of uncertainty led to a regrettable loss of experienced staff.
29There continues to be an urgent need for more precision about how the deaneries will...
Concluded (the committee's words)
There continues to be an urgent need for more precision about how the deaneries will operate in future. The distinct position of postgraduate dean should continue to exist to provide an independent professional voice. There needs to be greater clarity about relationships with the General Medical Council, the Director of Medical Education and Health Education England. Finally, there must be a convincing plan to realise the Government’s stated aspiration for deaneries to become “truly multi- professional” in their new role.
30We welcome the Department’s intention to continue within the new system the work done in...
Concluded (the committee's words)
We welcome the Department’s intention to continue within the new system the work done in recent years—through the Health Innovation and Education Clusters and Academic Health Science Centres—to link innovation with education and training. We also welcome the intention to build on this through the creation of Academic Health Science Networks. However, there is a risk, through creating a yet more complicated landscape of Boards, Clusters, Centres / Systems, Networks and Collaborations, that the resulting arrangements could be incoherent and ineffective. The Department must develop a plan to rationalise these bodies and structures, to bring about as much de-cluttering and geographical coterminosity as possible without limiting local initiative and creativity.
31The same point applies to the planned new education, training and workforce planning system as...
Concluded (the committee's words)
The same point applies to the planned new education, training and workforce planning system as a whole. The NHS Future Forum has rightly referred to the “number of players in the system” as a complicating factor. Nothing we have heard suggests that the new arrangements will be any less overpopulated with stakeholders, sometimes with overlapping or unclear responsibilities. If this is not addressed, it will be a serious shortcoming in the Government’s reforms.
32The current arrangements under which providers are paid by the NHS for education and training...
Concluded (the committee's words)
The current arrangements under which providers are paid by the NHS for education and training are anachronistic and anomalous. Payment is only partially based on student or trainees numbers; it is not linked to quality; it is unjustifiably inconsistent between different professional groups, parts of the country and types of provider; and there is an almost total lack of transparency about how it is spent.
33Accordingly, we welcome the Government’s intention to move payment onto a tariff basis, including a...
Concluded (the committee's words)
Accordingly, we welcome the Government’s intention to move payment onto a tariff basis, including a quality premium, as recommended by the NHS Future Forum. However, we note that there is so far slender evidence of progress in converting this desirable policy into a system that will work in practice. Bearing in mind that Education, training and workforce planning 63 implementation of the new system is supposed to begin in April 2013, we believe this work needs to attract a greater sense of urgency.
34While taking this work forward the Government needs to recognise that there are significant difficulties...
Concluded (the committee's words)
While taking this work forward the Government needs to recognise that there are significant difficulties involved in constructing a workable tariff. It is important that the transition to any new system avoids unnecessary turbulence, and—in particular—threats to the quality of clinical services.
35We support the Government’s intention to introduce a levy on all healthcare providers (whether or...
Concluded (the committee's words)
We support the Government’s intention to introduce a levy on all healthcare providers (whether or not they supply services to the NHS) to provide a more transparent and accountable system of funding for education and training in the health and care sector.
36We heard from some independent-sector representatives that they fear a levy would put them at...
Concluded (the committee's words)
We heard from some independent-sector representatives that they fear a levy would put them at an unfair disadvantage. However, we are unconvinced by these arguments. If there is to be a comprehensive tariff system for funding education and training, as the Government intends, it should be possible for independent-sector providers to be remunerated for training that they undertake on a fair and transparent basis, alongside NHS organisations.
37We urge the Government to ensure that the levy system covers social care services, as...
Recommended (the committee's words)
We urge the Government to ensure that the levy system covers social care services, as well as healthcare, to ensure that the education and training system reflects the policy intention to deliver more integrated health and social care services.
38We recognise that there are particular concerns about the potential effect of a levy system...
Concluded (the committee's words)
We recognise that there are particular concerns about the potential effect of a levy system on smaller voluntary-sector organisations. However, we believe that it is possible to construct workable exemption arrangements to cover these cases and this issue cannot be used to justify the current opaque and unaccountable system.
39Although, however, we support the Government’s policy objective in this area we note—once again—that there...
Concluded (the committee's words)
Although, however, we support the Government’s policy objective in this area we note—once again—that there is slender evidence of progress in converting this desirable policy into a system that will work in practice. We believe this work needs to attract a greater sense of urgency.
40We heard from the Department that its policy is currently to keep NHS funding for...
Concluded (the committee's words)
We heard from the Department that its policy is currently to keep NHS funding for education and training broadly the same in cash terms from year to year. Against a background of inflation and major cost pressures, this is an extremely challenging financial settlement
41We have heard evidence that education commissions are being significantly cut.
Concluded (the committee's words)
We have heard evidence that education commissions are being significantly cut. Given the wider financial situation in the NHS, there is also the risk that SHAs will raid education and training budgets in 2012–13, as they have done before.
42“Raiding” of education and training funds for other purposes has a long history.
Recommended (the committee's words)
“Raiding” of education and training funds for other purposes has a long history. While we welcome the Government’s willingness to apply a “ring-fence” to the Multi Professional Education and Training levy, we are sceptical about its effectiveness. We believe the Government’s plans for more fundamental reform discussed earlier in this chapter represent a more realistic way of safeguarding education and training activity within the health and care system. In the meantime the Government must act to safeguard funding for education and training during 2012–13.