MR PETER STANSBIE AND MR DAVID HIGHTON

14 DECEMBER 2006

  Q793 Chairman: Good morning, gentlemen. Could you give us your names and the positions you hold for the record, please?

  Mr Highton: I am David Highton. I am the managing director of Clinicenta, an ISTC bidder, and I am representing the NHS Partners Network which is an alliance of independent sector providers, providing NHS care.

  Mr Stansbie: I am Peter Stansbie. I am director of organisational development for Skills for Health, which is the Sector Skills Council for health.

  Q794  Chairman: You both represent non-NHS organisations which have an important role to play in workforce planning for the health service. What is your assessment of the current arrangements for workforce planning?

  Mr Stansbie: We are talking about workforce planning, not education planning. That is a really important distinction. Secondly, health probably has the most complex workforce in the country. It is about two million people across the UK. Roughly 80% of that will be in England. Around 400,000 of those work outside the NHS. Those staff run from the ubiquitous porter to the ubiquitous brain surgeon. You have a huge range of skills there. In general up to now, workforce planning has produced the number of staff that we need until recently reasonably within the funding that is available. It is based mainly on looking at planning for education and for the registered group of staff in the health sector and based on existing groups and existing practices. What we are all saying is that what has suited us in the past probably will not suit us in the future with changes to technology, to systems and all the demographic changes that we are seeing. I think we do need to see a significant change to make sure that we get a strategic plan for our workforce and that education and training are employer led and follows what is needed to deliver care for the patient and better health.

  Mr Highton: From my standpoint, there are two factors, one probably emphasising what Peter just said. The professional identities and the registered professions are very dominant in how the workforce is organised. They provide a recognisable currency by which employers can recognise a group of skills and competences but there is a down side to their strength in that it makes it very difficult for new job roles to emerge based on a different mix of key competences. Therefore, the planning has tended to be an incremental change from the past rather than perhaps taking a more fundamental look at how those competences might be organised in the future. The second thing is what was covered largely in the previous evidence I heard about the way the use of performance targets at the micro level sought to influence local workforce planning. As a subset of that, the merger of WDCs and SHAs has made it harder for the non-NHS bodies to access that dialogue. The move from a membership organisation to a statutory authority has made it harder for that to happen.

  Q795  Chairman: If I ask about changes you would like to see, presumably you think it should be more strategic and the educational training should be employer led as opposed to led by other institutions and representative bodies?

  Mr Stansbie: Absolutely. "Employer led" is in some ways code for saying that the best people who can determine what workforce is needed to deliver what the patient needs or indeed what the public need in terms of public health are the employers, the people who are actually delivering that. This has to be led by the strategic need of the sector. It really is important to say that the sector has a single workforce. I know this is about England but there is a UK workforce in health and that will always be the case. Of course, although the NHS probably takes about 80% of the workforce in health, that workforce moves into the independent sector, into the voluntary sector and vice versa. Our view is if we can make sure that our planning is delivered to meet the needs of the patient and the sector through the employer that gives us the best chance of getting a flexible workforce and a workforce that can deliver what is necessary and that keeps up with changes in technology and systems. Those changes have been huge in the last 10 years and I suspect will continue to be huge in the next 10 years.

  Q796  Chairman: Do you agree with that, David?

  Mr Highton: Yes. Employers are generally quite good at anticipating future innovations and future changes that are going to happen over a longer time frame; whereas the institutionalised workforce planning tends to produce incremental growth targets from a base which starts to get rather fossilised. I think there starts to be a tension and the difficulty of getting over professional boundaries sometimes hampers employers in implementing sensible innovations.

  Q797  Chairman: We took evidence abroad with this Committee a few months ago now and one of the things that was put to us by a member of a leading organisation in America was that a surgeon who does cataracts should be a brilliant surgeon who does cataracts and does not have to be anything else. Would you agree with that?

  Mr Highton: There are aspects of care delivery which, if someone becomes an expert in quite a narrow focus, mean they do not necessarily need all the training to be a generalist. On cataracts, it would be possible to train someone to be very good at phaeco-emulsification without them necessarily having gone through all the medical training earlier in their career. My own company is linked with the teaching hospitals in Canada and they train respiratory therapists to be anaesthetic assistants. In theatre, for minor operations where the patients are conscious but have had some sort of local or regional anaesthesia, there is a consultant supervising the whole suite of four or five theatres but the individual monitoring the patient in the theatre is not a doctor but an anaesthetic assistant. The equivalent in the US would be nurse anaesthetists. In Canada, they have gone through a different training route. Those things are not really prevalent in this country and in my experience would be considerably resisted by the medical workforce.

  Chairman: I was going to say, "Could it happen here?" but I think you have answered that question.

  Q798  Dr Naysmith: What you are outlining is a rather different approach to training and workforce planning and the needs of the employer being paramount rather than professional little empires and so on which is what we have been talking about this morning. Mr Stansbie, in your written evidence you explain that Skills for Health aims to improve the flexibility of the workforce and to encourage the use of competences as the currency for workforce planning. We have already touched on that. Would you like to say a little bit more about it? Why is this approach important?

  Mr Stansbie: First, we are not suggesting—nor is anybody else—that we throw the baby out with the bath water. We need very skilled professionals and we will continue to need those. What we are saying is that what we should use as the building blocks are the competences that people need to deliver the service that is required by the patient or the population. If you identify those competences then you can start to identify different ways of providing the workforce that can deliver that effectively, timely and in the right location. What we have seen and what we are seeing is all of those three things change. The effectiveness changes, the location changes, you get new drugs and new approaches. If you cannot have that flexibility your workforce, if you are not careful, is always chasing the changes rather than having a workforce which has the competences to deliver what is needed at that time. I do not think health is that different from all the other industries in this country. We like to think it is and that health is always special, but all of the industries in this country and indeed across the world are facing these challenges. For us, competences are no more a panacea than every other thing that you can talk about, but they are very powerful building blocks that will allow you to get a change to the way that you plan your workforce and then, more importantly, a change to the way you deliver that workforce.

  Q799  Dr Naysmith: How much progress in your organisation have you made in this? Do you have evidence that it is effective and proving effective and popular with the workforce?

  Mr Stansbie: It is not an exact science. I guess you find that in workforces generally. We estimate we have mapped around 70% of the core competences in health so there is still some way to go. Even with those competences, we have already had very significant success. I will mention some examples because they are always best. We looked at breast screening and developed competences in breast screening that allow associate specialists to be developed who are not radiographers or radiologists. That allowed the breast screening service to deliver something like 40% more breast screening. It also allowed the highly skilled radiologists and radiographers to use their skills better so they were not doing things that other people could do. A quote from one doctor on that was that they simply could not have met their target for breast screening had those new posts not been there. Those competences that we developed are national. They are UK-wide, so those competences are now being used across the UK. Perhaps the most striking example in terms of money, if we want to talk about money—