Health Education England (HEE) is officially established on the 1st April 2013, and we are seeking your views on our proposed strategic priorities. ‘Introducing Health Education England: Our Strategic Intent’ sets out our purpose and the role that we will play in leading education, training and development across the system to deliver improvements in the quality of care for patients. It also includes high level guidance for workforce planners.
This document is informed by discussions by our Board and with the Chairs and Managing Directors of 13 Local Education and Training Boards (LETB). We are publishing it to obtain your views, and those of our stakeholders, to help shape our vision and support its implementation.
The aim of the publication is two-fold. Firstly, it clearly sets out the purpose of HEE and our LETBs: that we exist to support the delivery of excellent healthcare and health improvement to the patients and public of England. We do this by ensuring that we have the right numbers of staff, with the right skills and right behaviours, when and wherever they are needed. Because of the time it takes to select, educate, train, recruit and develop the healthcare workforce, the decisions we make today will need to be informed by our imperfect understanding of the future. This purpose, and our focus on the current and future workforce, will be at the heart of all that we do, and we will use it as a guide to action over the coming months and years.
Secondly, we realise that we cannot achieve our purpose alone. We will need to work with many stakeholders to understand their current challenges and future opportunities, so that HEE, through our LETBs, can make local and national visions happen through our education commissions and ongoing training and development programmes. From today, we are asking our stakeholders to join a conversation with us to help further define our strategic priorities.
Comments on
Health Education England
Introducing Health Education England -
Our Strategic Intent
The Royal College of Physicians of Edinburgh (“the College”) is pleased to respond to Health Education England’s consultation on Introducing Health Education England - Our Strategic Intent.
Question 1: Is our purpose clear? Do you understand our role and remit, and how it fits with yours?
The College feels that the purpose is clear, albeit ambitious, and it will be necessary to be very clear about short-term priorities to manage expectations. The establishment, however, of a unifying national board for health education is laudable and welcome.
Question 2: How can we align our planning processes with the commissioning, provision, regulatory, professional or educational cycle to get the most benefit?
It is felt that the publishing of such documents in good time to inform the planning of others would be helpful, and would encourage all stakeholders to be transparent in their own short-term priorities to avoid duplication or conflict. Health Education England, the GMC, Royal Colleges and employers all have a role in supporting CPD and we need to be clear who is accountable for which component (HEE are accountable for principles and ensuring employers deliver, the GMC sets the regulatory framework, Colleges set the standards and deliver much of the CPD, Trusts manage individuals through job plans and fund PDPs.) At the same time the difficulties of manpower shortages in training doctors in the many areas of the UK, including the devolved nations, are likely to require local solutions in the context of a national strategy. It is to be hoped that local LETBs will get enough autonomy to be able to deliver what is needed.
Furthermore, in England, alignment of planning with commissioning will depend on commissioners being aware of changes to or distortions of local health care demands. At the moment, it is perceived that commissioners are not adequately aware of their role and responsibilities to the education and training of the healthcare workforce. The relationship of HEE with the commissioning bodies must be closely monitored to ensure satisfactory delivery of education and training across the country, and therefore the College supports the HEE role in monitoring the local commissioning process to ensure national and local needs are met.
Question 3. Do you agree with our values and principles, and how we intend to work with the system?
The values and principles as defined are worthy, but it is difficult to comment on how these will actually work as very little detail is provided in the document. The Operating Model for LETBs is still under development and will apparently need reviewed. As noted above, we have concerns that there is no comment on how HEE will ensure that training and education is not trumped by the service demands perceived by the providers on LETBs.
Stakeholders and advisory fora are mentioned but not detailed; it is also stated that HEE is reviewing their advisory structures and therefore it remains to be seen how precisely it will work.
The College welcomes, however, the role of stakeholder as the professional representative of many hospital physicians (trainee and trainer) in England and a parent organisation of JRCPTB that delivers the curricula and manages the progress of all trainees in the medical specialties.
Question 4. What are your views on our proposed priorities? Are there areas that we can work together on to amplify our efforts?
a) Time to train is critical to making training rewarding and effective for trainers and trainees and needs to be explicit in priorities to ensure training resources are deployed effectively by LETBs and employers. The focus on trainers is very welcome at a time when consultants are faced with impossible competing demands from the service and a lack of contracted time for training. As higher standards of educational supervision are being sought, many are giving up the role as they do not have time to meet these. If HEE can successfully address this, it would be very helpful.
Strategic aims include a review of educational curricula. The GMC and Medical Royal Colleges are presently responsible for those for the medical profession, so any review will need to be in partnership with these and the precise relationships defined.
b) Ensuring effective relationships between Academic Health Science Networks and LETBs is important, and technology aspirations are laudable. It is recognised that the next generation of trainees will expect apps etc, but this should not divert attention away from securing an adequate IT infrastructure for current systems eg out-dated internet facilities for trainee e-portfolios or inadequate clinical simulation facilities
c) In considering that the workforce should have the right numbers, skills and behaviours, the key actions outlined do not address the current problems with respect to retaining staff once recruited. Much more is needed (at least for the medical profession) to stem the flow of trainees overseas and away from busy hospital specialties with, for example, actions to tackle excessive workloads, unattractive shift working, the lack of LTFT and job sharing, and the sense of being undervalued and unsupported. Several of these issues are shared by consultants. Ensuring behaviours in the workforce are appropriate is especially pertinent in view of the Francis report.
The need for cross-UK working on workforce planning for the health professions should be reiterated.
HEE has a role in recruitment and training to secure the emergency/acute workforce and in the development of 24/7 services but the nature of the role is unclear. The College also cautions that, in the short term, moves away from secondary care support are dangerous and unevidenced.
d) The College is very supportive of the development of simulation facilities for training and is supportive of multi-disciplinary team learning through such facilities.
Question 5. What should be our strategy going forward beyond transition? How can we ensure alignment where appropriate with other strategies in the health and education system?
Going forward, the strategy will have to take into account the Shape of Training Review, the increasing feminisation of the medical workforce, the ageing population and workforce, and advancing technology. Much care will need taken that LETBs fulfil their remit and that training is not swamped by service need. An omission from the paper is thought to be information about the organisation of, and framework of, multidisciplinary education, a stated aim of the original White Paper. The relationship, and definition of roles, between HEE and the GMC will be critical.